2.2.0.0 Overview

DSMES ser­vices fa­cil­i­tate the knowl­edge, skills, and abil­i­ties nec­es­sary for op­ti­mal di­a­betes self-‍care and in­cor­po­rate the needs, goals, and life ex­pe­ri­ences of the per­son with di­a­betes. The over­all ob­jec­tives of DSMES are to sup­port in­formed de­ci­sion mak­ing, self-‍care be­hav­iors, prob­lem-‍solv­ing, and ac­tive col­lab­o­ra­tion with the health care team to im­prove clin­i­cal out­comes, health sta­tus, and qual­i­ty of life in a cost-‍ef­fec­tive man­ner (1). Providers are en­cour­aged to con­sid­er the bur­den of treat­ment and the pa­tient’s level of confidence/ self-‍efficacy for man­age­ment be­hav­iors as well as the level of so­cial and fam­i­ly sup­port when pro­vid­ing DSMES. Pa­tient per­for­mance of self-‍man­age­ment be­hav­iors, in­clud­ing its ef­fect on clin­i­cal out­comes, health sta­tus, and qual­i­ty of life, as well as the psy­choso­cial fac­tors im­pact­ing the per­son’s self-‍man­age­ment should be mon­i­tored as part of rou­tine clin­i­cal care.

In ad­di­tion, in re­sponse to the grow­ing lit­er­a­ture that as­so­ci­ates po­ten­tial­ly judg­men­tal words with in­creased feel­ings of shame and guilt, pro­viders are en­cour­aged to con­sid­er the im­pact that lan­guage has on build­ing ther­a­peu­tic re­la­tion­ships and to choose pos­i­tive, strength-‍based words and phras­es that put peo­ple first (2,3). Pa­tient per­for­mance of self-‍man­age­ment be­hav­iors as well as psy­choso­cial fac­tors im­pact­ing the per­son’s self-‍man­age­ment should be mon­i­tored. Please see Sec­tion 4, “Com­pre­hen­sive Med­i­cal Eval­u­a­tion and As­sess­ment of Co­mor­bidi­ties,” for more on use of lan­guage.

DSMES and the cur­rent na­tion­al stan­dards guid­ing it (1,4) are based on ev­i­dence of benefit. Specifically, DSMES helps peo­ple with di­a­betes to iden­ti­fy and im­ple­ment ef­fective self-‍man­age­ment strate­gies and cope with di­a­betes at the four crit­i­cal time points (de­scribed below) (1). On­go­ing DSMES helps peo­ple with di­a­betes to main­tain ef­fective self-‍man­age­ment through­out a life­time of di­a­betes as they face new chal­lenges and as ad­vances in treat­ment be­come avail­able (5).

Four crit­i­cal time points have been defined when the need for DSMES is to be eval­u­ated by the med­i­cal care pro­vider and/‍or mul­ti­dis­ci­plinary team, with re­fer­rals made as need­ed (1):

1. At di­ag­no­sis
2. An­nu­al­ly for as­sess­ment of ed­u­ca­tion, nu­tri­tion, and emo­tion­al needs
3. When new com­pli­cat­ing fac­tors (health con­di­tions, phys­i­cal lim­i­ta­tions, emo­tion­al fac­tors, or basic liv­ing needs) arise that influence self-‍man­age­ment
4. When tran­si­ti­ons in care occur

DSMES fo­cus­es on sup­porting pa­tient em­pow­er­ment by pro­vid­ing peo­ple with di­a­betes the tools to make in­formed self-‍man­age­ment de­ci­sions (6). Di­a­betes care has shift­ed to an ap­proach that places the per­son with di­a­betes and his or her fam­i­ly at the cen­ter of the care model, work­ing in col­lab­o­ra­tion with health care pro­fes­sion­als. Pa­tient-‍cen­tered care is re­spect­ful of and re­spon­sive to in­di­vid­u­al pa­tient pref­er­ences, needs, and val­ues. It en­sures that pa­tient val­ues guide all de­ci­sion mak­ing (7).