Gaps in DSMES Understanding Persist Among Health Care Professionals, Pilot Survey Finds

Although diabetes self-management education and support (DSMES) is widely recognized as an essential component of diabetes care, utilization of these services remains consistently low across the United States. Findings presented at the American Diabetes Association (ADA) Scientific Sessions suggest that gaps in health care professional (HCP) understanding of DSMES may contribute to underutilization.¹

In an study presented during the conference, investigators evaluated awareness, confidence, and perceived understanding of DSMES among ADA members. The study, conducted by Joyce Y-C. Lee and colleagues, examined whether clinicians who report familiarity with DSMES also demonstrate accurate understanding of its objectives, referral criteria, and implementation processes.¹

DSMES has been associated with improved glycemic control, reduced diabetes-related complications, improved quality of life, and decreased health care costs among patients with diabetes.^2-4 Current ADA Standards of Care recommend DSMES at diagnosis, annually, when treatment goals are unmet, during care transitions, and when complicating factors arise.² Despite these recommendations, participation and referral rates remain suboptimal nationwide.⁵

Pilot Survey Evaluates DSMES Knowledge Among ADA Members

Investigators disseminated a voluntary, anonymous cross-sectional survey through chairs of ADA’s 16 interest groups over a 3-month period. The 6-minute survey included 25 Likert-scale and open-ended questions assessing awareness and perceived understanding of DSMES objectives, core activities, referral criteria, benefits, and billing processes.¹

Among the 61 respondents who provided complete data, most participants were White and female (72%), and approximately 68.9% reported providing direct patient care. Only 19.7% indicated previous involvement with DSMES programs. The most common professional degrees represented were MD (29.5%) and RN (27.9%).¹

The investigators found that mean DSMES awareness was 2.97 ± 0.76 on a 0-to-4 scale, while perceived understanding averaged 61% ± 29%. Mean confidence was 2.81 ± 0.85 and demonstrated only a modest correlation with actual understanding (r = 0.46; P < .001).¹

These findings suggest that clinicians may feel confident discussing DSMES despite lacking full understanding of referral requirements, program structure, or reimbursement procedures.

Billing and Referral Processes Identified as Key Weaknesses

Survey findings demonstrated that awareness scores were generally highest for DSMES objectives and general benefits, while lower understanding was observed in areas such as billing and referral criteria.¹

This discrepancy may help explain why DSMES services remain underutilized in routine clinical practice. Prior studies have identified several barriers to DSMES referral, including limited provider familiarity with accredited programs, uncertainty surrounding eligibility criteria, and confusion regarding insurance reimbursement processes.^3,5

Research has consistently demonstrated that DSMES participation improves self-care behaviors and glycemic outcomes in adults with diabetes.⁴ However, despite the established clinical benefits, many eligible patients never receive referrals or engage with formal DSMES programs.⁵

Education Initiatives May Improve DSMES Integration

The investigators concluded that strengthened DSMES education for HCPs may improve understanding and ultimately support greater utilization of these services.¹ Increased clinician familiarity with referral pathways, billing requirements, and program benefits could help integrate DSMES more effectively into routine diabetes management.

As diabetes prevalence continues to increase nationally, experts continue to emphasize the importance of interdisciplinary diabetes care teams, including pharmacists, nurses, dietitians, and certified diabetes care and education specialists.² Enhanced provider education surrounding DSMES may represent one actionable strategy to improve patient access to evidence-based diabetes support services.

Although the study was limited by its small sample size and pilot design, the findings highlight persistent educational gaps even among clinicians engaged within the ADA professional community.¹ The authors noted that larger future studies may help further clarify how provider understanding influences DSMES referral patterns and patient participation.

REFERENCES

1. Lee JY-C, Barber ROLB, D’Souza J, et al. Evaluation of diabetes self-management education and support awareness and perceived understanding among health care professionals: a cross-sectional pilot survey. Presented at: American Diabetes Association 85th Scientific Sessions; June 2026; New Orleans, LA. Abstract 1481-P.

2. American Diabetes Association Professional Practice Committee for Diabetes* . 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Supplement_1):S89-S131. doi:10.2337/dc26-S005

3. Powers MA, Bardsley JK, Cypress M, et al. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care. 2020;43(7):1636-1649. doi:10.2337/dci20-0023

4. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926-943. doi:10.1016/j.pec.2015.11.003

5. Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. Use of Medicare's Diabetes Self-Management Training Benefit. Health Educ Behav. 2015;42(4):530-538. doi:10.1177/1090198114566271