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

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Version 4.0 VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus Compared to non-diabetes specialist nurses, there are no studies to support that diabetes education provided by certified diabetes educators improves outcomes. Community Health Workers Community health worker (CHW) characteristics are often poorly reported (CHWs included in studies all were members of the local community and of the same ethnicity/race as the study subjects). Diabetes programs include community health workers as team members in a variety of roles. There are some preliminary data demonstrating improvements in participant knowledge and behavior as well as participant satisfaction with CHW contacts. Effects on physiological measures and health behaviors were mixed. Data on health related quality of life, healthcare utilization and economic efficiency were sparse. Some of the successful interventions were multi-component and some were limited primarily or exclusively to the CHW (Norris et al., 2006). EVIDENCE TABLE Recommendation Sources LE QE SR 1 Education provided in either Rickheim et al., 2002 I Fair B individual or group settings. 2 Telehealth/electronic interventions Austin Boren S et al., 2006 I Fair B Barlow et al., 2007 Balas et al., 2004 3 Group visits Deakin et al., 2005 I Fair B Jaber et al., 2006 Sadur et al.,1999 Wagner et al., 2001 Trento et al., 2001 Kirsh et al., 2007 van Dam et al., 2005 § 4 Nurse interventions Loveman et al., 2003 § I Fair B Marrero et al., 1995 Piette et al., 2000 Thompson et al., 1999 5 Pharmacist interventions Machado et al., 2007 I Fair B Wubben & Vivian, 2008 LE-Level of Evidence; QE = Quality of Evidence; SR = Strength of Recommendation §=Systematic Review (see Appendix A) Module M: Self-management Page 117
Version 4.0 APPENDIX M-1 Core Competencies (Survival Skills) for Patients with Diabetes VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus The following core competencies are not substitutes for diabetes self-management education (DSME) or medical nutrition therapy. It is preferable for patients to participate in a comprehensive interdisciplinary DSME program. If such a program is not available or if the patient is unwilling to attend or is newly diagnosed and awaiting enrollment in such a program, core competency (survival skills) education should be given. Core competency education should cover at least the following topics: • Hyperglycemia • Hypoglycemia (if applicable) • Medication education (including insulin administration, if applicable) • Self-monitoring of blood glucose • Basic dietary guidelines • Sick day management • When to seek further treatment and/or medical advice. MEDICATION EDUCATION Education regarding diabetes medications should include (as appropriate): • Names of medications • Action & duration of medications • Times & mode of administration • Possible side effects • Drug/food interactions SELF-MONITORING OF BLOOD GLUCOSE Individualized education regarding self-monitoring of blood glucose should include: • Indications and frequency of routine monitoring, including target glycemic range • Indications for more frequent monitoring • Preparation and use of monitoring devices, including puncture devices • Recording and analysis of results • Collaborating with providers in applying results • Actions to take, whom to call when results are out of target range Module M: Self-management Page 118
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