Diabetes management is one component of the Community Health Improvement Plan submitted by St. Luke’s Hospital and the Rutherford Polk McDowell District Health Department, and a key priority of Polk Fit, Fresh and Friendly. To an extent greater than any other illness, management of diabetes mellitus requires sustained, knowledgeable involvement of the patient and carefully coordinated management of multiple different factors, including diet, exercise, psychosocial and physiologic stress and medication.

Optimal treatment of this illness includes diabetes self-management education (DSME) as well as diabetes self-management support (DSMS).

According to the National Standards for Diabetes Self-Management Education and Support (found in Clinical Practice Recommendations at care.diabetesjournals.org):

DSME is the ongoing process of facilitating the knowledge, skill, and ability necessary for prediabetes and diabetes self-care.  The overall objectives of DSME are to support informed decision making, self-care behaviors, problem solving, and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life.

DSMS involves activities that assist the person with prediabetes or diabetes in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis beyond or outside of formal self-management training.  The type of support provided can be behavioral, educational, psychosocial or clinical.

DSME is provided in Polk County by the Diabetes and Self-Management Wellness Program at Polk Wellness Center, which meets all national standards for DSME and is accredited by the American Association of Diabetes Educators.

The core curriculum of the program includes two three-hour class sessions, which are highly interactive and cover all the core educational topics; Small-group or 1:1 pattern management sessions in which blood sugar logs are discussed with the patient in detail. Through identification of patterns of blood sugar readings in conjunction with diet and activity records, problem areas are identified and behavioral goals adjusted accordingly. Correspondence with the referring provider may include thoughts about medications based on these blood sugar patterns.  Experts assist with adjusting insulin regimens to meet each individual’s specific personal and physiological needs; Development of an education plan, with issues and behavioral goals identified by patient and instructor. This plan also includes plans for DSMS following DSME or concurrent with ongoing DSME.  Progress with this education plan is followed up regularly; Detailed written communication with the referring provider, including Education Plan and Pattern Management Report after every small-group or 1:1 meeting.

This program has succeeded in achieving positive behavioral and clinical outcomes, especially for patients who complete the program.  Referral from the provider who is treating the patient’s diabetes is required.  For referral forms, brochure, or to talk with the program instructor, please leave a message for Melissa Melum, RN, CDE at 828-894-0944.

DSM support is a very important element in the overall process, critically important for building upon and sustaining the progress from DSME. It is offered following, or at the same time as, the DSME program according to the patient’s individual needs.

Options include referral to a registered dietitian at St. Luke’s Hospital for specialized medical nutrition needs or additional support with dietary goals from class; referral to a licensed certified social worker at Polk Wellness Center; ongoing pattern management work with RN, CDE.

Two significant sources of DSMS in the Polk County community, in which all patients from the DSME program are encouraged to participate, are:

Dining with Diabetes, an interactive meal planning and food preparation program offered by Jimmi Buell at the County Extension Service.  For more information, contact Jimmi Buell at 828-894-8218, and Living Healthy With Diabetes, a six-week program that utilizes the Stanford University Chronic Disease Self-Management Program curriculum.  Coordinated and co-facilitated by Jane Armstrong, MSW, of Region C-Area Agency on Aging, this program is not designed to help people learn more about their conditions, but rather to learn the skills and tools to better manage their illness on an ongoing basis through a problem-solving and goal-setting process.

Participants will learn techniques to deal with problems such as frustration, fatigue, pain and isolation; skills for communicating effectively with friends, family, and health care providers; healthy eating guidelines and exercise tips; how to make informed treatment decisions, and more.

For more information, contact Jane Armstrong at 919-548-0016.

Melissa Melum is a Certified Diabetes Educator with St. Luke’s Hospital, working collaboratively with Polk Wellness Center to provide education and support to people living with diabetes.