In this article, we discuss strategies that people with diabetes can use every day to improve their health. Two important indicators of diabetes control are levels of glycated hemoglobin and blood glucose.

Doctors recommend that people using insulin check their glucose levels. The right frequency of these checks varies from person to person, but doctors usually recommend monitoring levels before and after meals, at bedtime, and before exercising.

People with diabetes who are not taking insulin should also check their blood sugar levels. Self-monitoring can provide information about the effects of dietary changes, physical activity, and medication on blood sugar levels. There are also continuous glucose monitors , which provide real-time information about blood sugar levels.

These automatically measure levels every 5 minutes through a small sensor inserted under the skin. When a person uses it appropriately, this type of technology can improve health outcomes.

A healthcare team can use at-home blood sugar readings to modify medication, nutrition , and self-management plans. It is important for people with diabetes or prediabetes to achieve and maintain a healthy weight.

When doctors closely monitor weight loss progress, a person more likely to achieve their goals. Research suggests that, among people with excess weight, modest, consistent weight loss can help manage type 2 diabetes and slow the rate at which prediabetes becomes diabetes.

They also noted that making dietary adjustments can lower glycated hemoglobin levels by 0. Nutrition therapy can also lead to improvements in the quality of life.

To facilitate these lifestyle adjustments, the ADA recommend consulting a registered dietitian with expertise in diabetes and weight management. Following a meal plan can be among the most challenging aspects of diabetes self-management.

Developing a plan with a registered dietitian who is knowledgeable about diabetes-specific nutrition can help. For some people, dietary changes alone are not enough to control blood sugar levels. Diabetes is a progressive disease, which means that it can worsen over time.

The ADA recommend using a combination of medication and nutrition therapy to reach blood sugar targets. The basis of meal planning involves portion control and favoring healthful foods. The diabetes plate method is one tool designed to help people control their calorie and carbohydrate intakes.

It involves mentally dividing the plate into three sections. Half of the plate should contain nonstarchy vegetables , a quarter can contain grain-based and starchy foods, and the remaining quarter should contain protein. Research has shown that exercise can help control blood sugar levels, reduce cardiovascular risk factors, promote weight loss, and improve well-being.

Researchers behind one study found that engaging in a structured exercise program for at least 8 weeks lowered glycated hemoglobin levels by an average of 0.

The ADA recommend exercising for at least 10 minutes per session and getting a total of at least 30 minutes of exercise on most days of the week. If a person exercises every day — or lets no more than 2 days pass between workouts — this may help reduce insulin resistance.

Members of a diabetes healthcare team can help develop and tailor an exercise plan that is safe and effective. In addition to exercising regularly, it is important to avoid spending long periods in a seated position. Breaking up sedentary periods every 30 minutes can help with controlling blood sugar.

The ADA advise all people with prediabetes or diabetes to avoid tobacco products, including e-cigarettes. People with diabetes who smoke have higher risks of cardiovascular disease , premature death, and diabetes complications , as well as less blood sugar control, compared with people who do not smoke.

If a person with diabetes does not take their medication as recommended by a doctor, it can lead to:. A diverse range of issues can contribute to medication nonadherence.

Some may relate to psychological, demographic, and social factors. Key elements can include the cost of treatment and difficulties with healthcare providers and the healthcare system. Doubt about the seriousness of diabetes and the effectiveness of a treatment plan can keep a person from taking their medication, and this can lead to complications.

Nonadherence seems to be more common among people who have chronic diseases with symptoms that are not obvious. Also, complex treatment plans can be challenging to follow. The quality of the patient-doctor relationship is often a key factor in nonadherence.

Likewise, it is important to raise concerns about diabetes treatment with the doctor, who can adjust the plan to help ensure that targets are being met and no complications develop. Researchers have estimated that the collective cost of medication nonadherence for diabetes, high blood pressure , and high cholesterol in the U.

Diabetes is not curable, but a person can help manage it at home. This often involves following nutrition and medication plans. A person with diabetes or prediabetes should also be physically active and maintain a healthy weight. A diabetes care team can help develop and tailor an exercise plan.

Blood glucose meters and continuous glucose monitors can help a person track their progress and see the effects of self-management techniques. Read this article in Spanish. Some people can control type 2 diabetes without medication. Learn what factors help maintain healthy blood sugar levels and when someone may need….

First, it is important to provide support at the right moments, i. when patients experience a need for support due to changes in their daily routines or changes in their health.

Two such moments were identified in our study: the period directly after diagnosis and at instances when problems occur glycaemic control deteriorates.

In addition to physical limitations, such as pain and fatigue, which further complicate self-management, deterioration of health can cause feelings of loss of control, and disappointment that previous self-management strategies have failed.

At such moments, patients might be more open to professional support to make sustainable behavioural change to maintain glycaemic control, and prevent — or at least postpone — the debilitating long-term complications of insufficient glycaemic control.

Second, it is important to provide support for relevant element s , i. By taking into account these specific topics when developing tools and strategies, patients will be better supported and therefore better able to successfully self-manage their disease.

An important strength of this research is its focus outside medical context. The research addressed the participant as a person with T2DM , not as a patient. This way, participants expressed they felt comfortable in sharing their experiences regarding T2DM and self-management.

Participants mentioned that within the medical context, they fear being criticised on the way they cope with the disease as health professionals mostly focus on HbA1c values and less on the T2DM-related issues of the patient. Patients were triggered to think about their personal experiences regarding management of and dealing with T2DM prior to the interview.

Therefore, the researcher could touch upon a deeper layer of information during the interviews. This study explored self-management and self-management support needs from the perspective of patients with T2DM rather than health professionals.

We focused particularly on the subgroup of patients with a recent diagnosis and stable, adequate glycaemic control, for whom self-management support may be a more cost-effective- and efficient treatment approach than provider-led care. However, patients who have not yet achieved stable, adequate glycaemic control may have different support needs, which should be explored in further detail.

Furthermore, the sample size was sufficient for the current qualitative study, as the aim was to get detailed insights into the experiences of individuals. Nevertheless, to assess the generalizability of findings, it is important to replicate the current study with a larger sample of patients.

This may require different methodology as well. However, this methodology is less applicable to theory and model building [ 24 ]. To develop an overall representative theory of self-management from the patient perspective other qualitative methods such as grounded theory may be more appropriate.

Moreover, 7 out of 10 participants were female. Finally, the outcomes of this research do not yet provide insight in what patients currently miss regarding support in self-management.

In order to further improve self-management support, additional research is needed on this aspect. Two moments have been indicated by this study which are most optimal for providing support; when recently diagnosed and when problems occur.

Future research can further explore the differences and similarities for providing support to people in these different moments. It is possible that different strategies for support would be best for each moment. This research focused on the needs of a specific patient group; T2DM with stable, adequate glycaemic control.

This population has not been researched before, and therefore new insights are generated for this target group specifically. Outcomes of this study can now be further explored in a broader view, but these first insights already indicate the need for a more individualised approach to support patients with T2DM and a stable, adequate glycaemic control.

The current guidelines for treatment of T2DM are too standardised and lack personalised support in specific aspects as dietary behaviour, exercising, scheduled rhythm, medication, being in control, and knowledge. The interview records and sensitising booklets generated and analysed during the current study are not publicly available to protect participant confidentiality, but are available from the corresponding author on reasonable request.

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Download references. The authors thank the patients who participated in this study. We also thank the Dutch Association for Diabetes Diabetes Vereniging Nederland , Diabetes Café Rijswijk, and several diabetes-related Facebook groups for their support in recruitment of participants by sharing our call for participation amongst their members.

Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands. Astrid N. Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Dorijn F. Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. You can also search for this author in PubMed Google Scholar.

AS, DH, TD, AE and MM designed the study. AS recruited participants and collected the data. AS conducted the analyses, which were reviewed by DH, TD, AE and MM.

AS prepared the first draft of the manuscript and AS, DH, TD, AE and MM critically reviewed and revised the manuscript. All authors read, contributed to, and approved the final version. Correspondence to Marijke Melles. All authors, A. van Smoorenburg, D. Hertroijs, T.

Dekkers, A. Elissen and M. Melles, declare that they have no conflict of interest. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.

Reprints and permissions. van Smoorenburg, A. et al. BMC Health Serv Res 19 , Download citation. Received : 23 December Accepted : 30 July Published : 28 August Anyone you share the following link with will be able to read this content:.

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Referrals may also be limited by unconscious or implicit bias, which perpetuates health care disparities and leads to therapeutic inertia. To address these barriers, providers can meet with those currently providing DSMES services in their area to better understand the benefits, access, and referral processes and to develop collaborative partnerships.

Participant-related barriers include logistical factors such as cost, timing, transportation, and medical status 34 , 77 , 78 , For those who avail themselves of DSMES services, few complete their planned education due to such factors.

Underutilization of services may be because of a lack of understanding or knowledge of the benefits, cultural factors, a desire to keep diabetes private due to perceived stigma and shame, lack of family support, and perceptions that the standard program did not meet their needs and is not relevant for their life, and the referring providers may not emphasize the value and benefits of initial and ongoing DSMES 34 , 79 , 80 , Health systems, clinical practices, people with diabetes, and those providing DSMES services can collaborate to identify solutions to the barriers to utilization of DSMES for the population they serve.

Creative and innovative solutions include offering a variety of DSMES options that meet individual needs within a population such as telehealth formats, coaching programs, just-in-time services, online resources, discussion groups, and intense programs for select groups, while maximizing community resources related to supporting healthy behaviors.

Credentialed DSMES programs as well as individual diabetes care and education specialists perform a comprehensive assessment of needs for each participant, including factors contributing to social determinants of health such as food access, financial means, health literacy and numeracy, social support systems, and health beliefs and attitudes.

This allows the diabetes care and education specialist to individualize a plan that meets the needs of the person with diabetes and provide referrals to resources that address those factors that may not be directly addressed in DSMES. It is best that all potential participants are not funneled into a set program; classes based on a person-centered curriculum designed to address social determinants of health and self-determined goal setting can meet the varied needs of each person.

Environment-related barriers include limited transportation services and inadequate offerings to meet the various cultural, language, and ethnic needs of the population. Additionally, these types of barriers include those related to social determinants of health—the economic, environmental, political, and social conditions in which one lives The health system may be limited in changing some of these conditions but needs to help each person navigate their situation to maximize their choices that affect their health.

It is important to recognize that some individuals are less likely to attend DSMES services, including those who are older, male, nonwhite, less educated, of lower socioeconomic status, and with clinically greater disease severity 84 , Further, studies support the importance of cultural considerations in achieving successful outcomes 84 — Solutions include exploring community resources to address factors that affect health behaviors, providing seamless referral and access to such programs, and offering flexible programing that is affordable and engages persons from many backgrounds and living situations.

The key is creating community-clinic partnerships that provide the right interventions, at the right time, in the right place, and using the right workforces Several common payment models and newer emerging models that reimburse for DSMES services are described below.

For a list of diabetes education codes that can be submitted for reimbursement, see Supplementary Table 2 Billing codes to maximize return on investment ROI in diabetes care and education. CMS has reimbursed diabetes education services billed as diabetes self-management training since 40 , In order to meet the requirements, DSMES services must adhere to National Standards for Diabetes Self-Management Education and Support and meet the billing provider requirements 40 , Ten hours are available for the first year of receiving this benefit and 2 h in subsequent years.

Any provider physician, nurse practitioner, PA who is the primary provider of diabetes treatment can make a referral; there is a copay to use these services.

CMS also reimburses for diabetes MNT, which expands access to needed education and support. Three hours are available the first year of receiving this benefit and 2 h are available in subsequent years. A physician can request additional MNT hours through an MNT referral that describes why more hours are needed, such as a change in diagnosis, medical condition, or treatment plan.

There are no specific limits set for additional hours. There is no copay or need to meet a Part B deductible in order to use these services. Many other payers also provide reimbursement for diabetes MNT Reimbursement by private payers is highly variable.

Many will match CMS guidelines, and those who recognize the immediate and longer-term cost savings associated with DSMES will expand coverage, sometimes with no copay. With the transition to value-based health care, organizations may receive financial returns if they meet specified quality performance measures.

Diabetes is typically part of a set of contracted quality measures impacting the payment model. Health systems should maximize the benefits of DSMES and factor them into the potential financial structure.

There are reimbursable billing codes available for remote monitoring of blood glucose and other health parameters that are related to diabetes. The use of devices that can monitor glucose, blood pressure, weight, and sleep allow the health care team to review the data, provide intervention, and recommend treatment changes remotely.

Sample referral forms that provide the information required by CMS and other payers for referral to DSMES and MNT are available along with reimbursement resources see Supplementary Tables 1 and 2. These or similar forms can be embedded into an electronic health record for easy referral.

Health systems and clinical organizations can maximize billing potential by facilitating the reimbursement process, ensuring all applicable codes are being utilized and submitted appropriately. This usually requires support from those who frequently work with health care codes such as staff in billing and compliance departments.

Shared medical appointments can be performed with DSMES and they are reimbursable medical visits. This Consensus Report is a resource for the entire health care team and describes the four critical times to refer to DSMES services with very specific recommendations for ensuring that all adults with diabetes receive these benefits.

Diabetes is a complex condition that requires the person with diabetes to make numerous daily decisions regarding their self-management.

DSMES delivered by qualified personnel using best practice methods has a profound effect on the ability to effectively undertake these responsibilities and is supported by strong evidence presented in this report. DSMES has a positive effect on clinical, psychosocial, and behavioral aspects of diabetes.

DSMES provides the foundation with ongoing support to promote achievement of personal goals and influence optimal outcomes. Despite proven benefits and demonstrated value of DSMES, the number of people with diabetes who are referred to and receive DSMES is significantly low 73 — Barriers will not disappear without intentional, holistic interventions recognizing the roles of the entire health care team, individuals with diabetes, and systems in overcoming issues of therapeutic inertia The increasing prevalence of type 2 diabetes requires accountability by all stakeholders to ensure these important services are available and utilized.

health care system has changed with increased attention on primary care, technology, and quality measures DSMES services that directly connect with primary care are effective in improving clinical, psychosocial, and behavioral outcomes 92 — A variety of culturally appropriate services need to be offered in a variety of settings, utilizing technology to facilitate access to DSMES services, support self-management decisions, and decrease therapeutic inertia.

This article is being published simultaneously in Diabetes Care DOI: The authors would like to acknowledge Mindy Saraco Managing Director, Scientific and Medical Affairs from the ADA for her help with the development of the Consensus Report and related meetings and presentations, as well as the ADA Professional Practice Committee for providing valuable review and feedback.

The authors acknowledge the invited peer reviewers who provided comments on an earlier draft of this report: Christine Beebe Quantumed Consulting, San Diego, CA , Anne L.

Burns American Pharmacists Association, Alexandria, VA , Amy Butts Wheeling Hospital at the Wellsburg Clinic, Wellsburg, PA , Susan Chiarito Mission Primary Care Clinic, Vicksburg, MS , Maria Duarte-Gardea The University of Texas at El Paso, El Paso, TX , Joy A.

Dugan Touro University California, Vallejo, CA , Paulina N. Duker Health Solutions Consultant, King of Prussia, PA , Lisa Hodgson Saratoga Hospital, Saratoga Springs, NY , Wahida Karmally Columbia University, New York, NY , Darlene Lawrence MedStar Health, Washington, DC , Anne Norman American Association of Nurse Practitioners, Austin, TX , Jim Owen American Pharmacists Association, Alexandria, VA , Diane Padden American Association of Nurse Practitioners, Austin, TX , Teresa Pearson Innovative Health Care Designs, LLC, Minneapolis, MN , Barb Schreiner Capella University, Pearland, TX , Eva M.

Vivian University of Wisconsin, Madison, WI , and Gretchen Youssef MedStar Health, Washington, DC. Duality of Interest. is on an advisory board of Eli Lilly. is the treasurer for the American Academy of Nurse Practitioners Certification Board of Commissioners and Vice President of the American Nurse Practitioner Foundation.

reports receiving an honorarium from ADA as an Education Recognition Program auditor and is a participant in a speakers bureau sponsored by Abbott Diabetes Care and Xeris. reports being a paid consultant of Diabetes — What to Know, Arkray, and DayTwo.

reports being a participant in speakers bureaus sponsored by Boehringer Ingelheim, Novo Nordisk, and Xeris. reports research grant funding from Becton Dickinson. has received honoraria from ADA.

No other potential conflicts of interest relevant to this article were reported. Author Contributions. All authors were responsible for drafting the article and revising it critically for important intellectual content.

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Figure 1. View large Download slide. The four critical times to provide and modify diabetes self-management education and support. Table 1 DSMES Consensus Report recommendations.

DSMES improves health outcomes, quality of life, and is cost effective, and people with diabetes deserve the right to DSMES services. Therefore, it is recommended that:.

Discuss with all persons with diabetes the benefits and value of initial and ongoing DSMES. Ensure coordination of the medical nutrition therapy plan with the overall management strategy, including the DSMES plan, medications, and physical activity on an ongoing basis.

Identify and address barriers affecting participation with DSMES services following referral. Expand awareness, access, and utilization of innovative and nontraditional DSMES services.

Facilitate reimbursement processes and other means of financial support in consideration of cost savings related to the benefits of DSMES services. View Large. Table 2 Key definitions. This process incorporates the needs, goals, and life experiences of the person with diabetes.

Note: Diabetes services and specialized providers and educators often provide both education and support. Yet on-going support from the primary health care team, family and friends, specialized home services, and the community are necessary to maximize implementation of needed self-management.

Education is used in the National Standards for Diabetes Self-Management Education and Support and more commonly used in practice. In the context of this article, the terms have the same meaning.

Clinical staff who qualify for this title may or may not be a CDCES or BC-ADM, yet all who hold the CDCES and BC-ADM certifications are diabetes care and education specialists. Note: The Certified Diabetes Educator CDE certification title is now CDCES. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems.

Benefits rating. Table 4 Summary of DSMES benefits to discuss with people with diabetes 15 — 28 , 30 — 33 , 40 , Table 7 Sample questions to guide a person-centered assessment Table 5 Factors that indicate referral to DSMES services is needed.

Table 6 Checklist for providing and modifying DSMES at four critical times. Four critical times. Table 8 Overview of MNT: an evidence-based application of the nutrition care process provided by the RDN 1 , 40 , 69 — Characteristics of MNT reducing A1C by 0.

If they are not confident in these areas it is difficult to take advantage of the full impact of nutrition therapy. Implementation and assessment will drive confidence 2.

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Researchers behind one study found that engaging in a structured exercise program for at least 8 weeks lowered glycated hemoglobin levels by an average of 0. The ADA recommend exercising for at least 10 minutes per session and getting a total of at least 30 minutes of exercise on most days of the week.

If a person exercises every day — or lets no more than 2 days pass between workouts — this may help reduce insulin resistance. Members of a diabetes healthcare team can help develop and tailor an exercise plan that is safe and effective.

In addition to exercising regularly, it is important to avoid spending long periods in a seated position. Breaking up sedentary periods every 30 minutes can help with controlling blood sugar. The ADA advise all people with prediabetes or diabetes to avoid tobacco products, including e-cigarettes.

People with diabetes who smoke have higher risks of cardiovascular disease , premature death, and diabetes complications , as well as less blood sugar control, compared with people who do not smoke. If a person with diabetes does not take their medication as recommended by a doctor, it can lead to:.

A diverse range of issues can contribute to medication nonadherence. Some may relate to psychological, demographic, and social factors. Key elements can include the cost of treatment and difficulties with healthcare providers and the healthcare system.

Doubt about the seriousness of diabetes and the effectiveness of a treatment plan can keep a person from taking their medication, and this can lead to complications. Nonadherence seems to be more common among people who have chronic diseases with symptoms that are not obvious.

Also, complex treatment plans can be challenging to follow. The quality of the patient-doctor relationship is often a key factor in nonadherence.

Likewise, it is important to raise concerns about diabetes treatment with the doctor, who can adjust the plan to help ensure that targets are being met and no complications develop. Researchers have estimated that the collective cost of medication nonadherence for diabetes, high blood pressure , and high cholesterol in the U.

Diabetes is not curable, but a person can help manage it at home. This often involves following nutrition and medication plans. A person with diabetes or prediabetes should also be physically active and maintain a healthy weight.

A diabetes care team can help develop and tailor an exercise plan. Blood glucose meters and continuous glucose monitors can help a person track their progress and see the effects of self-management techniques. Read this article in Spanish. Some people can control type 2 diabetes without medication.

Learn what factors help maintain healthy blood sugar levels and when someone may need…. Several factors increase a person's risk of developing type 2 diabetes. In this article, learn about how to prevent the condition by losing weight…. Diabetes management includes artificial insulin and lifestyle adjustments.

Read on to learn more. Although it is not always possible to prevent gestational diabetes, eating well and exercising regularly to achieve or maintain a healthy weight can…. What are some of the ways that diabetes may develop? Read on to learn more about the different types of diabetes and their potential causes.

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Medical News Today. Health Conditions Health Products Discover Tools Connect. Human Biology. Nervous system Cardiovascular system Respiratory system Digestive system Immune system. How to manage diabetes. Medically reviewed by Maria Prelipcean, M. Self-monitoring Healthy weight Nutrition Exercise Stop smoking Take medication regularly Takeaway While there is no cure for diabetes, with treatment and self-management strategies, a person can live a long and healthy life.

Share on Pinterest People can self-monitor their diabetes with a blood glucose meter. Maintain a healthy weight. Get good nutrition. Exercise regularly. Share on Pinterest Regular exercise may help control blood sugar levels.

Stop smoking. Take medication regularly. Share on Pinterest A person should take their diabetes medication as prescribed to prevent further complications. How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.