Diabetes Self-Management Education: A Right for All
The epidemic of diabetes continues to increase at an alarming rate throughout the world. Diabetes is a complex, chronic condition that requires both high quality clinical care and effective self-management. In addition, prevention efforts for type 2 diabetes largely advocate lifestyle changes in order to reach and maintain a healthy weight and level of physical activity. As a result, diabetes self-management education and on-going support are significant contributors to metabolic and psychological outcomes among people with diabetes and those who are at risk of diabetes.
As the world prevalence of diabetes increases, efforts to promote diabetes self-management education are critical to reducing the human and economic burden of diabetes. A collaborative effort among people with diabetes and those at risk of diabetes, governments and health services, health care professionals and the general public, is needed.
Therefore, the International Diabetes Federation (IDF) believes diabetes self-management education is a critically important, fundamental and integral component of diabetes prevention and care and should be available and accessible to everyone.
The goal of IDF, through the work of its Consultative Section on Diabetes Education (DECS) is to address these and other issues by developing and implementing strategies that facilitate equitable access to high quality diabetes self-management education and support.
The purpose of diabetes self-management education (DSME) and diabetes self-management support (DSMS) is to prepare those affected by diabetes to:
- Make informed decisions
- Cope with the demands of living daily with a complex chronic disease
- Make changes in their behaviour that support their self-management efforts and improve outcomes.
The ultimate goal is to reduce the burden of diabetes on individuals, families, communities and healthcare systems, and, by supporting good health, prevent or delay the onset of diabetes related long-term complications. (IDF Standards 2009).
Although awareness of the value of education has improved, similar barriers to access to DSME exist in both developed and developing countries. The primary barrier to access to education is shortage of qualified diabetes educators.(IDF Diabetes Atlas 4th ed.) Additional barriers include lack of financial reimbursement or support for education, and inability for people with diabetes to get time away from work to receive education. There are inadequate resources to provide education to people with diabetes and those at risk of diabetes and to train health professional, lay and peer educators. Governments need to invest in education to support primary and secondary prevention and reduce health expenditure in the future.
It is the position of IDF that:
At the Individual Level
- All people with diabetes and those at risk of diabetes, no matter where they live, have the right to learn about diabetes, how it can be prevented, how it can be managed effectively and how to access educational and clinical resources.
- High quality education includes assessing, planning, implementing, using behaviour change strategies and evaluating the outcomes of diabetes self-management education.
- Diabetes self-management education that integrates the clinical, behavioural and psychosocial aspects of diabetes self-management should be available and sustained.
- The public must be made aware of the need to recognise diabetes early and how to prevent diabetes and the serious health consequences of diabetes.
At Health Care Settings and Professional Levels
- All healthcare providers have an education role when caring for people with diabetes and should facilitate access to diabetes self-management education and on-going support.
- Diabetes education is best provided by an integrated interdisciplinary team including, at a minimum, the person with diabetes, a nurse, a dietitian and physician who are skilled in diabetes prevention and management as well as educational, behavioural and psychosocial strategies. Other team members (e.g., family members, pharmacists, behavioural scientists) can be included as needed.
- Effective educational, behavioural and psychosocial strategies should be included in health professional education programs and postgraduate curricula. It should also be included in continuing education programs about diabetes and implemented based on the IDF International Curriculum for Health Professional Education.
At the National Level
- For the prevention and treatment of diabetes to be successful through educational initiatives, governments and local, national and international health associations must promote opportunities to enhance education, provide financial support, and facilitate access to and public awareness of diabetes self-management education.
- Health Ministries need to integrate a comprehensive diabetes self-management education plan into their National Diabetes Programmes, understanding the population-level of risk and public health implications of the diabetes epidemic to their countries.
- Health Ministries at all levels need to recognise the importance of diabetes self-management education being acknowledged, promulgated, funded and delivered according to the IDF International Standards for Diabetes Education.
- Governments need to develop rigorous accreditation systems for diabetes education and training, complemented by regulatory frameworks developed in cooperation with health workers and their professional organizations.
- Health ministries need to strengthen the capacity of primary care to respond to the diabetes epidemic and improve access to diabetes self-management education.
Chodosh J, Morton SC, Mojica W, Maglione M, Suttorp MJ, Hilton L, Rhodes S, Shekelle P: Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med 143: 427-438, 2005
Duke, S-A. S., Colagiuri, S., Colagiuri, R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews. 1, 2009 DOI: 10.1002/14651858.CD005268
Duncan, I., Birkmeyer, C., Coughlin, S., Qijuan, (E)L., Sherr, D., & Boren, S. Assessing the value of diabetes education. The Diabetes Educator 35, 752-760 , 2009
Hawthorne, K., Robles Y., Cannings-John, R., & Edwards, A. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database of Systematic Reviews: Reviews 3, 2008 DOI: 10.1002/14651858.CD006424
International Diabetes Federation. IDF International Curriculum for Diabetes Health Professional Education, 2nd edn. Brussels, Belgium: International Diabetes Federation, 2008.
International Diabetes Federation. IDF International Standards for Diabetes Education, 3rd edn. Brussels, Belgium: International Diabetes Federation, 2009.
International Diabetes Federation. IDF Diabetes Atlas, 4th edn. Brussels, Belgium: International Diabetes Federation, 2009.
Norris SL, Lau J, Smith SJ, et al: Self-management education for adults with type 2 diabetes: A meta-analysis on the effect on glycemic control. Diabetes Care 25:1159¬1171, 2002
Renders CM, Valk GD, Griffin SJ, Wagner EH, et al: Interventions to improve the management of diabetes in primary care, outpatient, and community settings: A systematic review. Diabetes Care 24:1821-1833, 2001
Skovlund SE, Peyrot M, on behalf of the DAWN International Advisory Panel: The Diabetes Attitudes, Wishes, and Needs (DAWN) program: a new approach to improving outcomes of diabetes care. Diabetes Spectrum 18:136-142, 2005