This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.
Over thirty million American have diabetes mellitus, with Type 2 (T2DM) the most common (CDC, 2024b). Unsurprisingly, T2DM is also more prevalent in rural America, (10% in rural compared to 8% in urban areas), with higher mortality rates. Potential health challenges contributing to these death statistics include more comorbidities exacerbating this chronic condition, difficulty in obtaining continuing diabetes treatment and in obtaining heart-healthy foods, and environmental factors (Dugani et al., 2022). A family history of T2DM, excessive weight, inadequate exercise, older age, and having certain racial and ethnic lineages (i.e., Alaska Native, American Indian, African American, Hispanic, and Asian or Pacific Islander) are other risks (University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis, 2020).
While research indicates diabetes self-management education and support (DSMES) are particularly important, over 60% of rural neighborhoods are without this asset (CDC, 2024b). DSMES provides preventative interventions, improves glycemic control, self-confidence, and quality of life, with fewer complications, emergency care, and hospitalizations. Resources (CDC, 2024a; 2024c) for both T2DM health professionals and patients include the following:
- Education and Support Information sends patients this patient-friendly information on how DSMES services can help people with diabetes learn how to take care of themselves.
Medicare will reimburse 10 hrs. of DSMES if health providers meet certain guidelines for billing. Fortunately, yearly training is available either after the initial benefit period or beginning in January of the following year (ACDES; 2022). While reimbursement to private payers varies, some may follow guidelines provided by the Centers for Medicaid and Medicare Services, possibly because of cost savings in reducing costs for acute emergencies and co-morbidities. Seeking programs that provide funding to providers for DSMES services offered to uninsured individuals with T2DM offers many benefits, but providers must be patient in identifying these resources to enhance diabetes care.
References
Association of Diabetes Care & Education Specialists (ACDES; 2022). Frequently asked questions: DSMES AND DSMT reimbursement. https://www.adces.org/docs/default-source/default-document-library/ask-the-reimbursement-expert-faq-2022-final.pdf?sfvrsn=f0b49158_0
Centers for Disease Control and Prevention (CDC, 2024a). Referring patients to DSMES. https://www.cdc.gov/diabetes/hcp/dsmes/index.html
Centers for Disease Control and Prevention (CDC, 2024b). Rural health: Diabetes self-management in rural America as a public health issue. https://www.cdc.gov/rural-health/php/public-health-strategy/public-health-considerations-for-diabetes-self-management-education-and-support-in-rural-america.html
Centers for Disease Control and Prevention (CDC, 2024c). About diabetes self-management education and support. https://www.cdc.gov/diabetes/education-support-programs/index.html
Dugani, S. B., Wood-Wentz, C. M., Mielke, M. M., Bailey, K. R., & Vella, A. (2022). Assessment of disparities in diabetes mortality in adults in U.S. rural vs. nonrural counties, 1999–2018. JAMA Network Open, 5(9), e2232318. https://doi.org/10.1001/jamanetworkopen.2022.32318
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M, Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., Uelmen,& Sachaet, A. L. (2020). 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. The Diabetes Educator, 46(4), 350-369. https://doi.org/10.1177/0145721720930959
University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis. (2020). Rural diabetes prevention and management toolkit [online]. Rural Health Information Hub. https://www.ruralhealthinfo.org/toolkits/diabetes
