Diabetes Self-Management Education: A Saga of Angels and Demons

Abstract

As American Diabetes Association (ADA) President, Health Care & Education this past year, I have enjoyed a unique opportunity to interact with diabetes educators representing a variety of different practice settings from all across the United States, as well as from many different countries in other parts of the world. As my year unfolded, I began noticing some common issues and concerns that kept coming up. As a result, I have spent quite a bit of time reflecting on the role of diabetes self-management education (DSME) today in the treatment of diabetes and particularly on three key issues that I see challenging our ability to deliver quality DSME. The prevalence of type 2 diabetes has virtually exploded over the past 20 years. The Centers for Disease Control and Prevention (CDC) estimates that the incidence of diabetes is 1.3 million new cases annually.1 Many of us have seen the CDC's colored maps.2 These maps graphically illustrate the notion that our health care delivery system may be becoming overloaded from the challenge of treating > 18 million Americans with diabetes, to say nothing of the 41 million with prediabetes.1 Today, we have access to more and better pharmaceuticals and newer technologies than ever before to aid in the effective medical management of diabetes. So how well are our patients doing? Are Americans with diabetes wining or losing their war on diabetes? One well-regarded national measure of success is the National Committee on Quality Assurance (NCQA) Health Plan Employer Data and Information Set (HEDIS). This quality management tool is used by many health care professionals and policy makers to evaluate the quality of performance in key areas such as diabetes management. The NCQA 2004 State of Health Care Quality Report cites HEDIS data showing that 15% of diabetes patients covered …