Diabetes education: looking through the kaleidoscope.

BACKGROUND: Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and those at risk for developing diabetes. In spite of growing evidence of the value of DSME in reducing hospitalization costs, improvement in glucose, weight and medication adherence, DSME remains an underutilized insurance benefit and access to qualified diabetes educators is problematic. PURPOSE: This paper reviews the current challenges, principles and evidence of DSME, importance of integration of diabetes education with clinical care, and the future of diabetes educators and education in the emerging health care delivery models. DATA SOURCES: Scientific literature review, Pub Med, EBP websites and other online literature databases and resources. LIMITATIONS: This is not a systematic literature review or meta-analysis of diabetes education. CONCLUSION: Because diabetes is a complex condition reaching pandemic proportions, which requires self-management of the chronic disease on a daily basis, the future of DSME faces challenges in the current fee for service environment. The National Standards for Diabetes self-management education and support and the American Association of Diabetes Educators Practice Guidelines offers new concepts for meeting the future demand of diabetes educators and education.

Evolution of the American Association of Diabetes Educators' diabetes education outcomes project.

PURPOSE: This is the initial article in a series that describes a multiyear project of a professional membership organization to define, standardize, collect, and report the outcomes of diabetes self-management education. The purpose of this article is to describe and summarize the contributions of each phase of the project: determining a conceptual framework, developing and testing measurement instruments, defining outcome standards for diabetes self-management education, and implementing a technology approach to capturing the outcomes. METHODS: Association archives, project participants, presentation slides, and published articles provide the historical information that is presented in this article. RESULTS: Evidence for diabetes education as an intervention has been demonstrated, but key questions remain about what settings and which interventions, provided by whom and over what period of time, produce what outcomes. This project integrated diabetes education outcomes reporting into a system of diabetes care through the development of measurement methods and a data collection system for patients and educators at the point of service. CONCLUSIONS: The AADE7 Outcomes System supports educators in collecting and reporting on program design, patient self-care behaviors, and educational, behavioral, and clinical interventions and outcomes.

Development of the American Association of Diabetes Educators' Diabetes Self-management Assessment Report Tool.

PURPOSE: The purpose of this article is to describe the development and testing of a new tool for collecting patient information for diabetes self-management education (DSME): the Diabetes Self-management Assessment Report Tool (D-SMART). The D-SMART was designed through expert panel consensus based on a hybrid conceptual framework and is intended to serve multiple functions at the level of the patient, the program, and the field. METHODS: The D-SMART has completed 3 rounds of pilot testing and is currently undergoing a fourth round, with each round resulting in revisions to the original instrument. RESULTS: Findings from the pilot testing indicate that the instrument has acceptable reliability, validity, and sensitivity (or responsiveness) to change. A full-scale field test is currently under way, in which data from the D-SMART will be used to guide the delivery of services and to evaluate and enhance program functioning with a goal of improving education and care. Additional data from the field test are reported elsewhere, and further analyses are planned. CONCLUSIONS: The D-SMART provides educators with a tool that measures patients' behaviors and identifies those priorities for, and barriers to, change.

Microvascular complications of diabetes.

The microvascular complications of diabetes are serious, and can be life threatening. They involve injury to the blood vessels in the retina, kidney, nervous system, gingiva, and skin. Controlling the risk factors for microvascular complications involves controlling glucose level, blood pressure, and lipids, along with healthy lifestyle changes. Early identification of these complications can promote early interventions and prevent of slow progression of these diseases. Nurses can play a major role through patient care and self-management education.