Building Competency in Diabetes Education THE ESSENTIALS

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CONCLUSION

Educational and psychological principles, models and skills training/teaching strategies are the tools of the trade in diabetes SME and SMS. Understanding how people learn is essential to preparing and implementing effective education, whether it is individual, group or population based. We have more to accomplish to meet the needs of people living with diabetes and its complications. We have more to learn about how to engage effectively in SME and SMS. Norris and colleagues looked at the results of self-management training in type 2 diabetes in a systematic review of 72 studies (36), and their findings indicated that, at six-month follow-up, education had positive effects on: • Knowledge. • Frequency and accuracy of monitoring of BG. • Self-reported dietary habits. • Glycemic control. Effects on lipids, physical activity, weight and blood pressure were variable (36). This review also emphasized the current gaps in the reach and measurable impact of SME and SMS efforts. Similar results and conclusions remain through many other reviews and analyses done in the intervening years (93-96). Currently, insufficient evidence exists to identify specific self-care behaviours, educational interventions or provider skills that are essential for effective SME and SMS (94-96). What we have learned is that the medical model of compliance is not effective in sustaining change. Any SME and SMS interventions need to be individualized, utilizing the person centered approach where the person, not the medical professional, is directing the course of action. People thrive on informed choice and collaborative planning. Learners need to be active and involved in their learning. Activities reinforce learning and have replaced solely didactic presentations. Any action needs to be supported to be sustained. We have learned a lot, but we still have a way to go. Future research with adequately controlled and well-designed studies may help us to further assess the effectiveness of the various educational modalities on diabetes patient-based outcomes (12,93-96). We will continue to try and identify the key successful self-management behaviours and core educator competencies by developing better study designs that isolate single behaviours. There is so much more to come.