Introduction

Diabetes self-management education (DSME) has long been revered as the cornerstone of care for all persons affected by diabetes. The diabetes educator provides this valuable service as an integral part of the healthcare delivery team. A large body of evidence supports the effectiveness of diabetes education (1) and, although there are variances in delivery methods, the educational process is universal. Since 1983, educators have focused on delivery of a formalized educational content. This content, as well as the process of DSME, is defined by the National Standards of DSME (2) and more recently supported by the Diabetes Self-Management Outcomes Continuum (3).

Other factors have also influenced the enhancement and effectiveness of diabetes self-management. These contributions include the shift from an acute medical management care model to a more public health view, reflective of diabetes as a chronic, progressive disease. Two models depict this shift. They are Wagner's chronic disease management model (4) and the ecological model, providing a framework for the multiple influences on health behavior by the community (5).

The overall combined goals of diabetes care and education continue to be to optimize health and metabolic control, prevent or delay complications, and improve or optimize the patient's quality of life (6). Healthy People 2010 supports these goals and plans to increase the proportion of individuals with diabetes who receive formal diabetes education from 40% to 60% (7). However, at present there continues to be significant knowledge and skill deficits in 50% to 80% of individuals with diabetes (5), and there are still under-served populations, i.e., only a small percentage of the people affected by diabetes attend educational events (8).

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