New diabetes support standards

by Robin Kemp

The American Diabetes Association has announced new national standards for diabetes self-care.

According to an article published Friday in the journal Diabetes Care, the National Standards for Diabetes Self-Management Education and Support urge health care teams “to acknowledge and address the emotional burden of living with and managing diabetes—diabetes distress—and to consider the multitude of daily demands and decisions required of PWD [people with diabetes], their families, and caregivers.”

While aimed at medical and support professionals, the article contains useful information for diabetics who want to know what to look for in a support system.

Diabetes affects Clayton County

For Clayton County residents, car-dependent neighborhoods, limited public transit (although that is changing), lack of sidewalks and bike paths, COVID-19, technology creep, low income, and food deserts can make it harder for people with diabetes to manage the disease.

At least 26,203 people in Clayton County have been diagnosed with diabetes, according to the U.S. Diabetes Surveillance System.

That’s about half the number of Clayton County residents diagnosed with COVID-19 since the pandemic started–or nearly one of every ten residents. And the problem is getting worse.

The article notes that diabetes is on the rise among children and teenagers nationwide: 34.2 million people live with the disease, and 88 million more are at risk of developing Type 2 (insulin-dependent) diabetes.

All of them face “devastating complications” that come from having too much sugar in their blood.

According to the Cleveland Clinic, this happens when the pancreas doesn’t make enough insulin or when the body can’t use the insulin

Some complications include vision problems, extreme hunger and thirst, rapid heartbeat, wounds that don’t heal, kidney disease, amputation, and blindness.

That’s why health care workers, dietitians, and doctors teach diabetic patients how to self-manage the disease. Monitoring food intake, blood sugar levels, exercise, and symptoms, as well as learning how to give oneself insulin injections, are important parts of diabetic self-care.

For example, “Diabetes Community Care Coordinator team members”–which can include everyone from physical therapists to doctors–“can provide basic instruction, reinforce self-management skills, support behavior change, facilitate group discussion, provide psychosocial support, and provide on-going self-management support.”

Diabetes can be stressful

But the strict attention to basic daily functions, danger of complications, and fear of rejection can lead to “distress, life stress, and clinical depression,” the article notes.

Craig Perry recently shared his own story about the stress surrounding a recent diabetic attack he had suffered on a trip to the grocery store. Adding to the stress of his actual medical emergency, he said, were concerns about race, how he might be perceived by the police or strangers, and the case of Kenneth Herring, who was fatally shot while apparently trying to drive himself to Southern Regional Medical Center.

The new standards “encourage the DSMES team to acknowledge and address the emotional burden of living with and managing diabetes—diabetes distress—and to consider the multitude of daily demands and decisions required of PWD, their families, and caregivers.”

In addition, the new standards “define timely, evidence-based, quality DSMES services that meet or exceed the Centers for Medicare & Medicaid Services quality standards. While the acronym DSMES is used in the literature and in current practice, it is important to note that the term diabetes self-management training (DSMT) is exclusively used when describing the Medicare benefit for diabetes self-management…. The DSMT benefit has reimbursement guidelines outside of the National Standards.”

According to the article, “less than 5% of Medicare beneficiaries with diabetes and 6.8% of privately insured people with diagnosed diabetes have utilized DSMES services….DSMES can help people with diabetes lower their A1C “by at least 0.6%, as much as many diabetes medications—however with no side effects.”

What to look for in a DSMES program

A good DSMES program covers:

The article calls for cutting administrative tasks and relying less on “structured programs”–instead, teaching diabetics how to take greater control of managing the disease and providing healthy coping strategies for diabetes-related stress. COVID-19 has heightened the need for patient-centered strategies, and the study notes that “one-on-one audio and audio-video contact can also improve outcomes similar to in-person DSMES.” The point is to give people with diabetes choices that best fit their own situations.

How do I find a diabetes education program?

The American Diabetes Association recommends that you ask for a diabetes education program referral if:

• You’ve just been diagnosed
• If you have diabetes but have never taken a diabetes education program
• Once every year
• When you have problems managing your diabetes due to
  • changes in access to food or money
  • emotional factors like stress or anxiety
  • new health issues
  • starting a new medication like insulin or steroids
  • changes in your living situation, like divorce or a death in the family
  • new insurance coverage

Ask your doctor to refer you to a diabetes education program. If you don’t have a doctor, contact the Clayton County Health District at (678) 610-7199.

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Read the full article

Visit the American Diabetes Association at diabetes.org for helpful information on living with diabetes.

Learn about diabetes and pre-diabetes from the CDC.

Check out the Diabetes Association of Atlanta for free diabetes prevention and management classes on the fourth Wednesday of each month, as well as other services and resources. Register online at diabetesatlanta.org/wednesday or call (404) 527-7180. (There’s a love healthy cooking demonstration Friday, Oct. 27 at noon.)

If you need help paying for insulin or diabetes medication, visit https://insulinhelp.org/

Write this number in your disaster kit: If you or a loved one has diabetes and are in a storm-affected area, call 1-800-DIABETES (800-342-2383) Monday through Friday from 9 a.m to 7 p.m. Eastern. See https://diabetes.org/resources/disaster-relief for a diabetes preparedness plan and more information about managing your diabetes during an emergency.

Recursos en español: https://diabetes.org/espanol