Melinda D. Maryniuk

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 …

Selected Vitamins and Minerals in Diabetes

The interrelationship between diabetes and various vitamins and minerals is characterized by a high degree of reciprocity. Chronic uncontrolled hyperglycemia can cause significant alterations in the status of these nutrients, and conversely, some of these substances, especially those that have been characterized as micronutrients, can directly modulate glucose homeostasis (1). Differences in patient populations studied and methodological uncertainties account for the discrepancies in most reported studies. Certain subgroups of individuals with diabetes, such as elderly patients, vegans (who consume no animal products), and pregnant and lactating women, are at particular risk for deficiencies for such nutrients. Additionally, caloric restriction for obese patients and the effects of a high fiber diet and a host of drugs on the metabolism of vitamins and minerals are of concern (2,3).

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

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

D IABETES ISACHRONICDISEASE that requires a person with diabetes to make a multitude of daily self-management decisions and to perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes. Diabetes self-management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes selfmanagement support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing basis. (See further definitions in Figure 1.) Although different members of the health care team and community can contribute to this process, it is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial

Diabetes Self-management Education and Support in Type 2 Diabetes

From International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers); MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley); ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress); LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker); University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell); University of Chicago, Chicago, Illinois (Ms Fischl); Joslin Diabetes Center, Boston, Massachusetts (Ms Maryniuk); School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio); and University of Wisconsin–Madison, Madison, Wisconsin (Dr Vivian).

Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of diabetes educators, and the Academy of nutrition and dietetics

Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and to perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes (1–7). Diabetes self-management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes self-management support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing basis. (See further definitions in Table 1.) Although different members of the health care team and community can contribute to this process, it is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial DSME is typically provided by a health professional, whereas ongoing support can be provided by personnel within a practice and a variety of community-based resources. DSME/S programs are designed to address the patient’s health beliefs, cultural needs, current knowledge, physical limitations, emotional concerns, family support, financial status, medical history, health literacy, numeracy, and other factors that influence each person’s ability to meet the challenges of self-management. View this table: TABLE 1. Key Definitions It is the position of the American Diabetes Association (ADA) that all individuals with diabetes receive DSME/S at diagnosis and as needed thereafter (8). This position statement focuses on the particular needs of individuals with type 2 diabetes. The needs will be similar to those of people with other types of diabetes (type 1 diabetes, prediabetes, and gestational diabetes mellitus); however, the research and examples referred to in this article focus …

The 3 R's of Glycemic Index: Recommendations, Research, and the Real World

T he ability to achieve optimal glycemic control in diabetes management is highly influenced by food intake. The initial focus for nutrition education messages is to aim for consistency in both type and quantity of carbohydrates consumed. However, research in the past decade has acknowledged that not all carbohydrates effect blood glucose levels in the same way. One of the methods for evaluating this effect is known as the glycemic index (GI). Using the GI in meal planning can improve diabetes control and other health parameters. Understanding the benefits of the GI and how one can implement it into the diet, allows health care practitioners to educate patients about its use. This article will define GI; highlight key recommendations regarding the use of GI scales; summarize recent research related to the impact of choosing lower-GI foods on diabetes control, lipids, and weight; and conclude with some practical, real-world tips for using the GI when counseling patients. The GI is a ranking system that indicates how quickly a carbohydrate food raises blood glucose. This is determined by measuring the area under the curve in the 2 hours after the consumption of a test food. These values are then compared to the area under the curve 2 hours after the consumption of a similar weight of glucose or bread. Foods ranked < 55 are considered to have a low GI. Low-GI foods include many fruits and vegetables, legumes, whole grains, and dairy products. Foods with a ranking between 56 and 75 are considered to have a moderate GI. High-GI foods, those with a ranking between 76 and 100, often include highly processed and refined carbohydrates such as instant oatmeal, white bread, and cornflakes (Table 1). Although the GI ranking compares standard carbohydrate portions (usually 25 or 50 g), the amount of …

Enhancing the Role of Medical Office Staff in Diabetes Care and Education

P roviding education for the 18.8 million people who have been diagnosed with diabetes in the United States is a challenge. Although there are now more than 17,000 certified diabetes educators (CDEs), only about one-third to one-half of the population with diabetes reports having ever received any type of formal diabetes education.1,2 In addition, it is well recognized that, to maximize access to diabetes education, it needs to be available in convenient, community-based settings such as within primary care offices. Enhancing the role of medical office staff (MOS) in primary care to provide additional support for diabetes-related care and education activities can have beneficial results for patient outcomes and physician satisfaction. Consider these facts: The purposes of this article are to: In 2010, the Joslin Diabetes Center collected and analyzed data to better understand the challenges and opportunities for improving diabetes care and education in primary care settings from the perspective of both patients and providers. Quantitative (surveys) and qualitative (focus groups) data were …

Quality diabetes self-management education: Achieving and maintaining ADA Education Program Recognition

PURPOSE The purpose of this article is to describe the ADA Education Recognition Program Review Criteria for the National Standards for DSME and to help ADA-Recognized programs be prepared in the event of a random audit. METHODS A multidisciplinary committee defined the Review Criteria and Indicators to demonstrate implementation of the 10 National Standards. Tips for completing the application as well as the 2 types of audits, random paper and onsite, are described. RESULTS Five percent of all ADA-Recognized education programs will receive an onsite review conducted by 2 trained auditors. Detailed steps (based on over 100 audits that have been conducted) are outlined describing what happens prior to and during an audit so education programs can more fully understand the process and be prepared. The most common reasons that applications and/or audits fail are described. CONCLUSIONS The Education Recognition Program of the ADA aims to ensure that diabetes education programs that meet quality standards will reach as many patients as possible. The lessons learned from other program applications and audits help to strengthen all diabetes education services to ensure that educators are doing the best for their patients.

Practical Aspects of Implementing Increased Dietary Fiber Intake

Two hundred twenty dietitians participated in a workshop conference on Health Implications of Dietary Fiber. They were given lectures to increase their knowledge base, and then in group sessions answered questions and wrote concensus opinions. The results are the content of this paper. The topics covered and responses are reported in four categories, 1) diabetes and obesity, 2) hyperlipidemia, hypertension and coronary heart disease, 3) gut function and gastrointestinal disease, and 4) cancer. Specific recommendation for implementing high fiber diets are made in each category. However, the dietitians expressed caution on accepting all of the conclusions expressed in the literature on the value of fiber and believed much education and instruction is needed in order to increase dietary fiber intake.