What Is Deterring DSME Service? Perspectives of Diabetes Educators

Diabetes self-management education and support (DSMES) is considered a cornerstone of diabetes mellitus (DM) care, yet numbers of people receiving DSMES is shockingly low. In response, new delivery models are being implemented in diverse practice sites to improve referral processes and participation. The study purpose was to gain insights from diabetes educators (DEs) providing DSME in a variety of settings to identify current perspectives on barriers and solutions. Thirty-five DEs from inpatient, outpatient, insurer-based, primary care (PC), specialty practices, and telemedicine models, participated in a focus group facilitated by a skilled moderator. DEs also completed worksheets to get feedback and record views they did not have the opportunity to share in the group. The discussion was transcribed verbatim, and responses from worksheets were coded by topic. Both transcript and topic codes were summarized to capture dominant themes. DEs expressed feelings of failure in meeting patient needs too late in the course of DM and that primary prevention be considered a major responsibility. DEs perceived that providers underappreciate DSME services (e.g., think it is limited to nutrition and lifestyle education), consider DSME reserved for complex patients (e.g., comorbidities), and use DSME as punishment for patients with uncontrolled DM (e.g., poor diet). Although DEs in models with direct provider contact had similar sentiments, they found building trust and first hand demonstration of their unique skill set were effective means for changing provider perceptions. For patients, advertising campaigns were recommended to inform patients about the role of the DE and benefits of DSME, particularly at critical and meaningful time points (e.g., starting insulin, disruption in social support).

In summary, findings highlight persistent barriers, namely negative connotations surrounding DSME and suggest a need for a paradigm shift that supports positive communication to garner appeal for this effective service.