Donna Tomky

National Standards for Diabetes Self-Management Education and Support

By the most recent estimates, 18.8 million people in the U.S. have been diagnosed with diabetes and an additional 7 million are believed to be living with undiagnosed diabetes. At the same time, 79 million people are estimated to have blood glucose levels in the range of prediabetes or categories of increased risk for diabetes. Thus, more than 100 million Americans are at risk for developing the devastating complications of diabetes (1). Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and those at risk for developing the disease. It is necessary in order to prevent or delay the complications of diabetes (2–6) and has elements related to lifestyle changes that are also essential for individuals with prediabetes as part of efforts to prevent the disease (7,8). The National Standards for Diabetes Self-Management Education are designed to define quality DSME and support and to assist diabetes educators in providing evidence-based education and self-management support. The Standards are applicable to educators in solo practice as well as those in large multicenter programs—and everyone in between. There are many good models for the provision of diabetes education and support. The Standards do not endorse any one approach, but rather seek to delineate the commonalities among effective and excellent self-management education strategies. These are the standards used in the field for recognition and accreditation. They also serve as a guide for nonaccredited and nonrecognized providers and programs. Because of the dynamic nature of health care and diabetes-related research, the Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes education community. In the fall of 2011, a Task Force was jointly convened by the American Association of Diabetes Educators (AADE) and the American Diabetes Association …

Professional practice committee for the 2014 clinical practice recommendations

LINDA HAAS, PHC, RN, CDE (CHAIR) MELINDA MARYNIUK, MED, RD, CDE (CHAIR) JONI BECK, PHARMD, CDE, BC-ADM CARLA E. COX, PHD, RD, CDE, CSSD PAULINA DUKER, MPH, RN, BC-ADM, CDE LAURA EDWARDS, RN, MPA EDWIN B. FISHER, PHD LENITA HANSON, MD, CDE, FACE, FACP DANIEL KENT, PHARMD, BS, CDE LESLIE KOLB, RN, BSN, MBA SUE MCLAUGHLIN, BS, RD, CDE, CPT ERIC ORZECK, MD, FACE, CDE JOHN D. PIETTE, PHD ANDREW S. RHINEHART, MD, FACP, CDE RUSSELL ROTHMAN, MD, MPP SARA SKLAROFF DONNA TOMKY, MSN, RN, C-NP, CDE, FAADE GRETCHEN YOUSSEF, MS, RD, CDE ON BEHALF OF THE 2012 STANDARDS REVISION TASK FORCE

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.

The Conceptual Framework of the National Diabetes Education Outcomes System (NDEOS)

PURPOSE this article describes the systems-based conceptual framework for the definition of diabetes education outcomes and the development of the National Diabetes Education Outcomes System (NDEOS). METHODS Development of the NDEOS was based on integrating diabetes education into the diabetes care system; identifying and tracking standardized learning, behavioral, and clinical outcomes measurements; and gathering data at the individual, program, and national levels. Each component was formulated based on available literature and through consensus with the American Association of Diabetes Educators (AADE) Outcomes Task Force and other multidisciplinary healthcare professionals. RESULTS Behavior change is the key outcome measurement for diabetes self-management education (DSME). In addition, diabetes educators should collect other immediate, intermediate, and long-term outcomes for monitoring the impact of DSME. The NDEOS system includes standardized data collection tools for the participant, the educator, and the program manager, and provides reports at the individual, program, and national levels. CONCLUSIONS By capturing outcomes data using valid, reliable, and evidence-based tools, the NDEOS strives to support diabetes educators and provide a uniform data set that can be used to influence public policy, support reimbursement negotiations, and assist researchers.

Developing a computerized diabetes self-management education module for documenting outcomes.

PURPOSE This paper describes a process used to develop a computerized diabetes self-management education record that complies with the National Standards for Diabetes Self-Management Education Programs. METHODS A working prototype was developed to computerize 1 of the 15 content modules outlined in the National Standards for use on the World Wide Web. During program development, three consultants reviewed the content and proposed structure. For the subsequent prototype, five diabetes educators served as users and evaluated the content, design, and flow of the system. RESULTS The module was found to be thorough in terms of curriculum content and proposed structure for subsequent teaching. Overall, users were satisfied with the graphic interface screens and provided important feedback for determining specific modifications for future development. CONCLUSIONS The World Wide Web format provides a universal platform for documenting diabetes education outcomes and allows a broad range of access and networking capabilities.

Using Self-Monitoring of Blood Glucose in Noninsulin-Treated Type 2 Diabetes

In Brief Self-monitoring of blood glucose (SMBG) is considered an essential component of diabetes self-management. However, research has yielded mixed results regarding the value of SMBG for people with type 2 diabetes who are not treated with insulin. Some studies have shown no benefit, whereas others have demonstrated improved A1C and behavior change linked to SMBG in a diabetes self-management education program that teaches how to use SMBG data. When used appropriately in these patients, SMBG can help to identify factors associated with hyper- and hypoglycemia, facilitate learning, and empower patients to make changes to improve their glycemic control. SMBG can also be useful to health care providers, who can teach patients to monitor glucose at specific times to assess the effectiveness of medications and guide medication management. All people with type 2 diabetes should be given the opportunity to learn about the value of and skills required to monitor blood glucose as appropriate to their specific needs.

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.

A Comparison of User Accuracy, Techniques, and Learning Time of Various Systems for Self Blood Glucose Monitoring

Accuracy of results of self blood glucose monitoring (SBGM) has been shown to be technique and user dependent. Thirty patients, using four commercially available meters (Accu-Chek II, Glucometer II, Glucoscan 2000, and ExacTech), were studied to test the relative accuracy, technique error rates, and learning time for the four meters. No significant difference was found in user accuracy among the four meters. The mean number of technique errors was significantly smaller with the ExacTech system compared with the other three. No significant changes in user accuracy were seen after 1 week of practice with unfamiliar meters. The authors conclude that while all meters had approximately the same user accuracy, the ExacTech meter, which required the least user technique, had fewer user errors and required less time to learn to use.

Commonly Asked Questions About Pump Therapy

Practical down-to-earth questions about the insulin pump are answered by two educators, one a social worker, the other a nurse practitioner. They have both been wearing a pump for two years.

Insight Into AADE’s Strategic Planning Process

• Data-informed environmental scanning to identify impactful trends • Structured brainstorming to spark creative thinking about implications of trends • Scenario planning to describe plausible but structurally different futures for the AADE (scenario planning, also called scenario thinking or scenario analysis, is a method best suited to turbulent times when it is risky to build plans around a single presumed future; scenarios ensure that the AADE considers a range of possible futures) • Rigorous analysis of the key success factors and strategies that will allow the AADE to thrive under all identified plausible scenarios • Tying the strategies back to programs and operations for accountability