Authors: Shivajirao P. Patil, MD, MPH, BC-ADM , Anastasia Albanese-O’Neill, PhD, APRN, CDCES , Kirsten Yehl, MS, MLIS , Jane Jeffrie Seley, DNP, MPH,MSN, GNP, BC-ADM, CDCES, CDTC , and Allyson S. Hughes, PhD
Diabetes technology requires HCPs to stay current with treatment goals and practice guidelines. The complexities of caring for persons with diabetes (PWD) who utilize diabetes technology is best accomplished in collaboration with the multiple members of the care team and support staff to cover all aspects of technology including prior authorizations, onboarding PWD, downloading and interpreting data and supporting ongoing utilization.
A recent publication, developed with support from ADCES, introduces a comprehensive set of role-based competencies for HCPs, DCESs, and staff for the selection, implementation and sustainability of diabetes technology when providing diabetes care, education, and support.
For guidance on leveraging all members of the care team and support staff to deliver comprehensive diabetes management and support to PWD utilizing diabetes technology in their self-care regimen, make sure to download and read the full paper The Professional Competencies for Diabetes Technology Use in the Care Setting.
Below is a sample of the full paper. Or, read the full paper.
Purpose: The integration of diabetes technology into diabetes care and self-management is evolving so rapidly that providing sufficient support has become an obstacle for many health care professionals (HCPs) in practice. Diabetes technology requires HCPs to stay current with treatment goals and practice guidelines. Diabetes care and education specialists (DCESs) are well positioned to take on this challenge by seizing opportunities to apply their skills, knowledge, and experience to contribute to a technology-enabled practice environment. Diabetes technology includes devices, hardware, and software utilized to manage all aspects of diabetes care, including lifestyle management, glucose monitoring, and insulin delivery.
The complexities of caring for persons with diabetes (PWD) who utilize diabetes technology is best accomplished in partnership with other members of the care team and support staff to cover all aspects of technology including prior authorizations, onboarding PWD, downloading and interpreting data, and supporting ongoing utilization. The purpose of this article is to introduce a comprehensive set of role-based competencies for HCPs, DCESs, and staff for the selection, implementation, and sustainability of diabetes technology when providing diabetes care, education, and support. The role-based competencies described in this article are intended to support the initiation, continuation, and optimal use of diabetes technology in practice through ongoing education and guidance of care team members.
Conclusion: This article describes the diabetes technology competencies essential for all levels of the care team and support staff in various care settings to deliver comprehensive diabetes management and support to PWD utilizing diabetes technology in their self-care regimen.
Based on the findings of the Delphi study,12 7 domains of diabetes technology competencies for diabetes care and education specialists were proposed. These 7 domains are organized in an intentional sequence to facilitate natural flow from device and data knowledge to special situations such as schools and camps. Within each domain, the competencies are organized by 4 practice levels: Basic, Fundamental, Intermediate, and Advanced.
Diabetes technology can improve the quality of life and health outcomes of PWD. Knowledgeable clinicians and staff are essential to support the optimal use of technology. Diabetes care team members should receive training on various aspects of diabetes technology applicable to their respective roles and settings. They should stay up to date as diabetes technology continues to evolve.
Objective data should inform diabetes care, education, and support, and clinic visits should utilize data collected by diabetes devices to formulate and adjust diabetes management plans for PWD. Therefore, the diabetes care team members need to know how to access and share data from available diabetes devices.
The ADA recommends individualizing glycemic targets based on individual and disease factors. These factors include risk of hypoglycemia, disease duration, life expectancy, significant comorbidities, established vascular complications, PWD preference, resources, and support system.13 Familiarity and ability to determine individual glycemic targets for a person with diabetes through a shared decision-making process is essential for diabetes care team members to provide according to their practice level. This includes setting up devices, using safety features, and making diabetes management decisions. Therefore, in Domain 3 (see Table 3 for more information), we propose increasing knowledge and skills related to glycemic targets and diabetes management as the level of practice increases from Basic to Advanced (eg, the ability to set up BGMs at a fundamental level vs insulin pumps or AID systems at the Advanced level).
Education for PWD is essential to achieve engagement and improve outcomes. Diabetes care team members should assist PWD in device/program selection and support device use over time through onboarding, initial skills training, ongoing education, and support. Although educating PWD on device use and safety features is essential, it is equally important to create and educate PWD about backup plans in case of device failures. In Domain 4, competencies that support sufficient education and empowerment are proposed.
Diabetes technology services should be designed, delivered, and supported in a person-centered manner while reducing disparities in their use. Technology processes should be effectively embedded in the health system structure to facilitate care team members and PWD use. Health policy, payers, health systems, providers, and health care teams should streamline reimbursement processes for sustainable diabetes technology use. Domain 5 includes competencies encouraging site-specific processes at various levels.
Well-equipped and efficient diabetes care team members and engaged PWD are essential for successfully utilizing diabetes technology. However, it is also important to recognize and address potential psychosocial effects of technology use for PWD and diabetes care team members, which may become barriers to achieving intended health outcomes. Domain 6 identifies such factors and proposes competencies to address these factors across technology practice levels.
Diabetes management must be around the clock for children, regardless of setting, including school, child care, and camp. Supporting the use of diabetes technology in these settings helps children stay healthy and safe, allowing them to enjoy the same activities as their peers. Domain 7 includes competencies that encourage and support diabetes technology use in these special settings.