Diabetes Education

South Dakota law provides health insurance coverage for diabetes equipment, supplies and self-management education, including medical nutrition therapy. Diabetes education (also known as Diabetes Self-Management Education or DSME) is a process by which people with diabetes learn to manage the disease with help from a diabetes educator.

Diabetes education focuses on:

• Healthy eating
• Being active
• Monitoring
• Taking medication
• Problem solving
• Healthy coping
• Reducing risks

Programs must be recognized by South Dakota Department of Health, the American Diabetes Association, or the American Association of Diabetes Educators for reimbursement purposes. The Information regarding each of these respective programs may be accessed at the following websites:
http://doh.sd.gov/diabetes/derp.aspx  
http://professional.diabetes.org/ERP_List.aspx  
http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=resourcesFactSheets#4
http://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html

Diabetes Self-Management Education
Diabetes Self-Management Education (DSME) is a key step in improving health outcomes and quality of life for people with diabetes. DSME focuses on self-care behaviors such as healthy eating, being active, and monitoring blood sugar. It is a collaborative process in which diabetes educators help people with diabetes gain the knowledge and problem-solving and coping skills needed to successfully self-manage the disease and its related conditions. DSME prevents complications and hospitalizations.

Measurable behavior change is the desired outcome of diabetes education.

AADE believes that behavior change can be most effectively achieved using the AADE7 Self-Care Behaviors™ framework. The 7 self-care behaviors are healthy eating, being active, monitoring, taking medication, problem solving, reducing risks and healthy coping. Below is a description of each behavior for patients and healthcare professionals.

Healthy eating
 

Making healthy food choices, understanding portion sizes and learning the best times to eat are central to managing diabetes. By making appropriate food selections, children and teenagers grow and develop as they would if they didn’t have diabetes. And, by controlling their weight and achieving optimal blood glucose levels, many adults may be able to manage their condition for a time without medications.

Diabetes education classes can assist people with diabetes in gaining knowledge about the effect of food on blood glucose, sources of carbohydrates and fat, appropriate meal planning and resources to assist in making food choices. Skills taught include reading labels, planning and preparing meals, measuring foods for portion control, fat control and carbohydrate counting. Barriers, such as environmental triggers and emotional, financial, and cultural factors, are also addressed.
 

Being active
 

Regular activity is important for overall fitness, weight management and blood glucose control. With appropriate levels of exercise, those at risk for type 2 diabetes can reduce that risk, and those with diabetes can improve glycemic control. Being active can also help improve body mass index, enhance weight loss, help control lipids and blood pressure and reduce stress.

Diabetes educators and their patients collaborate to address barriers, such as physical, environmental, psychological and time limitations. They also work together to develop an appropriate activity plan that balances food and medication with the activity level.
 

Monitoring
 

Daily self-monitoring of blood glucose provides people with diabetes the information they need to assess how food, physical activity and medications affect their blood glucose levels. Monitoring, however, doesn’t stop there. People with diabetes also need to regularly check their blood pressure, urine ketones and weight.

Diabetes education classes instruct patients about equipment choice and selection, timing and frequency of testing, target values, and interpretation and use of results.
 

Taking medication
 

Diabetes is a progressive condition. Depending on what type a person has, their healthcare team will be able to determine which medications they should be taking and help them understand how your medications work. They can demonstrate how to inject insulin or explain how diabetes pills work and when to take them. Effective drug therapy in combination with healthy lifestyle choices, can lower blood glucose levels, reduce the risk for diabetes complications and produce other clinical benefits.

The goal is for the patient to be knowledgeable about each medication, including its action, side effects, efficacy, toxicity, prescribed dosage, appropriate timing and frequency of administration, effect of missed and delayed doses and instructions for storage, travel and safety.
 

Problem solving
 

A person with diabetes must keep their problem-solving skills sharp because on any given day, a high or low blood glucose episode or a sick day will require them to make rapid, informed decisions about food, activity and medications. This skill is continuously put to use because even after decades of living with the disease, stability is never fully attained: the disease is progressive, chronic complications emerge, life situations change and the patient is aging.

Collaboratively, diabetes educators and patients address barriers, such as physical, emotional, cognitive, and financial obstacles and develop coping strategies.
 

Reducing risks
 

Effective risk reduction behaviors such as smoking cessation, and regular eye, foot and dental examinations reduce diabetes complications and maximize health and quality of life. An important part of self-care is learning to understand, seek and regularly obtain an array of preventive services.

Diabetes educators assist patients in gaining knowledge about standards of care, therapeutic goals, and preventive care services to decrease risks. Skills taught include smoking cessation, foot inspections, blood pressure monitoring, self-monitoring of blood glucose, aspirin use and maintenance of personal care records.
 

Healthy coping
 

Health status and quality of life are affected by psychological and social factors. Psychological distress directly affects health and indirectly influences a person’s motivation to keep their diabetes in control. When motivation is dampened, the commitments required for effective self-care are difficult to maintain. When barriers seem insurmountable, good intentions alone cannot sustain the behavior. Coping becomes difficult and a person’s ability to self-manage their diabetes deteriorates.

An important part of the diabetes educator’s work is identifying the individual’s motivation to change behavior, then helping set achievable behavioral goals and guiding the patient through multiple obstacles. They can provide support by encouraging you to talk about your concerns and fears and can help you learn what you can control and offer ways for you to cope with what you cannot.