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Domain 4

Community Health Workers

Managing Chronic Conditions in Schools

Chronic Disease Self-Management Program
Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, et al. A Meta-Analysis of Health Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease Self-Management Program. Prev Chronic Dis 2013;10:120112. DOI:

The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies to determine the program’s effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. The meta-analysis found that small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy.

The CDC-led National Diabetes Prevention Program
The CDC-led National Diabetes Prevention Program is designed to bring to communities evidence-based lifestyle change programs for preventing type 2 diabetes. It is based on the Diabetes Prevention Program research study led by the National Institutes of Health and supported by Centers for Disease Control and Prevention. The lifestyle program in this study showed that making modest behavior changes, such as improving food choices and increasing physical activity to at least 150 minutes per week, helped participants lose 5% to 7% of their body weight. These lifestyle changes reduced the risk of developing type 2 diabetes by 58% in people at high risk for diabetes. People with prediabetes are more likely to develop heart disease and stroke.

The CDC Diabetes Prevention Recognition Program
The CDC Diabetes Prevention Recognition Program (DPRP) is a key component of the National Diabetes Prevention Program. The purpose of the DPRP is to recognize organizations that have shown that they can effectively deliver a lifestyle change intervention program to prevent type 2 diabetes.

Diabetes Self-Management Education
Diabetes self-management education is a collaborative process through which people with diabetes gain the knowledge and skills needed to modify their behavior and successfully self-manage the disease and its related conditions. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards.

National Association of Chronic Disease Directors (NACDD) DSME Resource List
This list of DSME resources was compiled by the NACDD Diabetes Council to assist state health departments and their partners in identifying and locating resources relevant to increasing access to sustainable diabetes self-management education and support services.

Effectiveness/Impact of DSME
A large body of evidence supports the effectiveness of DSME/T in improving diabetes outcomes. Norris and colleagues (2002) demonstrated that self-management education improves A1C levels at immediate follow up, and that increased contact time is associated with an increased effect.(1) A systematic review of 71 trials by Warsi and colleagues in 2004 also showed reductions in A1C and systolic blood pressure in patients who received formal training in diabetes self-management.(2) A meta-analysis conducted by Deakin, et al, in 2005 showed that patients who received DSME in a group setting improved their diabetes knowledge and reduced their fasting blood glucose levels, A1C levels, systolic blood pressure levels, and body weight, thus reducing their need for diabetes medication.(3)

Cost Benefit of DSME
An economic analysis conducted in 2000 by Klonoff and Schwartz reported that for every $1 spent on DSME, there was a net savings of $0.44 to $8.76.(4) In a systematic review conducted by Boren, et a,l (2009) 18 of 26 papers reported findings associating diabetes education (and disease management) with decreased costs, cost savings, cost effectiveness, or positive return on investment.(5) A study by Duncan, et al, also published in 2009, documented that commercially insured members who use diabetes education cost, on average, 5.7% less than members who do not participate in diabetes education. Participating Medicare members cost significantly less (14%). In the commercially insured population, the gap between the cost of the diabetes education population and the non-education population increased over time, so that by year 3 the non-diabetes education population average cost was 12% higher. Similar results were seen in the Medicare population, although the differences were smaller.(6) In a follow-up study in 2011, Duncan and colleagues focused more specifically on DSME encounters provided by diabetes educators in accredited/recognized programs. Results indicated that patients exposed to those encounters showed lower cost patterns when compared with a control group of people with diabetes without DSME encounters. People with diabetes who had multiple DSME encounters were more likely to receive care in accordance with recommended guidelines and to comply with diabetes-related prescription regimens, resulting in lower costs and utilization trends. This analysis demonstrated that repeated DSME encounters over time result in a dose-response effect on positive outcomes.(7)

  1. Norris SL, et al. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002 Jul;25(7):1159-71. (
  2. Warsi A, et al. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164:1641-1649. (
  3. Deakin T, et al. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2005, Issue 2. (\
  4. Klonoff DC, Schwartz DM. An economic analysis of interventions for diabetes. Diabetes Care. 2000 Mar;23(3):390-404. (
  5. Boren SA, et al. Costs and benefits associated with diabetes education: a review of the literature. Diabetes Educ. 2009 Jan-Feb;35(1):72-96. (
  6. Duncan I, et al. Assessing the value of diabetes education. Diabetes Educ. 2009 Sep-Oct;35(5):752-60. (
  7. Duncan I, et al. Assessing the value of the diabetes educator. Diabetes Educ. 2011 Sep-Oct;37(5):638-57. (

American Diabetes Association (ADA) Education Recognition Program (ERP)(

American Association of Diabetes Educators (AADE) Diabetes Education Accreditation Program (DEAP)(

To promote quality education for people with diabetes, the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE) endorse the National Standards for Diabetes Self-Management Education and Support [PDF-599Kb]. Both organizations offer programs that assess whether organizations delivering DSME programs are adhering to the National Standards. The ADA ERP and the AADE DEAP are Centers for Medicare and Medicaid Services (CMS)-approved certifying bodies for Diabetes Self-Management Training.

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