Diabetes Training Programs are Underused

By Shereen Lehman

(Reuters Health) - Newly diagnosed diabetics generally don't take advantage of educational programs that could help them manage their disease, a new study suggests.

Diabetes self-management education and training (DMST) programs help patients learn to do all the self-care that is essential for control of their blood sugar, the authors of the study explain.

"The curriculum of DSMT often includes information about diabetes disease process and treatment options; healthy lifestyle; blood glucose monitoring; preventing, detecting and treating diabetes complications; and developing personalized strategies for decision making," study leader Rui Li told Reuters Health in an email.

Li, a researcher with the Centers for Disease Control and Prevention in Atlanta, and colleagues looked at claims data from almost 100,000 adults with private insurance who were diagnosed with diabetes in 2009-2012.

They found that less than 7% participated in diabetes self management education training.

Older adults, and patients taking insulin, were more likely to participate in training programs, as were people living in the North Central region of the U.S. and in metropolitan areas, the researchers reported November 21 in the Morbidity and Mortality Weekly Report.

Still, no subgroup participated at a rate higher than 15%, the authors wrote.

"Although many people with diabetes know about the classes, a major issue was that individuals with diabetes may not be attending DSMT once they are referred," Li said.

Li said better marketing efforts, focusing on education of doctors, patients, and support persons, are needed to publicize the DSMT programs. Promotion of the message that DSMT is the foundation of diabetes care might be helpful in promoting the programs, Li said.

In this study, everyone had private insurance, but Li said Medicare and many state Medicaid programs cover the cost of DSMT. "Forty states mandated private insurance coverage for DSMT, but there are private plans that still do not cover it and many others that require a co-payment," Li said.

Kate Lorig, director of the Stanford Patient Education Research Center at Stanford School of Medicine in California, who wasn't involved in the study, said basing it on insurance claims might underestimate the number of patients who got self-management training.

Lorig said the system for becoming a recognized diabetes program eligible for Medicare reimbursement is very difficult and restrictive, and it's expensive for a program to apply for and receive recognition.

"This greatly limits the number of programs that are willing to go for recognition," she said.

Lorig also explained that in some cases the billing codes may have been for 'case management' and not DSMT.

"My guess it is that the actual number is double or triple that given," she said, "However this is still very very low."

Lorig thinks the way to boost the use of diabetes training programs is to lower the barriers to reimbursement faced by the health care providers who do the training.

"Right now reimbursement is usually based on first having a billing code and then have the right content in the education and the right person giving it," she said.

Lorig said several community based DSME programs have been effective in randomized trials. "However, these are seldom reimbursed because they do not meet the billing code and all the other requirements for reimbursement," she said.

SOURCE: https://1.usa.gov/1y8bdSa

MMWR 2014.

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