Revised self-care guidance builds on new roles for diabetes specialists
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The Association of Diabetes Care & Education Specialists published an updated version of its self-care behavior framework this month, incorporating the latest advances in behavioral health, the expanded roles of diabetes care and education specialists and more than a decade’s worth of updates in diabetes technology.
The revised AADE7 Self-Care Behaviors, published in The Diabetes Educator, also reflects growing shifts in diabetes, prediabetes and cardiometabolic care since the organization’s last update in 2010. As Healio previously reported, ADCES formally changed its name in January.
“Our overall goals with this revision were quite simple,” Kellie Antinori-Lent, MSN, RN, ACNS-BC, BC-ADM, CDCES, FAADE, a diabetes clinical nurse specialist at the University of Pittsburgh Medical Center Shadyside Hospital and 2020 ADCES president, told Healio. “There are two goals. One is to provide the diabetes care and education specialists a framework upon which to provide the best care for their patients. Another is to ensure that the people we care for are able to reach their best outcomes and thrive. That is really what this is all about.”
The updated framework now incorporates the use of technology — an evolution that has revolutionized diabetes self-care — throughout the document, Antinori-Lent said, part of a broader effort to make the guidance reflect connected lifestyle changes.
“The original model was more linear,” Antinori-Lent said. “Even though there was overlap with the different behaviors, we have taken it to a more circular model. This has evolved beyond knowledge and behavior change. We are focusing on the person, and we are focusing on quality — the quality of care we deliver and on quality of life for the person with diabetes.”
The seven self-care behaviors outlined in the revised framework are:
healthy coping — defined as a “positive attitude toward diabetes and self-management, positive relationships with others and quality of life”;
healthy eating — referring to a “pattern of eating a wide variety of high-quality, nutritionally dense foods in quantities that promote optimal health and wellness”;
being active — inclusive of all types, durations and intensities of daily physical movement, which equates to bouts of aerobic exercise training as well as unstructured activities;
taking medication — practicing optimal medication-taking behaviors, such as following day-to-day prescribed treatments and continuing treatments for the prescribed duration;
monitoring — expanding beyond self-monitoring of blood glucose, the revised framework now stresses monitoring of blood pressure, activity, nutritional intake, weight, medication, feet and skin, mood, sleep and other aspects of self-care;
reducing risk — identifying risks and implementing behaviors that can minimize or prevent diabetes complications, such as hyperglycemia and hypoglycemia; and
problem-solving — using diabetes self-management education and support, or DSMES, to learn strategies to facilitate goal setting, goal achievement and skill achievement.
Healthy coping is the center of the framework, Antinori-Lent said, adding that it is “a critical first step” in the mastery of the other six behaviors.
“Stress, for anyone, makes life challenging,” Antinori-Lent said. “With diabetes, the stress can negatively impact your self-care and hence your health.”
Other changes include a greater awareness of social determinants of health, or the economic and social conditions that can influence behaviors, she said.
“The team that worked on this revision did an amazing job incorporating the pillars that support our new vision, to energize and motivate and encapsulate the work we do and are capable of doing,” Antinori-Lent said. “The actual behaviors remain the same. It is the content within them that has been enriched.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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