When to Refer
AADE, the American Diabetes Association and the Academy of Nutrition and Dietetics issued joint guidance on when DSMES is most critical and a referral is needed for optimal outcomes. These include:
- At Diagnosis
- During an annual assessment
- When a person with diabetes faces new complicating factors
- When there is a transition in care
Medicare covers up to 10 hours of DSMES (referred to as diabetes self-management training - DSMT - within Medicare) as a once-in-a-lifetime benefit that must be used within 12 consecutive months once started. Each subsequent calendar year, Medicare covers up to 2 hours of DSMT with a new referral. Most commercial insurers follow Medicare, but its best to have each person check with their insurer to verify coverage. DSMT programs may be able to assist participants with this.