Self-Management Education Chapter 7 Helen Jones, Lori D Berard, Gail MacNeill, Dana Whitham, Catherine Yu Canadian Diabetes Association 2013 Clinical Practice

Self-Management Education

Chapter 7

Helen Jones, Lori D Berard, Gail MacNeill,

Dana Whitham, Catherine Yu

Canadian Diabetes Association 2013 Clinical Practice Guidelines

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

Self-Management Education (SME)

A systematic intervention that involves

active patient participation

in self-monitoring and/or

decision-making


Key Points

1. Diabetes self-management education (SME)

improves health parameters

2. SME should teach behaviours as well as

knowledge and technical/problem-solving skills

3. SME should be patient-centred, tailored to the

individual, use a variety of teaching methods and be

regularly reinforced

2013


Knowledge is Power

• Empowering patients through self-management education improves:

– A1C– Quality of life– Weight loss– Cardiovascular fitness


Basic Knowledge and Skills

• Monitoring health parameters (including self-monitoring blood glucose [SMBG])

• Healthy eating• Physical activity• Pharmacotherapy and medication adjustment• Hypo-/hyperglycemia prevention/management• Prevention and surveillance of complications • Problem identification and solving


Not Just Knowledge: Work on Behaviour!

• Cognitive-behavioural interventions improve self-management and metabolic outcomes

• They may involve:– Cognitive re-structuring– Problem-solving– Cognitive-behavioural therapy (CBT)– Stress management– Goal setting– Relaxation


How should SME be delivered?

Interdisciplinary team and/or peer-education

Personal contact with healthcare workers

Combination of group and individual sessions

Combination of didactic and interactive


SME must be Reinforced Regularly

• Booking follow up sessions• Patient-educator contact between sessions• Automated or technology-based reminders


Diabetes Education… Improved!

• Collaborative and interactive• Patient-centred and individualized• Knowledge and technical skills, but also problem-

solving skills• Repeatedly reinforced• Educational, psychological, and behavioural

interventions and a variety of teaching methods


Steps to SuccessEvaluate and

support long-term self-management

Implement a realistic plan for skills training

Collaborate on decisions and goals for action

Make informed consideration of self-care options

Assess & identify personal self-care needs


Recommendation 1

1. People with diabetes should be offered timely

diabetes education that is tailored to enhance

self-care practices and behaviours [Grade A, Level 1A ].


Recommendation 2

2. All people with diabetes who are able should be

taught how to self-manage their diabetes [Grade A, Level

1A].


Recommendation 3

3. SME that incorporates cognitive-behavioural

educational interventions, such as problem-solving,

goal setting, and self-monitoring of health

parameters, should be implemented for individuals

with diabetes [Grade B, Level 2].


Recommendation 4

4. Interventions that increase patient participation

and collaboration in healthcare decision-making,

should be used by providers [Grade B, Level 2].


Recommendation 5

5. For people with type 2 diabetes, SME interventions

should be offered in small-group and/or one-on-

one settings, since both may be effective [Grade A, Level

1A].


Recommendation 6

6. In both type 1 and 2 diabetes, interventions that

target families’ ability to cope with stress or

diabetes-related conflict should be included in

educational interventions when indicated [Grade B, Level

2].


Recommendation 7

7. Technologically based home blood glucose

monitoring systems may be integrated into SME

interventions in order to improve glycemic control

[Grade C, Level 3].

2013


Recommendation 8

8. Culturally-appropriate SME, which may include

peer or lay educators, may be used to increase

diabetes-related knowledge, self-care behaviours,

and decrease A1C [Grade B, Level 2].

2013


Recommendation 9

9. Adding literacy and numeracy sensitive materials

to a comprehensive diabetes management and

education program may be used to improve

knowledge, self-efficacy, and A1C outcomes for

patients with low literacy [Grade C, Level 3].

2013


CDA Clinical Practice Guidelines

http://guidelines.diabetes.ca – for professionals

1-800-BANTING (226-8464)

http://diabetes.ca – for patients

http://guidelines.diabetes.ca/

http://diabetes.ca/

Documents

Self-Management Education Chapter 7 Helen Jones, Lori D Berard, Gail MacNeill, Dana Whitham, Catherine Yu Canadian Diabetes Association 2013 Clinical Practice