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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Accessibility of diabetes education in the United States: barriers, policy implications, and the road ahead.

Anna Tharakan1,2, Eugenia McPeek Hinz3, Emelia Zhu4

  • 1Department of Undergraduate Studies, Duke University, Durham, NC 27710, United States.

Health Affairs Scholar
|August 29, 2024
PubMed
Summary

Diabetes Self-Management Education and Support (DSMES) programs are underutilized due to low referral and completion rates. Barriers exist at patient, provider, and system levels, requiring technology, training, and policy changes for improved diabetes care.

Keywords:
diabetesdiabetes educationdiabetes policydiabetes self-management (DSMT)prevention programs

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Area of Science:

  • Endocrinology
  • Public Health
  • Health Services Research

Background:

  • Diabetes Self-Management Education and Support (DSMES) programs are crucial for improving health outcomes in individuals with diabetes.
  • Despite proven benefits, DSMES programs remain underutilized in clinical practice.

Purpose of the Study:

  • To examine referral and attendance rates for DSMES programs at an academic medical center.
  • To identify barriers hindering DSMES program utilization.
  • To propose policy and system-level solutions to enhance DSMES access and effectiveness.

Main Methods:

  • Retrospective analysis of referral and completion rates for DSMES at an academic medical center.
  • Qualitative assessment of barriers at patient, provider, and health system levels.
  • Review of current technology platforms, training, scheduling, and reimbursement policies.

Main Results:

  • A 10% referral rate and 37% completion rate were observed for DSMES among eligible patients.
  • Identified barriers include lack of provider/patient awareness, inadequate technology prioritization, inefficient scheduling, and restrictive Medicare reimbursement.
  • Significant wait times and limited capacity for Diabetes Care and Education Specialists were noted.

Conclusions:

  • Systemic changes are needed to increase DSMES utilization.
  • Recommendations include enhancing technology platforms, improving provider/patient education, optimizing scheduling, and reforming reimbursement policies.
  • Policy alterations can personalize and better support diabetes care through expanded DSMES access.