Background

The health burden of diabetes in the United States is significant. Every year, millions of Americans experience diabetes-related health complications and reduced quality of life.^4,5 Of the 37.3 million Americans with diabetes, more than 1 in 5 (23%) remain undiagnosed.⁶

People with diabetes are at higher risk for severe health complications, such as blindness, kidney failure, heart disease, stroke, and lower-limb amputations. Diabetes is also associated with increased risk for some types of cancer, including liver, pancreas, colon, breast, and bladder.⁷ In addition, studies show that type 2 diabetes increases the risk of vascular dementia and Alzheimer’s disease.⁸

Diabetes is the eighth leading cause of death in the United States, and people with diagnosed diabetes have a 50% higher risk of early death than those without diabetes. In addition, the financial burden of diabetes is substantial—an estimated $327 billion⁹ annually due to increased medical costs and lost productivity. People with diagnosed diabetes have on average 2.3 times higher medical costs than those without diabetes.⁶

Fortunately, better health management can help people with diabetes live longer and healthier lives. Evidence-based services such as DSMES can help people with diabetes and their health care teams prevent or delay diabetes complications.

Organizations offering DSMES services can apply for recognition by the American Diabetes Association (ADA) or accreditation by the Association of Diabetes Care & Education Specialists (ADCES). These organizations are eligible for reimbursement by Medicare, many private health plans, and some state Medicaid agencies.¹ Covered benefits for DSMES services vary by insurer, making it important to verify participants’ benefits at the outset.

Medicare Part B beneficiaries with diabetes are eligible for 10 hours of diabetes education over the course of a year after receiving a referral from their physician, nurse practitioner, clinical nurse specialist, or physician assistant. People with diabetes are then eligible to receive 2 hours of additional diabetes education in each subsequent year. More information is available through the Medicare Learning Network.

In 2020, a total of 2,158 sites were delivering DSMES services across the United States. Every year, nearly 1 million people with diabetes receive DSMES services recognized or accredited by ADA or ADCES. However, there are gaps in availability. Although ADA-recognized or ADCES-accredited DSMES programs are offered in 56% of counties across the Unites States, 62% of rural counties do not have a DSMES service.¹¹

DSMES services have been shown to have a positive impact on lifestyle changes, such as eating patterns and activity levels, ultimately leading to decreases in hemoglobin A1C levels, prevention or delay of diabetes complications, and improved quality of life.¹ Since on average a person with diabetes spends less than 1% of their life with their health care team accessing services,¹² the focus of DSMES is to help people with diabetes develop problem-solving skills and access ongoing decision-making support to self-manage diabetes.¹¹

Studies also confirm the cost-effectiveness of participation in DSMES services through reduced hospital admissions and readmissions.¹ Despite this evidence, use of DSMES services is low.