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

Version 4.0
ANNOTATION
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
Patients often hear of developments in diabetes or have specific questions regarding newer treatment modalities.
They may also decide they want to improve their glycemic control or their life style.
I. Provide Materials or Patient Reference List or Refer As Needed
OBJECTIVE
Provide additional information in response to the patient’s questions about new treatments or advanced selfmanagement
skills that have been communicated from other persons with diabetes or the media.
ANNOTATION
If the patient requests additional information it may not be essential for the caregiver to intervene professionally or
refer to a specialist.
J. Methods for Providing DSME
BACKGROND
There is a wide variety of means to provide self-management education and to promote self-management behaviors.
Choose the method most consistent with the patient, clinical, and organizational contexts.
RECOMMENDATIONS
The following overriding principles were based on existing evidence used to guide the review and revision of the
DSME Standards:
1. Diabetes education is effective for improving clinical outcomes and quality of life, at least in the shortterm.
2. DSME has evolved from primarily didactic presentations to more theoretically based empowerment
models.
3. There is no one “best” education program or approach; however, programs incorporating behavioral and
psychosocial strategies demonstrate improved outcomes. Additional studies show that culturally and age
appropriate programs improve outcomes and that group education is effective.
4. Ongoing support is critical to sustain progress made by participants during the DSME program.
5. Behavioral goal-setting is an effective strategy to support self-management behaviors.
DISCUSSION
Treatment Adherence
Vermeire et al., (2005) reviewed 21 studies assessing interventions aimed at improving adherence to treatment
recommendations, not to diet or exercise recommendations, in people with Type 2 diabetes in primary care,
outpatient, community and home, and hospital settings. Adherence measurement tools and outcomes evaluated in
these studies were heterogeneous. Nurse-led interventions, home aids, diabetes education, pharmacy led
interventions, adaptation of dosing, and frequency of medication taking showed a small effect on a variety of
outcomes including HbA 1 c. They concluded that the current efforts to facilitate adherence to treatment
recommendations of people with type 2 diabetes demonstrated neither significant effects nor harm. Other reviews
with different selection criteria have been somewhat more positive.
Telehealth/Electronics:
A wide variety of approaches have been used in delivery and support of computer-aided diabetes education and selfmanagement
programs. In a systematic review of 219 RCTs involving 3167 patients (92% adults), Austin Boren et
al., (2006) identified three computerized approaches in the trials reviewed: Computerized touch screen assessment
and instruction, computerized assessment with individualized counseling or feedback, and games or simulation;
methods used in the control groups were variable. Outcome measures were grouped according to DSME core
outcome measures: learning, behavior change, clinical improvement, and improved health status. Results
Module M: Self-management Page 114