TABLE 3.

Guiding Principles and Key Elements of Initial and Ongoing DSME/S (45,58,81)

Engagement. Provide DSME/S and care that reflects person’s life, preferences, priorities, culture, experiences, and capacity.
  • Solicit and respond to questions

  • Focus on decisions, reasons for the decisions, and results

  • Ask about strengths and challenges

  • Use shared decision making and principles of patient-centered care to guide each visit

  • Engage the patient in a dialogue about current self-management successes, concerns, and struggles

  • Engage the patient in a dialogue about therapy and changes in treatment

  • Remain “solution neutral” and support patient identifying solution(s)

  • Provide support and education to patient’s family and caregiver

Information sharing. Determine what the patient needs to make decisions about daily self-management.
  • Discuss that DSME/S is an important and essential part of diabetes management

  • Describe that DSME/S is needed throughout the life cycle and is on a continuum from prediabetes, newly diagnosed diabetes, health maintenance/follow-up, early to late diabetes complications, and transitions in care related to changes in health status and developmental or life changes

  • Avoid being didactic

  • Provide “need-to-know” information and avoid providing the encyclopedia on diabetes

  • Review that diabetes treatment will change over time

  • Provide information to the patient using the above engagement key elements

  • Take advantage of “teachable moments” to provide information specific to the patient’s care and treatment

  • Assess DSME/S patient/family needs for the behavioral and psychosocial aspects of informed decision making

Psychosocial and behavioral support. Address the psychosocial and behavioral aspects of diabetes.
  • Assess and address emotional and psychosocial concerns, such as diabetes-related distress and depression

  • Present that diabetes-related distress and a range of emotions are common and that stress can raise blood glucose and blood pressure levels

  • Discuss that diabetes self-management is challenging but worth the effort

  • Support self-efficacy and self-confidence in self-management decisions and abilities

  • Support action by the patient to identify self-management problems and develop strategies to solve those problems, including self-selected behavioral goal setting

  • Note that it takes about 2–8 months to change a habit/learn/apply behavior

  • Address the whole person

  • Include family members and/or support system in the educational and ongoing support process

  • Refer to community, online, and other resources

Integration with other therapies. Ensure integration and referrals with and for other therapies.
  • Ensure access to ongoing MNT

  • Recommend additional referrals as needed for behavioral therapy, medication management, physical therapy, etc.

  • Address factors that limit the application of diabetes self-management activities

  • Advocate for easy access to social services programs that address basic life needs and financial resources

  • Identify resources and services that support the implementation of therapies in health care and community settings

Coordination of care across specialty care, facility-based care, and community organizations. Ensure collaborative care and coordination with treatment goals.
  • Understand primary care provider and specialist’s treatment targets

  • Provide overview of DSME/S to referring providers

  • Follow medication adjustment protocols or make necessary recommendation to primary care provider

  • Correspond with referring provider about education plan, progress toward treatment goals, and needs to coordinate education and support from entire clinical team; ensure documentation in the health record

  • Ensure provision of culturally appropriate care

  • Use evidence-based decision support

  • Use performance data to identify opportunities for improvement