September 15, 2016

Act Now to Improve Access to DSME

Fall ColorsIt's September and here's my fall 2016 AADE President's letter:

If you live in a part of the country where the leaves change color, as I do, enjoy the yellows, reds and oranges. If not, enjoy your warm climate as the rest of us layer up.  

With my goal to familiarize you with the six key strategies in AADE’s 2016-2018 Strategic Plan this year, this one, the fifth, is: Advocate for improved access to diabetes self-management education and support. 

This strategy is core to the work many AADE members engage in directly or indirectly. When your AADE Board of Directors used the word “improved” we used it to communicate the need to improve the numbers of people who have access to, receive and clinically benefit from diabetes self-management education and support (DSMES). We were also communicating the need to improve, or maximize, the effective (ways) to implement DSMES.  

But, to our harsh reality. It’s unfortunate to report the abysmal utilization of DSMES. From a review of Medicare claims data, Strawbridge et al. reported only five percent of Medicare beneficiaries receive DSMES1, a figure recently cited in the Centers for Medicare & Medicaid Services (CMS) Proposed 2017 Rule for Physician Payment (which includes proposed changes to DSMES).2 And research by CDC and AADE report just under seven percent utilization in a population of individuals within their first year of developing diabetes.3  

These statistics are disheartening particularly because we know, and research from the AADE systematic review shows, DSMES can lower A1C 0.6% and offer additional clinical benefits.4 Our review also reveals that many people could benefit from more than the Medicare allotted 10 hours of DSMES4 within the first year of diagnosis of diabetes and 2 hours per year in ensuing years. I appreciate that we now, due to dedication of several of our colleagues, have the Joint Position Statement on DSMES in Type 2 Diabetes which details the four junctures during a person’s life with diabetes when their need for DSMES should be assessed and provided.5

Now, to our exciting and expansive future. One way to improve access to DSMES is to use the increasingly wide acceptance of telehealth to deliver services,6 a vast array of technologies and/or accessible environments, like pharmacies, supermarkets, and strip mall locations, have the potential to make DSMES (and potentially Diabetes Prevention Program (DPP)) services available where, how and when people want them. Check out on the opposite page how the AADE Change Champions I’m profiling use telehealth to reach people across the rural state of Nevada and to deliver DSMES in accessible locations, like an independent pharmacy. 

Finally, to that all important word advocate. Until September 6 you have a golden once-in-a-lifetime opportunity to offer your input in the regulatory process. You can provide your comments to the CMS Proposed 2017 Rule for Physician Payment, which includes proposed changes to DSMES and proposed regulations to implement the DPP yearlong program.2 As an organization AADE is fully engaged in providing input on both of the Medicare benefits, but the more comments CMS receives the better.

Other ways you can advocate to increase the awareness of diabetes educators and DSMES and DPP services is among primary care providers. We’ve got to get them to increase their referrals to these services. We also need to raise awareness about us and our services among people with, affect by and at risk for diabetes. Let’s work to get them ALL asking for DSMES. And last, but not least, is advocating about your work and services with your legislators.  

Join me in constantly and consistently raising our voices about the value we bring to healthcare systems and to drive those in need of our services to them. Now is our time!


1.Strawbridge L, et al: Use of medicare’s diabetes self-management training benefit. Health Education and Behavior. 2015; 42: 530-538. 

2.Centers for Medicare & Medicaid Services (CMS) Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year (CY) 2017. Accessed on July 12, 2016. (DSMES, page 199, DPP page 621)

3.Li R, et al.: Diabetes self-management education/training among privately insured persons with newly diagnosed diabetes US 2011-2012. MWR 2014;63:1045-1049.

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; 99(6):926-43.

5.AADE, ADA, Academy Nutrition and Dietetics. Joint Position Statement: Diabetes Self-management Education and Support in Type 2 Diabetes. The Diabetes Educator. 2015;41:417-430.

6.WEBINAR: Using Telehealth to Deliver Diabetes Self-Management Education (accredited by the American Association of Diabetes Educators (AADE) and presented by the Montana & Florida Diabetes Programs and the Health Resources & Services Administration’s (HRSA’s) Office of Regional Operations) . Accessed on July 12, 2016.