International Diabetes Center s Annual Symposium for Advanced Diabetes Educators: Discoveries in Diabetes: How They Will Change Your Practice

Transcription

1 International Diabetes Center s Annual Symposium for Advanced Diabetes Educators: Discoveries in Diabetes: How They Will Change Your Practice The Don Etzwiler Memorial Lecture: Critical Times for Diabetes Education: Joint Position Statement of the ADA, AADE and AND Margaret (Maggie) Powers, PhD, RD CDE International Diabetes Center at Park Nicollet Minneapolis, MN President, Health Care & Education American Diabetes Association April 19, 2016 IDC Mission Ensuring that every individual with diabetes or at risk for diabetes receives the best possible care

2 Best Possible Care IDC Practice Guidelines/ Core Content Best Possible Care

3 Diabetes Education What that means Assess cultural influences, health beliefs, current knowledge, physical limitations, family support, financial status, medical history, literacy, numeracy to determine content to provide and how: Medications Choices, action, titration, side effects Monitoring blood glucose Physical activity Complications Nutrition Risk reduction Concerns Changes When to test, interpreting and using glucose pattern management for feedback Safety, short term vs. long term goals/recommendations Preventing, detecting, and treating acute and chronic complications Food plan, planning meals, purchasing food, preparing meals, portioning food Smoking cessation, foot care Developing personal strategies to address psychosocial issues and concerns Developing personal strategies to promote health and behavior change Benefits Associated with DSME/S Improved health outcomes Reduced A1c by as much as 88% Reduced onset and/or advancement of complications Reduced hospital admissions and readmissions More healthful eating patterns and regular activity Enhanced self efficacy and empowerment Increased healthy coping Improved quality of life NOTE: 1) Benefits of education decrease over time, 2) sustained improvement requires time and follow up, and 3) effectiveness directly correlated to amount of time spent with educator Norris SL, et al. Diabetes Care 2001

4 Sorry State of DSME/S 6.8% of individuals with newly diagnosed T2D with private health insurance received DSME/S within 12 months of diagnosis 4% of Medicare participants received DSME/S and/or MNT Duncan et al. Diab Educ. 2009;35: Li et al. MMWR. 2014;63: Collaboration Writing Team Margaret A. Powers (Chair) Joan Bardsley Marjorie Cypress Paulina Duker Martha M. Funnell Amy Hess Fischl Melinda D. Maryniuk Linda Siminerio Eva Vivian

5 DSME/S Algorithm of Care 4 critical times to assess, provide and adjust 1. At diagnosis 2. Annually 3. Complicating factors occur 4. Transitions in care occur DSME/S Algorithm of Care and Action Steps

6 DSME/S Algorithm of Care Nutrition Registered dietitian for medical nutrition therapy Education Diabetes self management education and support Emotional Health Mental health professional, if needed Four critical times to assess, provide, and adjust diabetes self management education and support 1 At diagnosis 2 Annual assessment of education, nutrition, and emotional needs When primary care provider or specialist should consider referral: Newly diagnosed. All newly diagnosed individuals with type 2 diabetes should receive DSME/S Ensure that both nutrition and emotional health are appropriately addressed in education or make separate referrals Needs review of knowledge, skills, and behaviors Change in medication, activity, or nutritional intake HbA 1c out of target Unexplained hypoglycemia or hyperglycemia Planning pregnancy or pregnant For support to attain and sustain behavior change(s) Weight or other nutrition concerns New life situations and competing demands 3 When new complicating factors influence self management Change in: Health conditions such as renal disease and stroke, need for steroid or complicated medication regimen Physical limitations such as visual impairment, dexterity issues, movement restrictions Emotional factors such as anxiety or clinical depression Basic living needs such as access to food, financial limitations 4 When transitions in care occur Change in: Living situation such as inpatient or outpatient rehabilitation or now living alone Medical care team Insurance coverage that results in treatment change Age related changes affecting cognition, self care, etc. Target Audiences for Implementation Providers / Clinicians Programs Individuals PCPs DSME program Persons with diabetes Endos ERP and DEAP programs* Educators Hospitalists Health system Members of NCDBE Professional organizations Student training programs Medical Homes State health programs / health departments Bloggers Industry reps *ERP = Education Recognition Program (ADA) DEAP = Diabetes Education Accreditation Program (AADE) 12

7 It is recommended that all health care providers and/or systems develop processes to guarantee that all patients with type 2 diabetes receive DSME/S services and ensure that adequate resources are available in their respective communities to support these services. Powers MA et et al. al. DSME/S DSME/S Position Position Statement Statement Diabetes Diabetes Care, Care, The The Diabetes Diabetes Educator, Educator, Journal Journal of Academy of Academy of Nutrition of Nutrition and Dietetics and Dietetics Summary of DSME/S Position Statement 1. Provides the evidence base for the value of diabetes education 2. Identifies the four critical times to assess, adjust, and provide DSME/S 3. Provides objective criteria for referral 4. Summarizes the content/topics to address in DMSE/S 5. Provides clinicians and health systems with a framework to establish and coordinate patient centered diabetes care

8 Thank You!