Commentary
Working toward the next generation of diabetes self-management education

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Introduction

Approximately 16 million people have diabetes in the United States, about two thirds of whom have been diagnosed. As the seventh leading cause of death, diabetes is extraordinarily costly with estimates of its total costs approaching or exceeding $100 billion. Increasingly, providers, payers, policymakers, and purchasers of health care recognize diabetes as one of the most prevalent and expensive healthcare problems we face as a nation.

Sadly, despite the increased availability of improved therapeutic options and the growing recognition that diabetes is a serious public health problem, care for people with diabetes remains deficient. Most patients do not receive the level of health care that is recommended and are, therefore, not able to achieve optimal outcomes.1, 2, 3, 4, 5 Because our healthcare system is designed to diagnose and treat acute healthcare problems, chronic diseases, particularly those that are asymptomatic, may not receive the attention necessary for effective daily management and to prevent or detect, or both, long-term complications. In addition, many clinical practices are not designed to provide the training and support patients need to effectively care for and live with diabetes. The gap between what we know how to do and what actually occurs is a source of frustration for both patients and healthcare professionals.

Because the daily care for diabetes is carried out almost entirely by the person with diabetes, two critical factors are needed for achieving optimal care and obtaining desired outcomes. The first factor is to prepare patients to be effective self-managers of their diabetes by providing them with the information and support necessary to make informed decisions about the costs and benefits of various treatment options. The second factor is through health systems approaches that facilitate the ongoing monitoring, support, and routine care that a chronic illness such as diabetes requires. The Task Force on Community Preventive Services (the Task Force) is to be applauded for choosing to concentrate on recommendations about self-management education and health systems interventions, including case management.

Section snippets

Self-management education

Self-management education is essential for effective diabetes self-care. Patient education is necessary because diabetes is serious, largely self-managed, and a personal responsibility. In addition, diabetes self-management is usually complex and emotionally challenging. Patients need to know and understand diabetes and its management, available treatment options, personal costs and benefits of various therapeutic approaches, and behavior change and problem-solving strategies. In addition, they

Community-based self-management education

Diabetes is cared for on a daily basis in the psychological and physical world of the person with diabetes. The psychological world is made up of health-related priorities and experiences, religion, ethnicity, gender, socioeconomic status, and so forth. The physical world refers to the neighborhood and community in which patients live, as well as places they spend a substantial amount of time such as home, school, or work. Diabetes self-management not only has to fit the illness, but it also

Acknowledgements

Supported in part by the National Institutes of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (grant NIH 5P60-DK20572).

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