Background and Benefits of DSMES

Burden of diabetes

Diabetes is the eighth leading cause of death in the United States, and people with diagnosed diabetes have a 50% higher risk of early death than those without diabetes. People with diabetes have a higher risk for severe health complications, such as blindness, kidney failure, heart disease, stroke, and lower-limb amputations.

Diabetes is also associated with increased risk for some types of cancer, including liver, pancreas, colon, breast, and bladder. In addition, studies show that type 2 diabetes increases the risk of vascular dementia and Alzheimer’s disease.

The financial burden of diabetes is substantial—billions annually due to increased medical costs and lost productivity. People with diagnosed diabetes have on average 2.6 times higher medical costs than those without diabetes.

Improving health through DSMES

Fortunately, DSMES, which is an evidence-based service, can help people with diabetes live longer and healthier lives. Through DSMES, people with diabetes can prevent or delay diabetes complications.

Organizations offering DSMES can apply for recognition by the American Diabetes Association (ADA) or accreditation by the Association of Diabetes Care & Education Specialists (ADCES). These organizations are eligible for reimbursement by Medicare, many private health plans, and some state Medicaid agencies. Covered benefits for DSMES services vary by insurer, making it important to verify participants' benefits up front.

How people benefit from DSMES

Participating in DSMES is linked to positive changes in health behaviors and improved diabetes-related outcomes. This includes:

• Improved hemoglobin A1C levels.
• Improved management of blood pressure and cholesterol levels.
• Higher rates of medication adherence.
• Fewer or less-severe diabetes-related complications.
• Healthier lifestyle behaviors, such as better nutrition, increased physical activity, and use of primary care and preventive services.
• Enhanced self-confidence to manage diabetes.
• Decreased health care costs, including fewer hospital admissions and readmissions.

Medicare coverage

Medicare Part B beneficiaries with diabetes are eligible for 10 hours of diabetes education over the course of a year. They must receive a referral from their physician, nurse practitioner, clinical nurse specialist, or physician assistant. People with diabetes are then eligible to receive 2 hours of additional diabetes education in each subsequent year. More information is available through the Medicare Learning Network.

Milestones

In 2020, a total of 2,158 sites were delivering DSMES services across the United States. Every year, nearly 1 million people with diabetes receive DSMES services recognized or accredited by ADA or ADCES.

However, there are gaps in availability. Although ADA-recognized or ADCES-accredited DSMES programs are offered in 56% of counties across the Unites States, 62% of rural counties do not have a DSMES service.

Successes and future of DSMES

DSMES has a positive impact on lifestyle changes, such as eating patterns and activity levels. It's been shown to decrease hemoglobin A1C levels, prevent or delay of diabetes complications, and improve quality of life.

On average, a person with diabetes spends less than 1% of their life with their health care team, so the focus of DSMES is to help people with diabetes develop problem-solving skills to self-manage diabetes.

Studies also confirm the cost-effectiveness of participation in DSMES services through reduced hospital admissions and readmissions.

More work to be done

Despite the evidence, use of DSMES services is low. Less the 5% of Medicare beneficiares with diabetes and 6.8% of privately insured people with diabetes have participated in DSMES within the first year of diagnosis. This toolkit can be used to expand the use of DSMES so that all people with diabetes get the care, education, and support that they need.