Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes (1,2). The prevalence of diagnosed diabetes is projected to increase in the U.S. from 22.3 million (9.1% of the total population) in 2014, to 39.7 million (13%) in 2030, and to 60.6 million (17%) in 2060 (3). Approximately 90-95% of those with diabetes have type 2 diabetes (4). Diabetes is an expensive disease, and the medical costs of health care alone for a person with diabetes are 2.3 times more than for a person without diabetes (5). Confounding the diabetes epidemic and high costs, therapeutic targets are not being met (6). There is a lack of improvement in reaching clinical target goals since 2005 despite advancements in medication and technology treatment modalities. Indeed, between 2010 and 2016 improved outcomes stalled or reversed (6). The goals of this Consensus Report are to improve clinical care and education services, to improve the health of individuals and populations, and to reduce diabetesassociated per capita health care costs (1,7). This article is specifically directed toward health care providers (physicians, nurse practitioners, physician assistants [PAs]), referred to herein as providers, as it outlines the benefits of DSMES, defines four critical times to provide and modify DSMES (see Fig. 1), proposes how to locate DSMESrelated resources, and discusses potential solutions to access and utilization barriers. This

Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes (1,2). <p>The prevalence of diagnosed diabetes is projected to increase in the U.S from 22.3 million (9.1% of total population) in 2014, to 39.7 million (13%) in 2030, and to 60.6 million (17%) in 2060 (3). Approximately 90-95% of those with diabetes have type 2 diabetes (4). Diabetes is an expensive disease, and the medical costs of health care alone for a person with diabetes are 2.3 times more than for a person without diabetes (5). Confounding the diabetes epidemic and high costs, therapeutic targets are not being met (6). There is a lack of improvement in reaching clinical target goals since 2005 despite advancements in medication and technology treatment modalities. Indeed, between 2010 and 2016 improved outcomes stalled or reversed (6).</p> <p>The goals of the consensus report are to improve clinical care and education services, to improve the health of individuals and populations, and to reduce diabetes-associated per capita health care costs (1,7). This paper is specifically directed towards health care providers (physicians, nurse practitioners, PAs), referred to herein as providers, as it outlines the benefits of DSMES; defines 4 critical times to provide and modify DSMES (see Figure 1); proposes how to locate DSMES related resources; and discusses potential solutions to access and utilization barriers. This report provides guidance to others as well: health systems and organizations can use this report to anticipate and address the needs of persons with diabetes and create access to DSMES services; persons with diabetes can increase their awareness of DSMES services as part of quality care and can advocate for self-management education and support; and payers and policy makers can work to design reimbursement processes that support participation in DSMES. The consensus report’s recommendations are listed in Table 1.</p>

J.K.B reports being a past chair of the Certification Board for Diabetes Care and Education, is the program chair for the Association of Diabetes Care & Education Specialists annual meeting, and has been a consultant to Joslin Diabetes Center. M.M.F. is on an advisory board of Eli Lilly. D.H. is the treasurer for the American Academy of Nurse Practitioners Certification Board of Commissioners and vice president of the American Nurse Practitioner Foundation. A.H.-F. reports receiving an honorarium from ADA as an Education Recognition Program auditor and is a participant in a speakers bureau sponsored by Abbott Diabetes Care and Xeris. D.I. reports being a participant in a speakers bureau/consultant for Xeris Pharmaceuticals, Novo Nordisk, Dexcom, and Lifescan. M.D.M. reports being a paid consultant of Diabetes-What to Know, Arkray, and DayTwo. A.N. reports being a participant in speakers bureaus sponsored by Boehringer Ingelheim, Novo Nordisk, and Xeris. L.M.S. reports research grant funding from Becton Dickinson. S.U. has received honoraria from ADA. No other potential conflicts of interest relevant to this article were reported.

Purpose The purpose of this article is to present a framework for optimizing technology-enabled diabetes and cardiometabolic care and education using a standardized approach. This approach leverages the expertise of the diabetes care and education specialist, the multiplicity of technologies, and integration with the care team. Technology can offer increased opportunity to improve health outcomes while also offering conveniences for people with diabetes and cardiometabolic conditions. The adoption and acceptance of technology is crucial to recognize the full potential for improving care. Understanding and incorporating the perceptions and behaviors associated with technology use can prevent a fragmented health care experience. Conclusion Diabetes care and education specialists (DCES) have a history of utilizing technology and data to deliver care and education when managing chronic conditions. With this unique skill set, DCES are strategically positioned to provide leadership to develop and deliver technology-enabled diabetes and cardiometabolic health services in the rapidly changing healthcare environment.

Purpose Diabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has prompted the need to reexamine the knowledge, skills, and abilities necessary for diabetes care and education specialists in today’s dynamic health care environment. The purpose of this article is to introduce an updated set of competencies reflective of the profession in this dynamic health care environment. Diabetes care and education specialists are health care professionals who have achieved a core body of knowledge and skills in the biological and social sciences, communication, counseling, and education and who have experience in the care of people with diabetes and related conditions. Members of this specialty encompass a diverse set of health disciplines, including nurses, dietitians, pharmacists, physicians, mental health professionals, podiatrists, optometrists, exercise physiologists, physicians, and others. The competencies are intended to guide practice regardless of discipline and encourage mastery through continuing education, individual study, and mentorship. Conclusion This document articulates the competencies required for diabetes care and education specialists in today’s dynamic health care environment as they pursue excellence in the specialty.