![]() See Table 5.1 for specific nutrition recommendations. MNT delivered by an RD is associated with A1C decreases of 1.0–1.9% for people with type 1 diabetes ( 50) and 0.3–2% for people with type 2 diabetes ( 50). All individuals with diabetes should be offered a referral for individualized MNT provided by a registered dietitian (RD) who is knowledgeable and skilled in providing diabetes-specific MNT ( 49). Nutrition therapy has an integral role in overall diabetes management, and each person with diabetes should be actively engaged in education, self-management, and treatment planning with his or her health care team, including the collaborative development of an individualized eating plan ( 35, 48). There is not a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized. Additionally, there is growing evidence for the role of community health workers ( 36, 37), as well as peer ( 36– 40) and lay leaders ( 41), in providing ongoing support.įor many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat and following a meal plan. Certification as a certified diabetes educator (CDE) or board certified-advanced diabetes management (BC-ADM) certification demonstrates specialized training and mastery of a specific body of knowledge ( 4). Members of the DSMES team should have specialized clinical knowledge in diabetes and behavior change principles. Current research supports nurses, dietitians, and pharmacists as providers of DSMES who may also develop curriculum ( 33– 35). Technology-enabled diabetes self-management solutions improve A1C most effectively when there is two-way communication between the patient and the health care team, individualized feedback, use of patient-generated health data, and education ( 32). ![]() Emerging evidence demonstrates the benefit of Internet-based DSMES services for diabetes prevention and the management of type 2 diabetes ( 30– 32). Individual and group approaches are effective ( 13, 28, 29), with a slight benefit realized by those who engage in both ( 11). Better outcomes were reported for DSMES interventions that were over 10 h in total duration ( 11), included ongoing support ( 5, 21), were culturally ( 22, 23) and age appropriate ( 24, 25), were tailored to individual needs and preferences, and addressed psychosocial issues and incorporated behavioral strategies ( 6, 16, 26, 27). Studies have found that DSMES is associated with improved diabetes knowledge and self-care behaviors ( 8), lower A1C ( 7, 9– 11), lower self-reported weight ( 12, 13), improved quality of life ( 10, 14), reduced all-cause mortality risk ( 15), healthy coping ( 16, 17), and reduced health care costs ( 18– 20). Aĥ.5 Because diabetes self-management education and support can improve outcomes and reduce costs B, adequate reimbursement by third-party payers is recommended. Cĥ.4 Diabetes self-management education and support should be patient centered, may be given in group or individual settings or using technology, and should be communicated with the entire diabetes care team. Eĥ.3 Clinical outcomes, health status, and quality of life are key goals of diabetes self-management education and support that should be measured as part of routine care. Bĥ.2 There are four critical times to evaluate the need for diabetes self-management education and support: at diagnosis, annually, when complicating factors arise, and when transitions in care occur. Diabetes self-management support is additionally recommended to assist with implementing and sustaining skills and behaviors needed for ongoing self-management. 5.1 In accordance with the national standards for diabetes self-management education and support, all people with diabetes should participate in diabetes self-management education to facilitate the knowledge, skills, and ability necessary for diabetes self-care.
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