Self-management education for the child with diabetes mellitus
- Barbara Schreiner, PhD, RN, CDE, BC-ADM
Barbara Schreiner, PhD, RN, CDE, BC-ADM
- Core Faculty
- Capella University
- Stephen Ponder, MD, FAAP, CDE
Stephen Ponder, MD, FAAP, CDE
- Professor of Pediatrics
- Texas A&M University College of Medicine
Diabetes is an unrelenting chronic illness requiring management by skilled professionals, and daily attention and action by the child and parent. Diabetes Self-Management Education and Support (DSME/S) provides the framework and information for preparing a family to take responsibility for the child's diabetes care, and facilitates the transition to self-care as the child matures. DSME/S is an integral component of care for all patients with diabetes [1,2].
The curriculum, educational principles, and outcomes of DSME/S are outlined in this topic review. DSME/S should be closely coordinated with diabetes medical care, which is described separately. (See "Management of type 1 diabetes mellitus in children and adolescents".)
US NATIONAL STANDARDS
In 1986, the National Diabetes Advisory Board, the American Diabetes Association (ADA), and other professional organizations articulated initial standards of practice for diabetes education programs in the United States. In 2007, revised national standards for diabetes self-management education (DSME) were published that more fully incorporated the needs of diverse patient care settings . In 2011, the American Diabetes Association included DSME in its revised version of Standards of Medical Care in Diabetes and recommended that all people with diabetes receive DSME at diagnosis, and as needed thereafter . In 2012, the national task force added Diabetes Self Management Support (DSMS) to the national standards, reflecting the need for ongoing maintenance of healthy behaviors .
The national standards provide patients with information across nine content areas that represent the core body of knowledge needed by patients with diabetes :
●Diabetes disease process and treatment options
- Schreiner B. Diabetes self-management education. In: Intensive diabetes management, 5 ed, Wolfsdorf J (Ed), American Diabetes Association, Arlington, VA 2012.
- Haas L, Maryniuk M, Beck J, et al. National standards for diabetes self-management education and support. Diabetes Educ 2012; 38:619.
- American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care 2013; 36 Suppl 1:S11.
- Cavanaugh K, Huizinga MM, Wallston KA, et al. Association of numeracy and diabetes control. Ann Intern Med 2008; 148:737.
- Hassan K, Heptulla RA. Glycemic control in pediatric type 1 diabetes: role of caregiver literacy. Pediatrics 2010; 125:e1104.
- American Diabetes Association "Safe at School" materials. Available at: http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/ (Accessed on October 18, 2013).
- Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 1978; 88:251.
- Nwankwo, R, Tang, T. Tailoring diabetes education and care to minority patients and families. In: Practical psychology for diabetes clinicians, 2nd ed, Anderson, B, Rubin, R (Eds), American Diabetes Association, Alexandria, VA, 2002. p.37.
- Anderson, R, Funnell, M, Burkhart, N, et al. 101 tips for behavior change in diabetes education. American Diabetes Association, Alexandria, VA 2003. p.37.
- Providing diabetes health coverage: State laws & programs. National Conference of State Legislatures; November 2013. Available online at http://www.ncsl.org/research/health/diabetes-health-coverage-state-laws-and-programs.aspx (Accessed on September 12, 2015).
- CDC Fact Sheet: Preventing diabetes and its complications. Centers for Disease Control and Prevention, Washington DC, 2008.
- Glazier RH, Bajcar J, Kennie NR, Willson K. A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care 2006; 29:1675.
- Duncan I, Ahmed T, Li QE, et al. Assessing the value of the diabetes educator. Diabetes Educ 2011; 37:638.
- Peeples M, Mulcahy K, Tomky D, et al. The conceptual framework of the National Diabetes Education Outcomes System (NDEOS). Diabetes Educ 2001; 27:547.
- Zgibor JC, Peyrot M, Ruppert K, et al. Using the American Association of Diabetes Educators Outcomes System to identify patient behavior change goals and diabetes educator responses. Diabetes Educ 2007; 33:839.
- Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001; 24:561.
- Duncan I, Birkmeyer C, Coughlin S, et al. Assessing the value of diabetes education. Diabetes Educ 2009; 35:752.
- Gage H, Hampson S, Skinner TC, et al. Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness. Patient Educ Couns 2004; 53:333.
- Couch R, Jetha M, Dryden DM, et al. Diabetes education for children with type 1 diabetes mellitus and their families, Agency for Healthcare Research and Quality, Rockville, MD 2008. Available online at: http://www.ncbi.nlm.nih.gov/books/NBK38526/ http://www.ncbi.nlm.nih.gov/books/NBK38526/ (Accessed on September 12, 2015).
- Norris SL, Lau J, Smith SJ, et al. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care 2002; 25:1159.
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837.
- Santiprabhob J, Likitmaskul S, Kiattisakthavee P, et al. Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp. Patient Educ Couns 2008; 73:60.
- Wang YC, Stewart S, Tuli E, White P. Improved glycemic control in adolescents with type 1 diabetes mellitus who attend diabetes camp. Pediatr Diabetes 2008; 9:29.
- US NATIONAL STANDARDS
- ASSESSING LEARNER READINESS
- Barriers to readiness
- Social support
- Cultural competence
- PROVIDING DSME
- Teaching strategies
- - Individualized curriculum
- - Teachable moments
- - Scare tactics
- Time and expertise
- Behavior change
- Health outcomes
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS