DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
D. Determine Patient’s Extent of Knowledge and Self-Management Skill Deficit Based on Treatment
Goals
OBJECTIVE
Determine the education and skills enhancement needed to enable the patient to self-manage.
RECOMMENDATIONS
1. Assessment of the following factors should be completed to determine the extent of the patient’s
educational and skills deficit and his/her ability for self-management: knowledge of the diabetes disease
process, treatment goals, management skills, cultural influences, health beliefs/behavior, attitudes,
socioeconomic factors and barriers.
2. Documentation of the patient’s learning needs, abilities including physical and cognitive limitations, or
language barriers, preferences, cultural and religious practices, emotional barriers, health literacy and
numeracy, desire and motivation to learn and/or change, and the financial implications of care choices.
3. Assessment and documentation of the patient’s understanding of education.
DISCUSSION
Diabetes self-management is an active, ongoing process that will change as patients’ situations change. A useful
framework for patient centered diabetes education includes the following self-care behaviors:
• Eating healthy foods
• Getting 30 to 60 minutes of physical activity on most days of the week
• Monitoring
• Taking medications
• Solving Problems
• Reducing risks
• Learning to cope with stress
E. Does the Patient Need Referral for Further Education or Intervention?
OBJECTIVE
Identify patients who are at high-risk for diabetes complications or in need of further educational intervention.
BACKGROUND
Because primary care appointments frequently do not provide adequate time to address background and educational
issues, referrals or additional appointments to address the patient's needs may be required. As patients often present
with complex combinations of educational, treatment, coordination of care, psychosocial, and/or financial issues,
they may benefit from a more in-depth, risk-focused education or intervention. When appropriate, refer for followup
education in a comprehensive DSME program or to a provider/specialist to evaluate and address additional
needs. Medication adherence should be addressed if patients are not meeting goals.
RECOMMENDATIONS
1. Conditions that may warrant risk-focused intervention include:
• Markedly or persistently elevated HbA 1 c (For appropriate HbA 1 c target based on risk stratification, see
Module G: Table G-1).
• Progression to ESRD ( e.g., stage 3-5 CKD)
• Lower extremity complications
• Pregnancy, or planned pregnancy, or woman of child bearing age
• Impaired vision
• Severe psychosocial or economic barriers
• Cognitive impairment or frailty
• Intensive insulin therapy
Module M: Self-management Page 111