by Kelly Gunn, RN, MBA, NE-BC, Director of Clinical Services at Accountable Healthcare Staffing

Although patients should be educated by a healthcare professional with experience and/or certification in DSME (Diabetes Self-Management Education), every nurse who is caring for a patient with diabetes should be familiar with the basic concepts and content taught in DSME programs. Patients will receive comprehensive education from diabetic specialists, but they often need frequent, on the spot reinforcement, review, and reminders of the information that was taught; providing this is very often the responsibility of the nurse at the bedside. 

Education should include:

Assessment of the patient’s knowledge of diabetes

A useful assessment tool that can be used is the Diabetes Knowledge Test (DKT). The DKT has been in use for many years and been shown to be valid and reliable.

Basic information about the disease process of diabetes

Nutritional education

Exercise

Exercise and decreasing the amount of sedentary time has been shown to help control blood glucose and prevent diabetic complications.

Smoking cessation

Blood glucose monitoring

For most people a fasting blood glucose level should be between 70-130 mg/dL and a blood glucose one-two hours after a meal should be <180 m/dL. Daily blood glucose monitoring and then adjusting food intake, exercise intensity/frequency and proper use of diabetic medications all contribute to good blood glucose control. In addition, A1C is measured at least biannually with the goal for most patients an A1C<7%. The A1C level is used to predict the risk of long-term complications and determine the effectiveness of the current diabetic treatment regimen.

Safe and effective use of medications

Acute complications: hypoglycemia, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome

Chronic complications: diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, and diabetic foot ulcers

A diabetes diagnosis requires significant lifestyle changes to properly manage the disease and prevent diabetic complications. Although the day-to-day management of diabetes is the responsibility of the patient, HCP’s can ensure the patients have the information, resources, and tools they need to successfully self-manage their disease.

Centers for Disease Control and Prevention. National Diabetes Statistics Report. 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Centers for Disease Control and Prevention. National Diabetes Prevention Program. 2018. https://www.cdc.gov/diabetes/prevention/pdf/NDPP_Infographic.pdf

Fitzgerald JT, Funnell MM, Anderson RM, Nwankwo R, Stansfield RB, Piatt GA. Validation of the Revised Brief Diabetes Knowledge Test (DKT2). The Diabetes Educator. 2016;42(2):178-187. doi:10.1177/0145721715624968.

Funnell, Martha M. and Freehill, Karein. Keeping up-to-date with diabetes care and education. Nursing 2019. October 2018. Volume 48, Issue 10. https://journals.lww.com/nursing/Fulltext/2018/10000/Keeping_up_to_date_with_diabetes_care_and.8.aspx

G. S. Collins, S. Mughal, A. H. Barnett, J. Fitzgerald and C. E. Lloyd. Short Report: Education and Psychological Aspects Modification and validation of the Revised Diabetes Knowledge Scale

Singh VP, Bali A, Singh N, Jaggi AS. Advanced glycation end products and diabetic complications. Korean J Physiol Pharmacol. 2014;18(1):1–14. doi:10.4196/kjpp.2014.18.1.1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951818/