Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-23

SELF-MANAGEMENT EDUCATION

History and practice One of the most perplexing issues in chronic disease management and educational literature is a lack of standardization as to what is involved in self-management, SME, SMS, self management training . We have defined these entities, but we need to go further. Since education is at the heart of our profession, we must be clear as to how we are applying the standards to practice. The evolution of terminology follows the evolution of the empowerment approach. Self management itself refers to the involvement of the patient in his/her care, and this is not in debate (13); it is who provides the education, where, when and how that remains inconsistently defined in the various chronic disease self-management publications and models. It has also been difficult to articulate the benefits of this education, as the studies are often comparing very heterogeneous programs. In 1991, the Canadian Diabetes Association (now Diabetes Canada) Diabetes Educator Section (DES) belief statement noted that diabetes education “enables individuals with diabetes to make choices and take actions based on informed judgement and understanding of possible consequences”. This definition incorporated the essential characteristics of empowerment, but remained provider-focused. The term SME became more widely used in practice in the place of diabetes education as we moved away from a compliance approach. However, the term remains poorly understood and is used interchangeably with self-management training and SMS (which often refers to peer-led support programs for type 2 diabetes, diabetes registries or electronic patient portals). A major challenge for educators and their associations is to gain consensus and clarity on the essential components of SME. In the initial “Self-Management Education” chapter in the Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management for Diabetes in Canada , SME refers to a comprehensive educational behaviour change program that provides intervention(s) over a lifetime of living with diabetes and combines both educational and psychological interventions delivered by a multidisciplinary team, including peer members (58).