National Standards for DSME and DSMS – Part 3

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The fourth standard states, “Acoordinator will be designated to oversee the DSME program. Thecoordinator will have oversight responsibility for the planning,implementation, and evaluation of education services.”
This works well in larger cities wheretwo or more certified diabetes educators (CDEs) work for the sameoffice, however, I do have to wonder about CDEs working alone in someof the smaller offices, clinics, and hospitals. As the DSMEcontinues to evolve, the coordinator should play a pivotal role inensuring accountability and continuity in the education program. Will coordinators need to travel from large offices to smalleroffices and rural areas as an area coordinator? This is something tobe considered. The standard does state, in some cases, particularlyin small practices, the coordinator may also provide DSME and/orDSMS.
The fifth standard states, “Oneor more instructors will provide DSME and, when applicable, DSMS. Atleast one of the instructors responsible for designing and planningDSME and DSMS will be a registered nurse, registered dietitian, orpharmacist with training and experience pertinent to DSME, or anotherprofessional with certification in diabetes care and education, suchas a CDE or BC-ADM. Other health workers can contribute to DSME andprovide DSMS with appropriate training in diabetes and withsupervision and support.”
Maybe historically, nurses anddietitians were the main providers of diabetes education, but inrecent years, this has been expanded to mainly pharmacists. It istherefore natural to see this in the hierarchy of people in theliterature and whom they assign the functions of the differentstandards to for completion. At least the obligatory continuingeducation is included as a way of segregation to keep lay people onthe sidelines.
The next area seems an attempt to makeeveryone welcome, but remember it is only the CDEs that can superviseand monitor the education and support. This means fewer CDEs doingactual DSME and DSMS. A number of studies have shown that amultidisciplinary team approach to diabetes care, education, andsupport works well for the patient. Yet in too many cases, thepatient is often not the center of the efforts and central to theteam approach.
“Thedisciplines that may be involved include, but are not limited to,physicians, psychologists and other mental health specialists,physical activity specialists (including physical therapists,occupational therapists, and exercise physiologists), optometrists,and podiatrists. More recently, health educators (e.g., CertifiedHealth Education Specialists and Certified Medical Assistants), casemanagers, lay health and community workers, and peer counselors oreducators have been shown to contribute effectively as part of theDSME team and in providing DSMS.”
Yes, they do include lay health andcommunity workers plus peer counselors or educators when it is totheir advantage. But, notice that a system must be in place thatensures supervision of these lay people. I agree that for questionsthe lay people do not have answers for need to have professionalsavailable to answer when the questions are beyond their training. This is wise even for the CDEs to have doctors or other professionalsavailable to back them up, but this seems to be an insult to theircredentials.

This information is from the National Standards for DSME and DSMS.