Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-25

In order to work towards this goal of SME, we need to engage and support the patient in (49,59,62): 1. Acquiring knowledge to support learning. 2. Informed decision-making with active collaboration with diabetes team members. 3. Development of positive self-care behaviours. 4. Development of problem-solving skills. 5. Working towards improved clinical outcomes, health status and quality of life (1,48,59).

There is an ongoing debate as to how these actions can be best achieved. Several questions arise: • What elements have been most effective?

• How should we be delivering SME? • Who should be delivering SME?

The SME chapter of the 2018 Guidelines helps address these questions; a summary of the evidence is reviewed in the following discussion (3).

Effective elements leading to benefits in SME In an early systematic review in 2002 of “self-management training in type 2 diabetes”, Norris et al. found that didactic interventions were effective for knowledge acquisition and information, but less effective for glycemic control and blood pressure. Collaborative approaches had a mixed effect on knowledge acquisition, but a more positive effect on glycemic control (63). A conclusion drawn from this early review suggested that more attention should be directed to attitudes and motivation in order to affect behaviour change. It also suggested that we need to be measuring different variables to truly reflect the effectiveness of SME (63). The 2005 review done by Chodosh et al. concluded that SME had clinically important benefits in diabetes and hypertension, with an A1C reduction of 0.81% (64). This review supported an association for interventions that included the following characteristics (64):

• Tailoring to specific individual needs and circumstances. • Group settings with others that have a similar condition.