We all know that diabetes self-management education and support (DSME/S) produces reduction in A1C in short term results. We also know that better approaches in diabetes education produce better outcomes. Also - we know that that better outcomes are associated with more frequent encounters with diabetes educators. All this makes sense as diabetes education is dose dependent and it only works if taken the way it is intended.

The question remains: Are we doing all that needs to be done in between the in-person sessions and after, to achieve the desired outcomes?

I have been trying to answer that question on a more micro level with my own patients and my own performance as a digital/online diabetes educator. I have been providing digital/online support to several of my patients after they completed the in person DSME since 2015. I have been using our Digital Engagement Platform (DEP) and keeping the momentum going in between the Map sessions and after they completed their ten hours of DSME.

Here is what I have learned from providing online support and education:

1. A clear purpose, mission and intervention is needed as to why we are doing what we are doing
2. Patients want to know what is expected of them in the process
3. Ongoing self-reflection on short vs. long term goals is needed for both patient and the diabetes educator
4. Goals change - and if not addressed in a timely manner the patient may withdraw
5. Participants appreciate when I mention to them that I remember what they talked about at their last Map session or what was important to them in the past
6. Participants like it when I observe their goals and progress, and reflect on it weekly
7. They like when I send them a note once per week asking how are things going instead of just checking on their performance
8. We do not always address metabolic outcomes or education but life itself and come up with strategies to address other issues in order to open up possibilities for diabetes priorities
9. We celebrate small weekly or daily successes instead of just goal attainment
10. We focus on what can be done instead of what cannot be done on a daily basis and consequently dealing with real time issues

In conclusion, a clear scope of practice for diabetes educators involved in digital DSME/S is needed in order to provide evidence-based approaches and expect a desirable outcomes. I am very happy to learn from doing and allowing my patients to teach me what it takes to provide the support they need to succeed.

I realize that I am not providing a clear answer to my question of “Is providing in-person only diabetes education enough to achieve better diabetes care outcomes?” but what I can answer now is that my own patients want more than just in-person education and, achieving or maintaining a desirable outcomes are not sustainable without continuous engagement.