Anyone with type 1 or type 2 diabetes, defined as:

• Fasting blood sugar greater than or equal to 126 mg/dL on 2 separate occasions.
• Two-hour post-glucose challenge greater than or equal to 200 mg/dL on 2 separate occasions.
• Random glucose test over 200 mg/d with symptom(s) of uncontrolled diabetes.
• Note: HbA1C is not accepted by Medicare as diagnostic laboratory value for type 1 and type 2 diabetes.
• Has gestational diabetes mellitus

• List number of sessions and time per session
• Diabetes Self-Management training is a clinic appointment
• New patient visits are 60 minutes
• Return visits are 30 minutes
• Group sessions are planned for 60 minutes
• No set time commitment. DSMT is an extension of diabetes care. Patients are encouraged to follow up with their diabetes educator between traditional care visits (with PCP (primary care providers) or Endocrinology)

• Any newly diagnosed patient with diabetes
• Previously diagnosed patients could benefit from learning how to take their medications, monitor their blood glucose, and learning from the various curriculum topics.
• Longstanding diabetes with poor glycemic control
• Patients that have trouble controlling their blood sugar or understanding healthy eating for diabetics to prevent complications.

Research shows that people who receive diabetes education are more likely to:

1. Use primary care and preventive services, and be more proactive in their care
2. Take medications as prescribed
3. Control their glucose, blood pressure and LDL cholesterol
4. Have lower health care-related costs.

Managing diabetes can be overwhelming for patients and therefore, for you, as well. It is complicated and time-consuming, adding to the demands on your practice. For each patient, you are faced with balancing priorities and goals – choosing which problem is most urgent, as you try to help them manage their disease along with co-morbidities. And often, patients cannot or will not do all they need to do to help themselves – whether due to their level of health literacy or other circumstances – which can be frustrating. That’s where Diabetes Educators can step in and help!

Any physician or advanced practice provider who is “taking care of the person’s diabetes”. This could include, but is not limited to:

• PCP
• Hospital attending
• MD/DO, PA, NP
  • Non-prescribing clinicians can tee up orders for physicians to sign off.

See DSMT Referral Flyer

Diabetes educators come from a variety of diverse backgrounds. Many are registered nurses, registered dietitians, or pharmacists, among others. Many are certified in diabetes education – which means they have advanced education in the area and are either Certified Diabetes Care and Education Specialists (CDCES) or Board Certified in Advanced Diabetes Management (BC-ADM).

The American Association of Diabetes Care and Education Specialists (ADCES) conducted a survey of both healthcare providers and people with diabetes. The research found that although many prescribers know the importance of diabetes education, it is often under-prescribed. Even though there is solid evidence that diabetes education can make a significant difference in patient outcomes and satisfaction, less than half of people with diabetes receive formal diabetes education.

DSMT includes a comprehensive diabetes educational needs assessment pertaining to the following content areas:

• Glucose monitoring
• Physical activity
• Healthy eating
• Taking diabetes medications
• Problem solving
• Healthy Coping
• Risk reduction
• A Diabetes Care and Education Specialist will develop an educational care and action plan in collaboration with the patient and their referring provider(s).
• Educational interventions may include some, but not necessarily all the content areas listed above.
• DSMT may be provided by a variety of healthcare professionals whom are certified in diabetes care and education (CDCES), including but not limited to an RN, RD, PharmD, MSW...etc.
• MNT is a nutrition focused service which includes a nutrition assessment, diagnosis, intervention, and monitoring/evaluation plan.
• Provider types for MNT are typically restricted to Registered Dietitians (RD), however physicians can provide the service as well.
• An MNT visit is specifically focused on meal planning. This is not necessarily limited to diabetes meal planning but can include meal planning for CKD (chronic kidney disease), cardiovascular disease, hyperlipidemia, obesity...etc.

In Summary:

• DSMT and MNT are complementary but distinctly different services.
• After the DSMT assessment, it may be determined that a patient would benefit from a dedicated nutrition focused visit.
• When a patient is balancing several chronic conditions with nutrition implications (CKD, cardiovascular disease, hyperlipidemia, obesity), a specific MNT visit is more likely to be indicated.
• For uncontrolled or newly diagnosed diabetes, DSMT is a more holistic service and in most cases, the more appropriate referral

• DSMT and MNT are separate benefits available to people with diabetes. The services cannot be provided on the same calendar day.
• Medicare beneficiaries are allowed 10 hours of DSMT the first year the benefit is utilized, and 2 hours follow up DSMT thereafter.
  • Follow up DSMT is permitted indefinitely, granted diabetes is remains listed as a diagnosis.
• Medicare beneficiaries are allowed 3 hours of MNT the first year the benefit is utilized, and 2 hours follow up MNT thereafter.
  • Follow up MNT is permitted indefinitely, granted diabetes is remains listed as a diagnosis.
  • Commercial and non-Medicare government payors follow Medicare coverage guidelines at a minimum. It is common for a non-Medicare patient to be permitted more hours / more visits than listed above

For more info on DSMT, including benefits and testimonials, you can go to the CDC website here