Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association

Jane L. Chiang; M. Sue Kirkman; Lori M.B. Laffel; Anne L. Peters

Disclosures

Diabetes Care. 2014;37(7):2034-2054. 

In This Article

DSME and DSMS

DSME and DSMS are the ongoing processes of facilitating the knowledge, skill, and ability necessary for diabetes self-care. These processes incorporate the needs, goals, and life experiences of the person with diabetes. The overall objectives of DSME and DSMS are to support informed decision making, self-care behaviors, problem solving, and active collaboration with the health care team to improve clinical outcomes, health status, and quality of life in a cost-effective manner.[31] Because changes in both treatment and life circumstances occur across the life span, DSME and DSMS must be a continuous process adapted throughout the life of the person with type 1 diabetes so that self-management can be sustained.

No matter how sound the medical regimen, it can only be as successful as the ability of the individual and/or family to implement it. Family involvement remains an important component of optimal diabetes management throughout childhood and adolescence. Health care providers who care for children and adolescents must, therefore, be capable of evaluating the educational, behavioral, emotional, and psychosocial factors that impact implementation of a treatment plan and must assist the individual and family to overcome barriers or redefine goals as appropriate (Table 6). Diabetes education should occur at diagnosis and upon transition to adult diabetes care and should be an ongoing process. The information needs to be individualized and continually adapted to the patient's needs.

Recommendations.

  • Individuals with type 1 diabetes and parents/caregivers (for individuals aged <19 years) should receive culturally sensitive and developmentally appropriate individualized DSME and DSMS according to national standards for DSME and DSMS when their diabetes is diagnosed and routinely thereafter. (B)

Additional Considerations for Pediatrics

  • Education should be provided to appropriate school personnel as a significant portion of a child's day is spent in school. (E)

  • The developing teenager must be educated about the transition to adult health care, beginning in early to mid-adolescence, with increasing efforts to establish self-reliance in diabetes care beginning at least 1 year prior to the transition. Even after the transition to adult care is made, support and reinforcement are recommended. (E)

Additional Considerations for Adults

  • Adult learning theory can be used to tailor DSME and DSMS to the age, life stage, culture, literacy/numeracy, knowledge, experience, and cognitive ability of the patient. (C)

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