Table 6

Checklist for providing and modifying DSMES at four critical times

Four critical timesPrimary care provider/endocrinologist/clinical care team’s role in diabetes educationDiabetes care and education specialist’s role in diabetes education
At diagnosis (series of visits)• Answer questions and provide emotional support regarding diagnosis• Assess cultural influences, social determinants of health, health beliefs, current knowledge, physical limitations, family support, financial and work status, medical history, learning preferences and barriers, literacy, and numeracy to determine which content to provide and how
• Shared decision-making of treatment and treatment targets• Medication – choices, access, action, titration, side effects
• Teach survival skills to address immediate requirements (safe use of medication, hypoglycemia treatment if needed, introduction of eating guidelines)• Monitoring blood glucose – when to check, interpreting and using glucose pattern management for feedback
• Identify and discuss resources for education and ongoing support• Physical activity – safety, short-term vs. long-term goals/recommendations
• Make referrals for DSMES and MNT• Preventing, detecting, and treating acute and chronic complications
• Nutrition – food plan, planning meals, purchasing food, preparing meals, portioning food
• Risk reduction – smoking cessation, foot care, cardiac risk
• Developing personal strategies to address psychosocial issues and concerns; adjusting to a life with diabetes
• Developing personal strategies to promote health and behavior change
• Problem identification and solutions
• Identifying and accessing resources
Annually and/or when not meeting treatment targets• Refer for new techniques, technology, and updated information• Review and reinforce treatment goals and self-management needs
• Assess and refer if self-management targets not met to address barriers to self-care• Review barriers to treatment effectiveness
• Emphasize reducing risk for complications and promoting quality of life
• Discuss how to adjust diabetes treatment and self-management to life situations and competing demands
• Support efforts to sustain initial behavior changes and cope with the ongoing burden of diabetes
When complicating factors develop• Identify presence of factors that inhibit or facilitate achievement of treatment targets and personal goals• Provide support for the provision of self-management skills in an effort to delay progression of the disease and prevent new complications
• Discuss impact of complications and successes with treatment and self-management• Provide/refer for emotional support for diabetes-related distress and depression
• Develop and support personal strategies for behavior change and healthy coping
• Develop personal strategies to accommodate sensory or physical limitation(s), adapt to new self-management demands, and promote health and behavior change
When transitions in life and care occur• Develop diabetes transition plan• Adjust diabetes self-management plan as needed
• Communicate transition plan to new health care team members• Provide support for independent self- management skills and self-efficacy
• Establish DSMES regular follow-up care• Identify level of significant other involvement and facilitate education and support
• Assist with facing challenges affecting usual level of activity, ability to function, health benefits and feelings of well-being
• Maximize quality of life and emotional support for the person with diabetes (and family members)
• Provide education for others now involved in care
• Establish communication and follow-up plans with the provider, family, and others
• Develop goals and personal strategies to promote health and behavioral change and improve quality of life