2022 National Standards for Diabetes Self-Management Education and Support
Authors: Jody Davis, Amy Hess Fischl, Joni Beck, Lillian Browning, Amy Carter, Jo Ellen Condon, Michelle Dennison, Terri Francis, Peter J. Hughes, Stephen Jaime, Ka Hei Karen Lau, Teresa McArthur, Karen McAvoy, Michelle Magee, Olivia Newby, Stephen W. Ponder, Uzma Quraishi, Kelly Rawlings, Julia Socke, Michelle Stancil, Sacha Uelmen, Suzanne Villalobos
Journal: Diabetes Care (2022)

By the most recent estimates, 34.2 million people in the U.S. have diabetes (1).At the same time, 88 million people are at increased risk for developing type 2 diabetes.The U.S. also sees an increasing prevalence of both type 1 and type 2 diabetes in children and adolescents (2).Thus, more than 122 million Americans are at risk for developing devastating complications associated with chronic hyperglycemia (1).Diabetes self-management education and support (DSMES) is a critical element of care for all people with diabetes (PWD)."The purpose of DSMES is to give PWD the knowledge, skills, and confidence to accept responsibility for their self-management.This includes collaborating with their healthcare team, making informed decisions, solving problems, developing personal goals and action plans, and coping with emotions and life stresses" (3).DSMES interventions include activities that support PWD to implement and sustain the self-management behaviors and strategies to improve diabetes and related cardiometabolic conditions and quality of life on an ongoing basis.Despite progress in diabetes treatment modalities, glycemic and cardiometabolic outcomes continue to decline in the U.S. (4).Now, more than ever, the provision of DSMES is a vital component of the full treatment for diabetes.PWD are at risk for distress, life stress, and clinical depression, which can lead to poor health outcomes (5).The National Standards for Diabetes Self-Management Education and Support (hereinafter referred to as the National 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 (6-9).To further illustrate, PWD generally visit their primary care physician (PCP)/other qualified healthcare professional two to four times per year, where the average appointment lasts 15-20 min and addresses four or more health conditions (10).This equates to the person with diabetes (PWD) spending less than 1% of their life with their healthcare professionals (10).Therefore, diabetes management decisions largely fall on PWD and/or caregivers, further highlighting the importance of increasing access to DSMES services that support ongoing self-management and decision making.The National 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 Medicare benefit for DSMT was established by the Balanced Budget Act (BBA) of 1997 with a final rule (65 FR 83130) published on 29 December 2000, implementing the BBA provisions and DSMT regulations (Title 42 of the Code of Federal Regulation sections 410.140 to 410.146).The DSMT benefit has reimbursement guidelines outside of the National Standards.