By Lindsay Hodgson, Dietetic Intern at Hailey Crean Nutrition LLC

What is DSMES?

Diabetes Self-Management Education and Support (DSMES) is a collaborative learning process where people with diabetes develop knowledge, make lifestyle changes, and gain skills to care for themselves and their diabetes (1). The Association of Diabetes Care and Education Specialists developed 7 self-care themes to be addressed in DSME, which are (2):

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

DSMES is associated with improved blood sugar control, as it has been found to correlate with lower A1C levels among people with type 2 diabetes( 3,4,5).  Despite its efficacy, DSMES is often underutilized in the United States (3,6,7).   Only approximately 5% of people with diabetes who had Medicare coverage used DSMES according to a 2015 study, and the rates are estimated at about 6.8% for people with private health insurance (3,6,7).  These statistics reveal the need to increase awareness while decreasing barriers to accessing DSMES services. 

Providers who offer DSMES are called Certified Diabetes Care and Education Specialists (CDCES). A CDCES informs patients about their condition and teaches them to apply evidence-based management strategies. This also includes developing knowledge about how medications, diet, exercise, stress, sleep, and additional health conditions affect blood sugar. While there are general guidelines that may be helpful to people with diabetes, there is no one-size-fits-all approach. Many DSMES programs are collaborative, patient-centered, and therefore allow patients to set personalized goals based on their routines and preferences.

The support component to DSMES is incredibly valuable as well. A CDCES is an ally to provide accountability and help problem-solve diabetes-related issues. Some DSMES programs offer peer support groups, which create community and can be significant in coping with the mental and emotional burdens of managing diabetes. 

Technology has opened new possibilities for providers to reach people with diabetes by offering virtual diabetes education and support. Studies have noted benefits such as lower A1Cs and increased self-efficacy when virtual DSMES was provided via smartphone apps and WeChat platforms to people with type 2 diabetes (8,9).  Telemedicine and virtual DSMES may be tech-friendly solutions to increase access to DSMES.  

Seeking virtual DSMES may be a new concept to people with diabetes, but being aware of the virtual option is worthwhile because it introduces numerous advantages for patients. 

Benefits of Virtual DSMES:

Virtual DSMES offers more scheduling flexibility. For many people, time and scheduling are barriers for diabetes support. Busy lives and competing priorities can make it difficult to attend regular appointments. Many patients appreciate the ease of being able to seek care from a CDCES from the comfort of their home before, during, or after the workday.

Virtual DSMES provides increased accessibility by eliminating the barrier of location to establish care with a CDCES in the patient’s town of residence. In fact, a CDCES may be able to establish care with out-of-state patients so long as the CDCES is licensed in that state and in-network with their health insurance. The virtual formal is especially convenient for patients who live in rural areas or who lack reliable access to transportation who would otherwise have to plan long commutes. It also eliminates the need to reschedule appointments when traveling or out of town.

Virtual DSMES, when conducted from the patient’s home, is useful because typically patients have their diabetes management supplies on hand. Patients can show the CDCES a specific product for direct answers to their questions. Learning carbohydrate counting, if applicable, can be more personalized because patients can select foods or snacks from their own kitchen to walk through the process with their CDCES.  

VIrtual DSMES can use technology relevant to diabetes management such as glucose monitor sharing capabilities and online food logs. Patients can share their data when appropriate so their providers have a more holistic view of their lifestyles, blood sugar trends, and help them collaborate on individualized goals. 

It is worthwhile for people with diabetes to know about the DSMES services that may promote their physical and mental health. It is never too late to begin. Virtual DSMES may help eliminate barriers to accessing diabetes support and empower patients with a care routine that works for their lives. Many states require that insurance companies cover DSMES in some capacity. Click here to see the status in your state, and call your health insurance company to find out your eligibility.

Reference List 

1. Burke SD, Sherr D, Lipman RD. Partnering with diabetes educators to improve patient outcomes. Diabetes Metab Syndr Obes. 2014;7:45-53. Published 2014 Feb 12. doi:10.2147/DMSO.S40036
2. Using the ADCES7 Self-Care Behaviors to Manage Your Condition. Association of Diabetes Care & Education Specialists. Accessed September 21, 2021. https://www.diabeteseducator.org/living-with-diabetes/Tools-and-Resources 
3. Diabetes Self-Management Education and Support (DSMES) Toolkit. Center for Disease Control and Prevention. Accessed September 20, 2021. https://www.cdc.gov/diabetes/dsmes-toolkit/index.html 
4. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016 Jun;99(6):926-43. doi: 10.1016/j.pec.2015.11.003. 
5. Steinsbekk A, Rygg LØ, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012 Jul 23;12:213. doi: 10.1186/1472-6963-12-213. 
6. Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. Use of Medicare’s Diabetes Self-Management Training Benefit. Health Educ Behav. 2015;42(4):530-538.
7. Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes. Med Care. 2017;55(4):391-397.
8. Wu X, Guo X, Zhang Z. The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth. 2019 Jan 15;7(1):e12297. doi: 10.2196/12297.
9. Dong Y, Wang P, Dai Z, Liu K, Jin Y, Li A, Wang S, Zheng J. Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients: A randomized clinical trial. Medicine (Baltimore). 2018 Dec;97(50):e13632. doi: 10.1097/MD.0000000000013632.