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