1. Self-Management Education Chapter 7 Helen Jones, Lori D Berard, Gail MacNeill, Dana Whitham, Catherine Yu Canadian Diabetes Association 2013 Clinical Practice Guidelines

2. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Self-Management Education (SME) A systematic intervention that involves active patient participation in self-monitoring and/or decision-making

3. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Key Points 1.Diabetes self-management education (SME) improves health parameters 2.SME should teach behaviours as well as knowledge and technical/problem-solving skills 3.SME should be patient-centred, tailored to the individual, use a variety of teaching methods and be regularly reinforced 2013

4. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Knowledge is Power Empowering patients through self-management education improves: – A1C – Quality of life – Weight loss – Cardiovascular fitness

5. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Basic Knowledge and Skills Monitoring health parameters (including self- monitoring blood glucose [SMBG]) Healthy eating Physical activity Pharmacotherapy and medication adjustment Hypo-/hyperglycemia prevention/management Prevention and surveillance of complications Problem identification and solving

6. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Not Just Knowledge: Work on Behaviour! Cognitive-behavioural interventions improve self- management and metabolic outcomes They may involve: – Cognitive re-structuring – Problem-solving – Cognitive-behavioural therapy (CBT) – Stress management – Goal setting – Relaxation

7. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association How should SME be delivered? Interdisciplinary team and/or peer-education Personal contact with healthcare workers Combination of group and individual sessions Combination of didactic and interactive

8. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association SME must be Reinforced Regularly Booking follow up sessions Patient-educator contact between sessions Automated or technology-based reminders

9. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Diabetes Education… Improved! Collaborative and interactive Patient-centred and individualized Knowledge and technical skills, but also problem- solving skills Repeatedly reinforced Educational, psychological, and behavioural interventions and a variety of teaching methods

10. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Steps to Success Evaluate and support long-term self-management Implement a realistic plan for skills training Collaborate on decisions and goals for action Make informed consideration of self-care options Assess & identify personal self-care needs

11. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 1 1.People with diabetes should be offered timely diabetes education that is tailored to enhance self-care practices and behaviours [Grade A, Level 1A ].

12. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 2 2.All people with diabetes who are able should be taught how to self-manage their diabetes [Grade A, Level 1A].

13. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 3 3.SME that incorporates cognitive-behavioural educational interventions, such as problem- solving, goal setting, and self-monitoring of health parameters, should be implemented for individuals with diabetes [Grade B, Level 2].

14. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 4 4.Interventions that increase patient participation and collaboration in healthcare decision-making, should be used by providers [Grade B, Level 2].

15. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 5 5.For people with type 2 diabetes, SME interventions should be offered in small-group and/or one-on- one settings, since both may be effective [Grade A, Level 1A].

16. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 6 6.In both type 1 and 2 diabetes, interventions that target families ability to cope with stress or diabetes-related conflict should be included in educational interventions when indicated [Grade B, Level 2].

17. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 7 7.Technologically based home blood glucose monitoring systems may be integrated into SME interventions in order to improve glycemic control [Grade C, Level 3]. 2013

18. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 8 8.Culturally-appropriate SME, which may include peer or lay educators, may be used to increase diabetes-related knowledge, self-care behaviours, and decrease A1C [Grade B, Level 2]. 2013

19. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 9 9.Adding literacy and numeracy sensitive materials to a comprehensive diabetes management and education program may be used to improve knowledge, self-efficacy, and A1C outcomes for patients with low literacy [Grade C, Level 3]. 2013

20. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association CDA Clinical Practice Guidelines http://guidelines.diabetes.cahttp://guidelines.diabetes.ca – for professionals 1-800-BANTING (226-8464) http://diabetes.ca http://diabetes.ca – for patients