Implementing diabetes self-management training programs: breaking through the barriers in primary care.

OBJECTIVE: To review issues, examples, and recommendations for the delivery of diabetes self-management training (DSMT) services in the primary care setting.
METHODS: Barriers to provision of DSMT at the point of care and strategies to overcome such challenges are discussed. In addition, new avenues to support continuing diabetes education are presented.
RESULTS: Diabetes is a complex disease that requires education, monitoring, and medication adjustment to achieve treatment goals. Unfortunately, adequate support is seldom available for the increased time and effort needed for optimal management of diabetes. Health-care delivery systems are designed to provide a response to acute illnesses and are poorly configured to meet the needs of patients with complex chronic illnesses. Although team care and DSMT have proved to be effective, they have infrequently been integrated in primary care offices, where most patients with diabetes receive treatment. It is encouraging that the studies conducted to date have generally found office-based counseling and educational strategies to be effective for the vast majority of patients with diabetes. Community-based programs that extend DSMT have also been successful.
CONCLUSION: Diabetes is a chronic disease that requires providers to deliver multifaceted care and patients to be proficient in many self-care skills. Team care and DSMT approaches have been found to yield beneficial results, yet such strategies are seldom used in the primary care office. Thus, models that support the team approach to delivery of diabetes care and self-management education interventions should be explored and encouraged.