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provement in hepatic steatosis, 50 –75% in\ninflammation and hepatocyte ballooning\n(necrosis), and 30 –40% in fibrosis (259, | [
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(necrosis), and 30 –40% in fibrosis (259,\n260). It may also reduce the risk of HCC(260). Metabolic surgery should be usedwith caution in individuals with compen-sated cirrhosis (i.e., asymptomatic stage ofcirrhosis without associated liver complica-tions), but with experienced surgeons therisk of hepatic decompensation... | [
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that for individuals with less advanced liver | [
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disease. Because of the paucity of safetyand outcome data, metabolic surgery is notrecommended in individuals with decom-pensated cirrhosis (i.e., cirrhosis stagewith complications such as varicealhemorrhage, ascites, hepatic encepha-lopathy, or jaundice) who also have amuch higher risk of postoperative devel- | [
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opment of these liver-related complica-\ntions (163,176,177).\nA number of studies now recognize | [
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A number of studies now recognize\nthat adults with type 2 diabetes andNAFLD are at an increased risk of car-diovascular disease and require compre-hensive management of cardiovascularrisk factors (163,176,177). Within an in-terprofessional approach, statin therapyshould be initiated or continued for car-diovascular ri... | [
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indicated. Overall, its use appears to be | [
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safe in adults with type 2 diabetes andNASH, including in the presence of com-pensated cirrhosis (Child-Pugh class Aor B cirrhosis) from NAFLD. Some stud-ies even suggest that their use in peoplewith chronic liver disease may reduce ep-isodes of hepatic decompensation and/oroverall mortality (261,262). Statin therapy | [
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is not recommended in decompensated\ncirrhosis given limited safety and ef ficacy\ndata (163,176,177).\nObstructive Sleep Apnea\nAge-adjusted rates of obstructive sleep ap-nea, a risk factor for cardiovascular dis-ease, are signi ficantly higher (4- to 10-fold) | [
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with obesity, especially with central obesityS68 Comprehensive Medical Evaluation and Assessment of Comorbidities Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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(263) (see Section 5, “Facilitating Positive\nHealth Behaviors and Well-being to\nImprove Health Outcomes ”). The preva- | [
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Improve Health Outcomes ”). The preva-\nlence of obstructive sleep apnea in thepopulation with type 2 diabetes may beas high as 23%, and the prevalence ofany sleep-disordered breathing may beas high as 58% (264,265). In participantswith obesity enrolled in the Look AHEADtrial, the prevalence exceeded 80% (266). | [
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Individuals with symptoms suggestive of\nobstructive sleep apnea (e.g., excessivedaytime sleepiness, snoring, and wit-nessed apnea) should be considered forscreening (267). Sleep apnea treatment(lifestyle modi fication, continuous posi-\ntive airway pressure, oral appliances, andsurgery) signi ficantly improves quality o... | [
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life and blood pressure management.\nThe evidence for a treatment effect on\nglycemic control is mixed (268).\nPancreatitis | [
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Diabetes is linked to diseases of theexocrine pancreas, such as pancreatitis,which may disrupt the global architectureor physiology of the pancreas, often result-ing in both exocrine and endocrine dysfunc-tion. Up to half of individuals with diabetesmay have some degree of impaired exo-crine pancreas function (269). Pe... | [
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exo-crine pancreas function (269). People withdiabetes are at an approximately twofold | [
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higher risk of developing acute pancreatitis\n(270).\nConversely, prediabetes and/or diabe- | [
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tes has been found to develop in approxi-mately one-third of individuals after anepisode of acute pancreatitis (271); thus,the relationship is likely bidirectional.Postpancreatitis diabetes may includeeither new-onset disease or previouslyunrecognized diabetes (272). Studies ofindividuals treated with incretin-based | [
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therapies for diabetes have also reported\nthat pancreatitis may occur more fre-quently with these medications, but re-sults have been mixed and causality hasnot been established (273 –275).\nIslet autotransplantation should be | [
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Islet autotransplantation should be\nconsidered for individuals requiring totalpancreatectomy for medically refractorychronic pancreatitis to prevent postsur-gical diabetes. Approximately one-third\nof individuals undergoing total pancrea- | [
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of individuals undergoing total pancrea-\ntectomy with islet autotransplantationare insulin free 1 year postoperatively,and observational studies from differentcenters have demonstrated islet graftfunction up to a decade after the surgeryin some individuals (276 –280). Both per- | [
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son with diabetes and disease factorsshould be carefully considered when de-ciding the indications and timing of thissurgery. Surgeries should be performed inskilled facilities that have demonstrated\nexpertise in islet autotransplantation.\nPeriodontal Disease\nPeriodontal disease is more severe, and | [
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Periodontal Disease\nPeriodontal disease is more severe, and\nmay be more prevalent, in people withdiabetes than in those without and hasbeen associated with higher A1C levels(281–283). Longitudinal studies suggest | [
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that people with periodontal diseasehave higher rates of incident diabetes.Current evidence suggests that peri-odontal disease adversely affects diabe-tes outcomes, although evidence for\ntreatment bene fits remains controver-\nsial (284,285). In an RCT, intensive peri-\nodontal treatment was associated withbetter glyce... | [
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7.8% in control subjects and the inten-\nsive-treatment group, respectively) andreduction in in flammatory markers after\n12 months of follow-up (286).\nSensory Impairment\nHearing impairment, both in high-frequency and low- to midfrequencyr a n g e s ,i sm o r ec o m m o ni np e o p l ew i t h\ndiabetes than in those w... | [
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diabetes than in those without, with stron-\nger associations found in studies of youngerpeople (287). Proposed pathophysiologicmechanisms include the combined contri-\nbutions of hyperglycemia and oxidative | [
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butions of hyperglycemia and oxidative\nstress to cochlear microangiopathy andauditory neuropathy (288). In a NationalHealth and Nutrition Examination Survey(NHANES) analysis, hearing impairment\nwas about twice as prevalent in people | [
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was about twice as prevalent in people\nwith diabetes than in those without, afteradjusting for age and other risk factors forhearing impairment (289). Low HDL choles-terol, coronary heart disease, peripheral\nneuropathy, and general poor health have | [
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neuropathy, and general poor health have\nbeen reported as risk factors for hearingimpairment for people with diabetes, butan association of hearing loss with bloodglucose levels has not been consistently\nobserved (290). In the Diabetes Control | [
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observed (290). In the Diabetes Control\nand Complications Trial/Epidemiology ofDiabetes Interventions and Complications(DCCT/EDIC) cohort, increases in the time-weighted mean A1C was associated with\nincreased risk of hearing impairment\nwhen tested after long-term ( >20 years) | [
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when tested after long-term ( >20 years)\nfollow-up, with every 10% increase in A1Cleading to 19% high-frequency impair-\nment (291). Impairment in smell, but not\ntaste, has also been reported in individualswith diabetes (292).\nStatins | [
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Statins\nSystematic reviews of observational studiesand randomized trials have found no ad-verse effects of statins on cognition (293).The FDA postmarketing surveillance data-bases have also revealed a low reportingrate for cognitive function– related adverse | [
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events, including cognitive dysfunction ordementia, with statin therapy, similar torates seen with other commonly pre-scribed cardiovascular medications (293).Therefore, fear of cognitive decline should\nnot be a barrier to statin use in people with\ndiabetes when indicated.\nReferences\n1. Stellefson M, Dipnarine K, S... | [
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References\n1. Stellefson M, Dipnarine K, Stopka C. The\nchronic care model and diabetes management in\nUS primary care settings: a systematic review.\nPrev Chronic Dis 2013;10:E26\n2. Coleman K, Austin BT, Brach C, Wagner EH.\nEvidence on the Chronic Care Model in the newmillennium. Health Aff (Millwood) 2009;28:75– 8... | [
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0.003... |
3. Gabbay RA, Bailit MH, Mauger DT, WagnerEH, Siminerio L. Multipayer patient-centeredmedical home implementation guided by thechronic care model. Jt Comm J Qual Patient Saf2011;37:265– 273\n4. UK Prospective Diabetes Study (UKPDS) Group.\nIntensive blood-glucose control with sulphonylureas | [
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0.06639742851257324,
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Intensive blood-glucose control with sulphonylureas\nor insulin compared with conventional treatmentand risk of complications in patients with type 2diabetes (UKPDS 33). Lancet 1998;352:837– 853\n5. Nathan DM, Genuth S, Lachin J, et al.; Diabetes\nControl and Complications Trial Research Group. | [
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Control and Complications Trial Research Group.\nThe effect of intensive treatment of diabetes onthe development and progression of long-termcomplications in insulin-dependent diabetes mellitus.\nN Engl J Med 1993;329:977– 986\n6 . L a c h i nJ M ,G e n u t hS ,N a t h a nD M ,Z i n m a nB ; | [
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-0.05027008429169655,
-0.02... |
6 . L a c h i nJ M ,G e n u t hS ,N a t h a nD M ,Z i n m a nB ;\nDCCT/EDIC Research Group. Effect of glycemicexposure on the risk of microvascular complicationsin the diabetes control and complications trial —\nrevisited. Diabetes 2008;57:995– 1001 | [
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0.027408303692936897,
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-0.02058127522468567,
0.02883070707321167,
-0.02683650329709053,
-0.055655... |
revisited. Diabetes 2008;57:995– 1001\n7. White NH, Cleary PA, Dahms W, Goldstein D,Malone J; Diabetes Control and Complications Trial(DCCT)/Epidemiology of Diabetes Interventionsand Complications (EDIC) Research Group.Beneficial effects of intensive therapy of diabetes | [
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... |
during adolescence: outcomes after the conclusionof the Diabetes Control and Complications Trial(DCCT). J Pediatr 2001;139:804– 812\n8. Rodriguez K, Ryan D, Dickinson JK, Phan V.Improving quality outcomes: the value of\ndiabetes care and education specialists. Clin\nDiabetes 2022;40:356 –365 | [
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Diabetes 2022;40:356 –365\n9. Anderson RM, Funnell MM. Compliance andadherence are dysfunctional concepts in diabetescare. Diabetes Educ 2000;26:597 –604\n10. Sarkar U, Fisher L, Schillinger D. Is self-ef ficacy | [
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0.04456... |
10. Sarkar U, Fisher L, Schillinger D. Is self-ef ficacy\nassociated with diabetes self-management acrossrace/ethnicity and health literacy? Diabetes Care2006;29:823– 829diabetesjournals.org/care Comprehensive Medical Evaluation and Assessment of Comorbidities S69\n©AmericanDiabetesAssociation | [
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5. Facilitating Positive Health\nBehaviors and Well-being toImprove Health Outcomes:\nStandards of Care in\nDiabetes —2024\nDiabetes Care 2024;47(Suppl. 1):S77 –S110 |https://doi.org/10.2337/dc24-S005American Diabetes Association\nProfessional Practice Committee *\nThe American Diabetes Association (ADA) “Standards of ... | [
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the ADA ’s current clinical practice recommendations and is intended to provide the\ncomponents of diabetes care, general treatment goals and guidelines, and tools to | [
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evaluate quality of care. Members of the ADA Professional Practice Committee, an in-terprofessional expert committee, are responsible for updating the Standards of Careannually, or more frequently as warranted. For a detailed description of ADA stand-ards, statements, and reports, as well as the evidence-grading system... | [
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practice recommendations and a full list of Professional Practice Committee members,please refer to Introduction and Methodology. Readers who wish to comment on the\nS t a n d a r d so fC a r ea r ei n v i t e dt od os oa tp r o f e s s i o n a l . d i a b e t e s . o r g / S O C . | [
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Building positive health behaviors and maintaining psychological well-being are foun-\ndational for achieving diabetes management goals and maximizing quality of life | [
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(1,2). Essential to achieving these goals are diabetes self-management education andsupport (DSMES), medical nutrition therapy (MNT), routine physical activity, counsel-ing and treatment to support cessation of tobacco products and vaping, health be-\nhavior counseling, and psychosocial care. Following an initial compr... | [
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evaluation (see Section 4, “Comprehensive Medical Evaluation and Assessment of\nComorbidities ”), health care professionals are encouraged to engage in person-\ncentered collaborative care with people with diabetes (3 –6 ) ,a na p p r o a c ht h a ti s | [
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guided by shared decision-making in treatment plan selection; facilitation of obtain-ing medical, behavioral, psychosocial, and technology resources and support; andshared monitoring of agreed-upon diabetes care plans and behavioral goals (7,8).\nReevaluation during routine care should include assessment of medical and... | [
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ioral health outcomes, especially during times of change in health and well-being.\nDIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT\nRecommendations\n5.1Strongly encourage all people with diabetes to participate in diabetes self- | [
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management education and support (DSMES) to facilitate informed decision-making, self-care behaviors, problem-solving, and active collaboration withthe health care team. A\n5.2In addition to annually, there are critical times to evaluate the need for DSMES | [
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to promote skills acquisition to aid treatment plan implementation, medical*A complete list of members of the American\nDiabetes Association Professional Practice Committeecan be found at https://doi.org/10.2337/dc24-SINT.\nDuality of interest information for each author is\navailable at https://doi.org/10.2337/dc24-SD... | [
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available at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association\nProfessional Practice Committee. 5. Facilitatingpositive health behaviors and well-being toimprove health outcomes: Standards of Care in\nDiabetes —2024 . Diabetes Care 2024;47(Suppl. 1):\nS77–S110 | [
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Diabetes —2024 . Diabetes Care 2024;47(Suppl. 1):\nS77–S110\n© 2023 by the American Diabetes Association.Readers may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.5. FACILITATING POSITIVE HEALTH BEHAVIORSDiabetes Care Volume 47, Supplement 1, January 2024 S77\n©AmericanDiabetesAssociation | [
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nutrition therapy, and well-being: at\ndiagnosis, when not meeting treat-\nment goals, when complicating fac-\ntors develop (medical, physical, and\npsychosocial), and when transitions inlife and care occur. E\n5.3Clinical outcomes, health status,\nand well-being are key goals of DSMESthat should be assessed as part of... | [
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tine care. C\n5.4DSMES should be culturally sensi-\ntive and responsive to individual pref-\nerences, needs, and values and may\nbe offered in group or individual set-\ntings. ASuch education and support\nshould be documented and made avail-able to members of the entire diabetes\ncare team. E\n5.5Consider offering DSME... | [
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care team. E\n5.5Consider offering DSMES via tele-\nhealth and/or digital interventions to\naddress barriers to access and improve\nsatisfaction. B\n5.6Since DSMES can improve outcomes\nand reduce costs, reimbursement bythird-party payers is recommended. B\n5.7 Identify and address barriers to | [
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5.7 Identify and address barriers to\nDSMES that exist at the payer, healthsystem, clinic, health care profes-\nsional, and individual levels. E\n5.8 Include social determinants of\nhealth of the target population in\nguiding design and delivery of DSMES\nCwith the ultimate goal of health\nequity across all populations... | [
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Cwith the ultimate goal of health\nequity across all populations.\nThe overall objectives of DSMES are to\nsupport informed decision-making, self-\ncare behaviors, problem-solving, and ac-\ntive collaboration with the health careteam to improve clinical outcomes, health\nstatus, and well-being in a cost-effective | [
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status, and well-being in a cost-effective\nmanner (2). DSMES services facilitate theknowledge, decision-making, and skills\nmastery necessary for optimal diabetes\nself-care and incorporate the needs, goals,and life experiences of the person with\ndiabetes. Health care professionals are | [
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diabetes. Health care professionals are\nencouraged to consider the burden oftreatment (9) and the person ’s level of\nconfidence and self-effi cacy for manage-\nment behaviors as well as the level of so-cial and family support when providing\nDSMES. An individual ’s engagement in\nself-management behaviors and the ef- | [
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self-management behaviors and the ef-\nfects on clinical outcomes, health status,and quality of life, as well as the psychoso-\ncial factors impacting the person ’s ability\nto self-manage, should be monitored aspart of routine clinical care. A randomized\ncontrolled trial (RCT) testing a decision-\nmaking education an... | [
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making education and skill-building pro-\ngram (10) showed that addressing thesetargets improved health outcomes in a\npopulation in need of health care resour-\nces. Furthermore, following a DSMES cur-\nriculum improves quality of care (11).\nAs the use of judgmental words is asso-\nciated with increased feelings of s... | [
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ciated with increased feelings of shame\nand guilt, health care professionals areencouraged to consider the impact that\nlanguage has on building therapeutic re-\nlationships and should choose positive,\nstrength-based words and phrases that\nput people first (4,12). Please see Section 4,\n“Comprehensive Medical Evaluat... | [
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“Comprehensive Medical Evaluation and\nAssessment of Comorbidities, ”for more on\nuse of language.\nIn accordance with the national stand-\nards for DSMES (13), all people with dia-\nbetes should participate in DSMES, as it\nhelps people with diabetes to identify and\nimplement effective self-management\nstrategies and... | [
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strategies and cope with diabetes (2). On-\ngoing DSMES helps people with diabetes\nto maintain effective self-managementthroughout the life course as they en-\ncounter new challenges and as advances\nin treatment become available (14).\nIn addition to annually, there are critical | [
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In addition to annually, there are critical\ntime points when the need for DSMESshould be evaluated by the health care\nprofessional and/or interprofessional team,\nwith referrals made as needed (2):\n\x81At diagnosis\n\x81When not meeting treatment goals\n\x81When complicating factors (e.g., health\nconditions, physic... | [
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conditions, physical limitations, emo-\ntional factors, or basic living needs) that\ninfluence self-management develop\n\x81When transitions in life and care occur\nDSMES focuses on empowering individu-\nals with diabetes by providing them with thetools to make informed self-management\ndecisions (15). DSMES should be p... | [
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decisions (15). DSMES should be person-\ncentered; this is an approach that places\nthe person with diabetes and their family\nand/or support system at the center of\nthe care model, working in collaboration\nwith health care professionals. Person-\ncentered care is respectful of and respon-\nsive to individual and cul... | [
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sive to individual and cultural preferences,\nneeds, and values. It ensures that the val-\nues of the person with diabetes guide all\ndecision-making (16).Evidence for the Benefits\nDSMES is associated with improved dia-\nbetes knowledge and self-care behaviors\n(17), lower A1C (17 –22), lower self-reported\nweight (23... | [
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weight (23), improved quality of life\n(19,24,25), reduced all-cause mortality\nrisk (26), positive coping behaviors (5,27),and lower health care costs (28 –30). DSMES\nis associated with an increased use of pri-mary care and preventive services (28,31,32)and less frequent use of acute care and inpa-tient hospital serv... | [
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betes who participate in DSMES are more\nlikely to follow best practice treatmentrecommendations, particularly those with\nMedicare, and have lower Medicare and\ninsurance claim costs (29,32). Better out-comes were reported for DSMES interven-\ntions that were >10 h over the course of\n6–12 months (20), included ongoin... | [
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6–12 months (20), included ongoing sup-\nport (14,33), were culturally (34 –36) and\nage appropriate (37,38), were tailored\nto individual needs and preferences, ad-dressed psychosocial issues, and incorpo-\nrated behavioral strategies (15,27,39,40).\nIndividual and group approaches are ef-fective (41 –43), with a slig... | [
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ized by those who engage in both (20).\nStrong evidence now exists on the\nbene fits of virtual, telehealth, telephone-\nbased, or internet-based DSMES for dia-\nbetes prevention and management in a\nwide variety of populations and age-groups of people with diabetes (44 –56). | [
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Technologies such as mobile apps, simu-lation tools, digital coaching, and digitalself-management interventions can also\nbe used to deliver DSMES (57 –62). These\nmethods provide comparable or even im-\nproved outcomes compared with traditionalin-person care (63). Greater A1C reductions\nare demonstrated with increase... | [
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are demonstrated with increased engage-\nment (64), although data from trials areconsiderably heterogeneous.\nTechnology-enabled diabetes self-\nmanagement solutions improve A1C mosteffectively when there is two-way commu-nication between the person with diabetes\nand the health care team, individualized | [
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and the health care team, individualized\nfeedback, use of person-generated healthdata, and education (47). Continuous glu-\ncose monitoring (CGM), when combined\nwith individualized diabetes education orbehavioral interventions, has demonstrated\ngreater improvement on glycemic and psy- | [
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greater improvement on glycemic and psy-\nchosocial outcomes compared with CGMalone (64,65). Similarly, DSMES plus inter-\nmittently scanned CGM has demonstrated\nincreased time in range (70 –180 mg/dL | [
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increased time in range (70 –180 mg/dL\n[3.9–10.0 mmol/L]), less time above range,S78 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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and a greater reduction in A1C compared\nwith DSMES alone (66). Incorporating asystematic approach for technology as-sessment, adoption, and integration intothe care plan may help ensure equity in\naccess and standardized application of\ntechnology-enabled solutions (www.diabeteseducator.org/danatech/home)(8,31,67 –70)... | [
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Research supports diabetes care and\neducation specialists (DCES), includingnurses (registered nurses and nurse prac-titioners), registered dietitian nutritionists(RDNs), pharmacists, and other health\nprofessionals as providers of DSMES who\ncan also tailor curricula to individual needs(71–73). Members of the DSMES te... | [
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should have specialized clinical knowledge\nof diabetes and behavior change principles.\nIn addition, a DCES needs to be knowledge-able about technology-enabled servicesand may serve as a technology championwithin their practice (68). Certi fication as a\nDCES (cbdce.org/) and/or board certi fi- | [
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DCES (cbdce.org/) and/or board certi fi-\ncation in advanced diabetes manage-ment (diabeteseducator.org/education/certification/bc_adm) demonstrates an\nindividual ’s specialized training in and\nunderstanding of diabetes managementand support (56), and engagement withqualified professionals has been shown | [
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to improve diabetes-related outcomes(74). Additionally, there is growing evi-dence for the role of community healthworkers (75,76), as well as peer (75 –80)\nand lay leaders (81), in providing ongoing\nsupport.\nGiven individual needs and access to re-\nsources, a variety of culturally adapted | [
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sources, a variety of culturally adapted\nDSMES programs need to be offered in avariety of settings. The use of technology\nto facilitate access to DSMES, support\nself-management decisions, and decreasetherapeutic inertia calls for broader adop-tion of these approaches (82). Additionally,\nit is important to include s... | [
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it is important to include social determi-\nnants of health (SDOH) of the target popu-lation in guiding design and delivery ofDSMES. The DSMES team should consider\ndemographic characteristics such as race, | [
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demographic characteristics such as race,\nethnic/cultural background, sex/gender,age, geographic location, technology ac-cess, education, literacy, and numeracy(56,83). For example, a systematic review\nand meta-analysis of telehealth DSMES in- | [
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and meta-analysis of telehealth DSMES in-\nterventions with Black and Hispanic peoplewith diabetes showed a 0.465% decreasein A1C, demonstrating the importance of\nconsidering demographic factors in rela-\ntion to DSMES interventions (53).Despite the bene fits of DSMES, data\nfrom the 2017 and 2018 Behavioral Risk | [
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from the 2017 and 2018 Behavioral Risk\nFactor Surveillance System of 61,424adults with self-reported diabetes indi-cate that only 53% of individuals eligible\nfor DSMES through their health insur-\nance receive it (84). Barriers to DSMESexist at the health system, payer, clinic,health care professional, and individual | [
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levels. Low participation may be due to\nlack of referral or other identi fied bar-\nriers, such as logistical issues (accessibil-ity, timing, and costs) and the lack of a\nperceived bene fit (85). Health system,\nclinic, programmatic, and payer barriers\ninclude lack of administrative leadershipsupport, limited numbers ... | [
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fessionals, not having a referral to DSMES\neffectively embedded in the health sys-tem service structure, and limited reim-bursement rates (86). Thus, in addition to\neducating referring health care professio-\nnals about the bene fits of DSMES and the\ncritical times to refer, efforts need to bemade to identify and add... | [
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barriers at each level (2). For example, a\nmultilevel diabetes care intervention thatcombined clinical outreach, standardizedprotocols, and DSMES with SDOH screen-\ning and referrals to social needs support\ndocumented a 15% increase in receipt ofDSMES, including among people on Med-icaid (87). Support from institutio... | [
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ership is foundational for the success of\nDSMES. Expert stakeholders should alsosupport DSMES by providing input andadvocacy (56). Alternative and innovative\nmodels of DSMES delivery (58) need to\nbe explored and evaluated, including theintegration of technology-enabled diabe-tes and cardiometabolic health services | [
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(8,68). One potential model is virtual envi-\nronments, which allow people with diabe-tes to self-represent as avatars and interactin a world with embedded informational re-\nsources accessed using principles of gamifi -\ncation. An RCT testing DSMES in a virtual\nenvironment demonstrated greater weightloss but similar ... | [
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pressure, cholesterol, and triglycerides com-\npared with DSMES via a standard website(88). Barriers to equitable access to DSMESmay be addressed through telehealth deliv-\nery of care, virtual environments, and other\ndigital health solutions (56).\nReimbursement | [
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digital health solutions (56).\nReimbursement\nMedicare reimburses DSMES when thatservice meets the national standards(2,56) and is recognized by the American\nDiabetes Association (ADA) through the Ed-ucation Recognition Program (professional.diabetes.org/diabetes-education) or bythe Association of Diabetes Care & Edu... | [
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tion Specialists (diabeteseducator.org/\npractice/diabetes-education-accreditation-program). DSMES is also covered by mosthealth insurance plans. Ongoing support\nhas been shown to be instrumental for im-\nproving outcomes when it is implementedafter the completion of education services.Medicare reimburses remote physi... | [
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monitoring for glucose and other cardio-\nmetabolic data if certain conditions aremet (89). For Medicare Part B, the basicsof the DSMES bene fit include individual\nencounters reimbursable for the first 10 h | [
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0.012543044053018093,
-0.041176967322826385,
-0.0... |
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