Table 5

Factors that indicate referral to DSMES services is needed

At diagnosis• Newly diagnosed—all newly diagnosed people with type 2 diabetes should receive DSMES
• Ensure that both nutrition and emotional health are appropriately addressed in education or make separate referrals
Annually and/or when not meeting treatment targets• Review of knowledge, skills, psychosocial, and behavioral outcomes or factors that inhibit or facilitate achievement of treatment target and goals
• Long-standing diabetes with limited prior education
• Treatment ineffective for attaining therapeutic target
• Change in medication, activity, or nutritional intake or preferences
• Maintenance of clinical and quality of life outcomes
• Unexplained hypoglycemia or hyperglycemia
• Support to attain or sustain improved behavioral or psychosocial outcomes
When complicating factors developChange in:
• Health conditions, such as renal disease and stroke, need for steroids, or complicated medication plan
• Health status requiring changes in nutrition, physical activity, etc.
• Planning pregnancy or pregnant
• Physical limitations such as cognitive impairment, visual impairment, dexterity issues, movement restrictions
• Emotional factors such as diabetes distress, anxiety, and clinical depression
• Basic living needs such as access to shelter, food, health care, medicines, and financial limitations
When transitions in life and care occurChange in:
• Living situation such as inpatient or outpatient or other change in living situation (i.e., living alone, with family, assisted living, etc.)
• Clinical care team
• Initiation or intensification of insulin, new devices or technology, and other treatment changes
• Insurance coverage that results in treatment change (i.e., provider changes, changes in medication coverage)
• Age-related changes affecting cognition, vision, hearing, self-management, etc.