Joni Beck

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

Intensive vs. conventional insulin management initiated at diagnosis in children with diabetes: Should payer source influence the choice of therapy?

Intensive insulin management (IIM) in type 1 diabetes facilitates improved glycemic control and a reduction in long‐term diabetes complications. We hypothesized that IIM can be started at diagnosis without deleterious effects on hemoglobin A1c (A1c), body mass index (BMI), and severe hypoglycemia regardless of payer source. Type 1 diabetes patients aged 0–18 yrs, in an academic endocrinology practice were identified for a retrospective chart review. Fifty‐four patients on conventional insulin management (CIM) were compared to 51 on IIM. Insulin regimens, payer, and A1c values were compared at baseline, 12, 15, and 18 months. Secondary analyses included BMI changes and hypoglycemia frequency. Overall mean A1c values for the IIM group (8.15 ± 1.41) were lower across all time periods compared to the CIM group (8.57 ± 1.52). Repeated measures anova revealed a significant treatment group effect (p = 0.01) with no time effect (p = 0.87) or interaction (group by time) effect (p = 0.65). Private insurance patients had lower mean A1C values than Medicaid patients (χ2 = 4.5186, p < 0.05), regardless of regimen. A1c values between IIM and CIM were not statistically different within the Medicaid group. BMI changes between groups were not different. Chi‐square analysis for severe hypoglycemia revealed no group differences. In conclusion, IIM had improved glycemic control. Private insurance vs. Medicaid patients had lower mean A1c values regardless of treatment group. Considering Medicaid patients only, IIM was not inferior, and for those with private insurance, IIM was superior. IIM, initiated at diagnosis, is a reasonable approach for newly diagnosed children with diabetes regardless of payer source.

Use of the Mastery of Stress Instrument in Caregivers of Children Newly Diagnosed With Type 1 Diabetes: Identifying a Need for Further Intervention

Purpose The purpose of this study was to determine if the Mastery of Stress Instrument (MSI) can assess further education needs of primary caregivers of children newly diagnosed with type 1 diabetes. The MSI has been utilized to measure mastery in response to both illness and interventions, including education. The primary objective was to correlate MSI subscales and stress scores with caregiver age, ethnicity, gender, and education. Secondary objectives were to correlate MSI scores with child age at diagnosis, payer source, hemoglobin A1C (A1C), emergency room (ER) visits, or hospitalization for diabetic ketoacidosis (DKA). Methods Caregivers from a pediatric endocrinology practice completed the MSI after basic diabetes education. Demographic data from caregivers and patients were obtained. A1C, ER, and DKA were evaluated 2 years following completion of the MSI. Descriptive univariate statistics and proportions on nominal or discrete data were used to describe the data. Bivariable analyses included t tests and ANOVAs. Results Eighty-five of 88 participants completed the instrument. Caregivers between 40 and 49 years of age scored worse on change, acceptance, and growth subscales compared to those 18 to 29 years of age. Those 40 to 49 years of age reported having more stress compared to caregivers 18 to 29 years of age. Males reported having less stress and were more willing to implement change compared to females. No statistically significant relationships between secondary outcomes measurements and MSI scores were detected. Conclusions The mastery of stress instrument identified groups of caregivers in need of further education or team interventions.

A Novel Approach to the Management of Neonatal Diabetes Using Sensor-Augmented Insulin Pump Therapy With Threshold Suspend Technology at Diagnosis.

Neonatal diabetes mellitus (NDM) is a rare genetic condition with an incidence of 1 in 100,000 (1) that presents before 1 year of age (2). There are two main clinical forms of NDM: permanent NDM (PNDM), which requires lifelong treatment with insulin, and transient NDM (TNDM), which may spontaneously remit and sometimes recurs in the second to third decade of life. In most cases, TNDM and PNDM cannot be distinguished clinically at the time of diagnosis, and genetic analysis needs to be performed. The genetic origin for >90% of TNDM cases has been established. In TNDM, 68% of the cases have abnormalities in an imprinted region on chromosome 6q24; 10% have KCNJ11 gene mutations; and 13% have an ABCC8 gene mutation (3). Multiple genes involved in pancreatic development, β-cell apoptosis, or dysfunction cause PNDM (4). The most common mutations are in the KATP channel genes KCNJ11 (30%) and ABCC8 (11%) or the insulin (INS) gene (13%) (3). Insulin is acutely required in most infants to establish metabolic control in NDM (5). Early initiation of sulfonylurea treatment is also recommended (6) as a treatment option in selected cases of NDM caused by ABCC8 and KCNJ11 mutations, and, in responsive cases, sulfonylurea therapy provides better long-term metabolic control (7,8) and could even improve neurodevelopmental outcomes (9). The MiniMed 530G (Medtronic, Inc., Northridge, CA) is a first-generation artificial pancreas system approved by the U.S. Food and Drug Administration (FDA) on 26 September 2013 for the management of diabetes in people ≥16 years of age. The system includes an external glucose sensor and insulin pump, transmitter, glucose meter, and therapy management software. Sensor signals are transmitted to the MiniMed 530G insulin pump and converted into glucose values every 5 minutes. Fingerstick blood glucose testing is still required for both …

A Continuous Subcutaneous Insulin Infusion Needle Break.

### Adverse Event Our patient was 13 years and 2 months old, a white boy with type 1 diabetes diagnosed 2 years and 5 months before this adverse event (AE). He had no other significant medical history. His A1C was 7.6% 1 month before the insulin infusion needle break event. The patient had started on the t-slim insulin pump (Tandem Diabetes Care, San Diego, Calif.) 1 year and 6 days before the AE occurred. He was using the contact Detach (Unomedical, Inc., Bridgewater, N.J.) infusion set and lispro insulin. The contact Detach infusion set features a very fine, 29-gauge, 90° steel needle. With its additional adhesive pad, contact Detach provides extra security against needle dislodging. Its simplicity and security make it a good choice for active young children, pregnant women, and adults for whom soft cannula sets do not work well. The contact Detach set is available in 6- and 8-mm needle lengths and 23- and 32-inch tubing lengths (1). There were no reported previous pump AEs, emergency department visits, or diabetes ketoacidosis episodes related to continuous subcutaneous insulin infusion (CSII) therapy. The patient’s BMI was 18.65 kg/m2. The patient’s mother reported changing the pump site, per usual, on 16 July 2014. When she went to remove the infusion set, the needle was not attached to it. The parents could not find the needle. The patient did not feel any pain or discomfort where the infusion set had been placed. At the time the 8-mm needle broke off from the infusion site, it had been placed on the upper left buttock area at a 90° angle with IV3000 1-HAND adhesive dressing (Smith & …

2017 National Standards for Diabetes Self-Management Education and Support

This article was copublished in Diabetes Care 2017;40:1409–1419 and The Diabetes Educator 2017;43:449–464 and is reprinted with permission. The previous version of this article, also copublished in Diabetes Care and The Diabetes Educator, can be found at Diabetes Care 2012;35:2393–2401 (https://doi.org/10.2337/dc12-1707).

Diabetes educator mentorship program: mentors requested.

Purpose The purpose of this article is to describe the Diabetes Educator Mentorship Program, communicate mentors’ experiences and perceptions during the first 3 years following implementation, and provide strategies to encourage mentoring. Conclusions Creation of this collaborative program has fostered successful attainment of additional certified diabetes educators who obtained diabetes self-management education and support (DSMES) practice requirement hours through a voluntary Diabetes Educator Mentorship Program. There is a significant need for additional mentors to meet the growing need for mentoring partnerships. Increasing the number of mentors will provide more opportunities to those seeking to gain DSMES experience and will ultimately expand the number of health professionals available to educate those with diabetes or prediabetes.