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Category: Diabetes

The Co-Occurrence of Diabetes & Heart Disease

The number of people living with diabetes has tripled since 2000, leading to enormous financial ramifications: the global cost of the disease is $850 billion each year. The latest estimates from the International Diabetes Federation indicate that one in 11 adults worldwide have diabetes; most have type 2 diabetes, which is strongly linked to obesity and lack of exercise. There is a strong link between type 2 diabetes and cardiovascular disease, as people with diabetes are more than twice as likely to develop cardiovascular disease and lower life expectancy.

According to a study presented at the American Heart Association’s Scientific Sessions last week, data indicates that children and young adults with diabetes mellitus have a fivefold increased risk of all-cause mortality, and a sevenfold increased risk of sudden cardiac death, compared with age-matched individuals without diabetes. The findings highlight the critical need for continuous cardiovascular risk monitoring and management in young people with DM.

Less than half of those diagnosed with diabetes are aware that the diseases places them at a much higher risk for cardiovascular disease complications; the lack of awareness prevents addressing risks and improving health–often leading to preventable deaths. Ken Thorpe, Chairman of the Partnership to Fight Chronic Disease, urges education and the power of prevention. “We must do better to diagnose, treat, and prevent chronic conditions like diabetes and cardiovascular diseases, and one of the first and most important actions we can take is to raise awareness among patients, providers, and policymakers of the alarming co-existence of these two debilitating conditions, and what can be done to avoid them in the first place.”

The total number of diabetes worldwide is now 451 million, and is expected to reach 693 million by 2045 if current trends continue.

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New ADA/AADE Standards Combine Diabetes Education & Support

New recommendations from the American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) combine the concepts of diabetes self-management education and support for the first time.


The document, published in both Diabetes Care and the Diabetes Educator, is an update from 2014, when guidelines for diabetes self-management support and diabetes self-management education had been outlined separately.

Today, the view is that “diabetes self-management education and support (DSMES) is a critical element of care for all people with diabetes and those at risk for developing the condition,” write task force co-chairs and certified diabetes educators Joni Beck, PharmD, and Deborah A Greenwood, PhD, RN, and colleagues.

“DSMES is the ongoing process of facilitating the knowledge, skills, and ability necessary for prediabetes and diabetes self-care, as well as activities that assist a person in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis, beyond or outside of formal self-management training,” they explain.

While the standards define evidence-based DSMES services that meet or exceed Medicare’s diabetes self-management training (DSMT) regulations, they don’t actually guarantee reimbursement. “The hope is that payers will view these standards as a tool for reviewing DSMES reimbursement requirements and consider change to align with the way their beneficiaries’ engagement preferences have evolved,” the authors say.

Currently, less than 5% of Medicare beneficiaries use the DSMES benefits that are covered.

The standards apply to diabetes educators in a variety of settings and within new and emerging models of care, such as virtual visits, accountable care organizations, patient-centered medical homes, and value-based payment models.

These same DSMES standards are used both for ADA recognition and AADE accreditation and also can serve as a guide for non-accredited and non-recognized diabetes education providers.

Although there is overlap between DSMES services and those of the National Diabetes Prevention Program (National DPP) lifestyle-change program, the two are tailored to different audiences (diabetes vs prediabetes) and have different goals (diabetes management vs prevention). Recognition of DPP programs is handled by the US Centers for Disease Control and Prevention. Centers providing both types of services have been shown successful, but they need to meet both sets of standards.

The new document details 10 specific standards for DSMES programs: internal structure, stakeholder input, evaluation of population served, quality coordinator overseeing DSMES services, the DSMES team, curriculum, individualization, ongoing support, participant progress, and quality improvement.

While previous standards have used the term “program,” the current terminology is “services,” which “more clearly delineates the need to individualize and identify the elements of DSMES appropriate for an individual. This revision encourages providers of DSMES to embrace a contemporary view of the new complexities of the evolving healthcare landscape,” the authors write.

Expect the next revision sooner than 3 years from now, they say. “Given the rapidly changing healthcare environment and the ever-growing field of technology, the 2017 Standards Revision Task Force recognizes the potential need to review the literature for evidence-driven updates more frequently in the future as advances in healthcare delivery are evolving.”

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