Quality Standards for Diabetes Care Toolkit

Self-management education (SME)

The International Diabetes Foundation (IDF) International Standards for Diabetes Education are based on the available evidence about diabetes self-management education (DSME), diabetes self-management support (DSMS) and behaviour change. A summary of the evidence is as follows:

DSME is effective for improving clinical outcomes and quality of life – at least in the short term.

Diabetes education has evolved from primarily didactic presentations to more theoretically-based empowerment models.

There is no single best educational programme or approach. However, programmes incorporating behavioural and psychological strategies have demonstrated improved outcomes. Additional studies show that age and culturally appropriate programmes improve outcomes and that group education is at least as effective as individual education.

Ongoing support is critical in order to sustain the participant’s progress resulting from DSME. People with diabetes experience a significant amount of psychological distress at the time of diagnosis and throughout their life, and these psychosocial issues affect their self-management efforts.

Strategies such as self-directed goal-setting and problem solving are effective for supporting behaviour change.

The full document can be found here: www.idf.org/education/resources/standards
The State of Michigan’s Health Care Providers’ Guide to Diabetes Self-Management Education (DSME) Programs in Michigan provides the following academic rationale:

Norris et al (2001) reviewed 72 randomised controlled trials of diabetes self-management training (DSMT) in type 2 diabetes and concluded that there were positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits and glycaemic control in studies with follow-up timeframes of six months or less.

Another meta-analysis by Norris et al (2002) concluded that DSMT is effective in decreasing HbA1c in the short term and states ‘... effective diabetes education is an integral part of comprehensive diabetes care’(p 1168)

The 10year United Kingdom Prospective Diabetes Study (UKPDS) confirmed that intensive blood glucose control in patients with type 2 diabetes reduced the incidence of diabetic complications, especially microvascular disease.

According to the UKPDS, for every percentage point decrease in glycosylated haemoglobin, (eg, 9% to 8%), there was a 35% reduction in the risk of microvascular complications.

A study published in the Journal of the American Medical Association indicated that a sustained reduction in HbA1c among adult persons with diabetes was associated with a cost reduction of $685 to $950 less per person per year within one to two years of improvement.

The Diabetes Prevention Program (DPP) found that lifestyle change that effects modest weight loss and increased physical activity can return the blood glucose levels of persons with ‘prediabetes’ (persons at risk for developing diabetes) to normal range.

Data analysis in 2007 from the Michigan Behavioral Health Risk Factor Surveillance Survey (MiBRFSS) showed people who had taken a diabetes self-management course were twice as likely to have obtained the recommended annual dilated eye exam, foot exam and two HbA1c tests compared to people with diabetes who had not taken a self-management course.

The full document can be found here: www.michigan.gov/documents/mdch/ProviderHandbookFINAL9-08_256129_7.pdf