Background

The health burden of diabetes in the United States is significant. Millions of Americans experience diabetes-related morbidity, mortality, and reduced quality of life each year.^4,5 There are 37.3 million Americans with diabetes, with nearly one-fourth (23%) remaining 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 risks 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 the disease. In addition, the financial burden of diabetes is substantial. The disease costs the United States an estimated $327 billion⁹ annually due to increased medical costs and lost wages. 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, and evidence-based services exist to help people with diabetes and their healthcare teams prevent or delay diabetes complications. One evidence-based diabetes management service model is DSMES.

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

For Medicare Part B beneficiaries, people 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 (NP), clinical nurse specialist (CNS), or physician assistant (PA). People with diabetes are then eligible to receive two hours of additional diabetes education in each subsequent year. More information is available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM3185.pdf [PDF – 66 KB].

“As of 2016, more than 4,100 diabetes self-management education and support (DSMES) programs were offered across the United States.”¹⁰ DSMES services aim to improve preventive practices for people with diabetes, and in 2016, approximately 1.1 million people with diabetes participated in services recognized by the ADA or accredited by the AADE.¹⁰ However, there are gaps in availability. “Although ADA-recognized or AADE-accredited DSMES programs are offered in 56% of counties across the Unites States, 62% of rural counties do not have a DSMES service.”¹¹

For people with diabetes, numerous studies report associations between diabetes self-management education and support and improved health. 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 healthcare team accessing services¹², the focus of DSMES is to help “the person with diabetes develop problem-solving skills and attain ongoing decision-making support necessary 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.

In the U.S., less than 5% of Medicare beneficiaries with diagnosed diabetes and 6.8% of privately insured individuals with diagnosed diabetes have participated in DSMES services.²,³ The purpose of this toolkit is to increase use of DSMES services among people with diabetes and promote healthcare provider referrals. Expanded use of DSMES can help ensure that all people with diabetes receive the support they need.