2.3.0.0 Evidence for the Benefits
Studies have found that DSMES is associated with improved diabetes knowledge and self-care behaviors (8), lower A1C (7,9–11), lower self-reported weight (12,13), improved quality of life (10,14), reduced all-cause mortality risk (15), healthy coping (16,17), and reduced health care costs (18-20). Better outcomes were reported for DSMES interventions that were over 10 h in total duration (11), included ongoing support (5,21), were culturally (22,23) and age appropriate (24,25), were tailored to individual needs and preferences, and addressed psychosocial issues and incorporated behavioral strategies (6,16,26,27). Individual and group approaches are effective (13,28,29), with a slight benefit realized by those who engage in both (11). Emerging evidence demonstrates the benefit of Internet-based DSMES services for diabetes prevention and the management of type 2 diabetes (30-32). Technology-enabled diabetes self-management solutions improve A1C most effectively when there is two-way communication between the patient and the health care team, individualized feedback, use of patient-generated health data, and education (32). Current research supports nurses, dietitians, and pharmacists as providers of DSMES who may also develop curriculum (33-35). Members of the DSMES team should have specialized clinical knowledge in diabetes and behavior change principles. Certification as a certified diabetes educator (CDE) or board certified-advanced diabetes management (BC-ADM) certification demonstrates specialized training and mastery of a specific body of knowledge (4). Additionally, there is growing evidence for the role of community health workers (36,37), as well as peer (36-40) and lay leaders (41), in providing ongoing support.
DSMES is associated with an increased use of primary care and preventive services (18,42,43) and less frequent use of acute care and inpatient hospital services (12). Patients who participate in DSMES are more likely to follow best practice treatment recommendations, particularly among the Medicare population, and have lower Medicare and insurance claim costs (19,42). Despite these benefits, reports indicate that only 5–7% of individuals eligible for DSMES through Medicare or a private insurance plan actually receive it (44,45). This low participation may be due to lack of referral or other identified barriers such as logistical issues (timing, costs) and the lack of a perceived benefit (46). Thus, in addition to educating referring providers about the benefits of DSMES and the critical times to refer (1), alternative and innovative models of DSMES delivery need to be explored and evaluated.