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October 28, 2020 04:00pm
By Sara Karlovitch, Assistant Editor
The National Standard for Diabetes Self-Management Education and Support differentiates 2 important ways to improve diabetes care.
The National Standard for Diabetes Self-Management Education and Support differentiates 2 important ways to improve diabetes care:
1.Diabetes self-management education:“the ongoing process of facilitating knowledge, skill and ability necessary for prediabetes and diabetes self-care.”
2.Diabetes self-management support:“activities that assist the person with prediabetes or diabetes in implementing and sustaining the behaviors needed to manage his or her condition on an
We send our children off to school each year for the opportunity to learn, shape their minds, and grow their interests. We know that self-management of life may be complex and that they need proper education. Through a proven curriculum, children develop essential skills—reading, writing, math, art, gym, health, social studies, science—so they can meet the world confidently and be prepared for their next steps on their own. Along those same lines, diabetes self-management for children is complex and requires special education and support.
The 2010 Affordable Care Act supports coverage for diabetes self-management for children with the Children’s Health Insurance Program Reauthorization Act of 2009. Legislators have recognized self-management education as a key factor in preventing secondary complications, such as peripheral neuropathy, retinopathy, and nephropathy. It’s time now to explore new interventions that can increase self-management and maximize outcomes in this specific population.
One recent review suggests steps from evidence-based practices to develop self-management skills in children and youth with diabetes. The following recommendations deserve consideration in retail health:
1. Consider interventions designed to promote the development of self-management skills in children with type 1 diabetes (T1D)ortype 2 diabetes (T2D).
Protocols for standard T2D therapy in children aren’t well established, so practitioners should consider evidence in either type.
2. Address self-management readiness skills of children with diabetes younger than 14 years (eg, learning about diabetes and how to draw insulin, promoting a healthy and active lifestyle).
Before middle school, children with diabetes may be able to begin to learn skills such as self-administration of insulin, but they may still lack the executive functioning skills to consistently manage their disease autonomously. Consider environmental factors and potential barriers before implementing an intervention.
3. Provide self-management educationandsupport to children 14 years or older.
Consider helpful tricks such as associating pet care with daily and weekly diabetes self-management habits. For example, meal preparation or daily glucose checks when you feed the fish daily, and weekly follow-up with your physician when you change a portion of the water in the fish bowl.
Consider a more comprehensive learning tools like diabetes camp. This program may include daily medical education and discussions, and repeated insulin adjustments and supervised injections, among other useful learning tools. Continue to guide independent change in behavior and perceptions about skills as well as more medically focused indicators of diabetes management (eg, BMI or HbA1C levels).
4. Involve parents or primary caregivers in self-management education and support interventions.
Renegotiate the responsibilities between the parent and child and remind parents—less nagging, and more positive affirmations! Appropriate parental involvement in care increased adherence and the child’s ability to assume responsibility for diabetes care tasks than individual therapy.
5. Consider integrating the use of technology (eg, text message or e-mail reminders) in the self-management intervention.
Evidence suggests cell-phone—based glucose recording systems allow children to feel more independent in caring for their diabetes. This system involves text reminders to check their blood sugar, and the data collected could be shared and monitored by a health care provider as well as the parent. Internet-based intervention with personalized homepages, multimedia presentations, and discussion forums related to diabetes management also improved adherence.
It’s important to choose interventions that fit best into the lifestyle and attitudes of youth and match their readiness skills. Self-management education and support is critical for outcomes in children with either T1D or T2D, but the amount of research supporting different interventions for this population is far from impressive. These tips are critical for all clinicians, and more research will expand these steps and improve outcomes for our children and youth.
Cahill S, et al. Interventions to promote diabetes self-management in children and youth: a scoping review.Am J Occupl Ther. 2016;70(5):7005180020p1-7005180020p8.