National Standards for DSME and DSMS – Part 2

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Part 2 of 6 Parts
In this blog, I will start with thestandard number one and cover several of them. However, thedefinitions should be stated first and I will quote them.DSME (Diabetes Self-ManagementEducation). “The ongoingprocess of facilitating the knowledge, skill, and ability necessaryfor prediabetes and diabetes self-care. This process incorporates theneeds, goals, and life experiences of the person with diabetes orprediabetes and is guided by evidence-based standards. The overallobjectives of DSME are to support informed decision making, self-carebehaviors, problem solving, and active collaboration with the healthcare team and to improve clinical outcomes, health status, andquality of life.”
It is important to note thatprediabetes is mentioned here and no distinction is made to preferone type of diabetes over another. Yet, this distinction isprevalent in the activities of certified diabetes educators (CDEs) inpractice today. This is the reason for calling attention to this.
DSMS (Diabetes Self-ManagementSupport).“Activitiesthat assist the person with prediabetes or diabetes in implementingand sustaining the behaviors needed to manage his or her condition onan ongoing basis beyond or outside of formal self-managementtraining. The type of support provided can be behavioral,educational, psychosocial, or clinical.”
These are the two key definitions thatapply to this and several following blogs. Keep them in mind whenreading the materials.
The first standard states, ”Theprovider(s) of DSME will document an organizational structure,mission statement, and goals. For those providers working within alarger organization, that organization will recognize and supportquality DSME as an integral component of diabetes care.”
This is a powerful standard in anyprofession, but from practical knowledge, this is the first standardviolated by most providers (CDEs). There are a few that do have thisin place and do make use of it for the intended purpose. I am awareof one diabetes clinic in a Midwest city that has something like this on file andall new personnel are required to read this and agree with it beforean interview even takes place. In addition, some of the literaturehanded out by the clinic includes parts of this document. CDEs thatfall short of this or violate it are dismissed rather quickly. Thisis not my clinic, but one in a city about three hours distantdepending on the traffic.
Another clinic also has a similardocumentation, but this one was written by the doctors that own thediabetes clinic and it works very well. As to how it conforms to theabove standard, I can only guess, but a relative of mine does saythat she receives excellent education in all areas except nutrition. Since she is a retired nutritionist, she has learned not to includedietitians on her team.
The second standard states, “Theprovider(s) of DSME will seek ongoing input from externalstakeholders and experts in order to promote program quality.”
This is a standard that depends on theoffice, clinic, or hospital. Some doctors prefer their input only,while others want their CDEs out in the community and participatingin community meetings and after work activities. One primary carephysician does have his CDEs involved with the school system andchecking that pupils with diabetes are receiving proper care. Whenit was discovered that the school system had made a budget cut toeliminate the nurses, he went before the school board and warned themthat they had better reinstate the cut or have the ADA investigatingas well as the state board of education. It was reinstated at thenext meeting and the two nurses rehired.
Some diabetes clinics do work to haveinput from the community and have proper channels for other input. Iam not aware of any formal advisory boards, but they may exist and Idon't know about them.
The third standard states, “Theprovider(s) of DSME will determine who to serve, how best to deliverdiabetes education to that population, and what resources can provideongoing support for that population.”
Ouch! It is no wonder there iswidespread discrimination in the service provided. In many areas,this has to be the reason people with type 2 diabetes don't have CDEsavailable to them and receive no education about diabetes. Yes, eventhe standards authors recognize this and state, “Currently,the majority of people with diabetes and prediabetes do not receiveany structured diabetes education.”
It is interesting the follow upstatement the standards people make. Without the qualified people tobe available, this just points out the fact that lay people needtraining to fill in gaps where CDEs are not available.

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