The options for delivery of DSMES have grown dramatically in recent years as technology has been incorporated into healthcare, and simultaneously as more people have become comfortable using technology for communication, teaching, and learning. Various modes of delivery can support increased communication between PWD and the DSMES team and improve diabetes-related outcomes. Strong evidence supports DSMES delivery through virtual, telehealth, telephone, text messaging, and web-based/mobile phone applications (apps) (50–55).

The most effective and evidence-based delivery methods move beyond the mere acquisition of knowledge to support informed decision making while addressing psychosocial concerns of the PWD (56,57). The use of interactive teaching styles that include meaningful discussions to address individual questions and needs while fostering a culture of positivity within the DSMES services is recommended. The curriculum content and delivery should be creative, culturally appropriate (58,59), and adapted as necessary for the individuals and groups within the target population (60–64). Furthermore, culturally tailored services have been shown to be effective in improving diabetes care outcomes (59,65).

A curriculum provides guidance for the DSMES team, effective teaching strategies, and methods for evaluating learning outcomes and includes all aspects of diabetes self-management and support (66–68). DSMES delivery should integrate topics across content areas rather than creating silos of content that limit informed and wise decision making. The delivery of curriculum content must be dynamic and based on continuing assessment of need, preferences, and evaluation of outcomes (66,68–71). Recent education research endorses the inclusion of practical problem solving and self-advocacy approaches, as well as collaborative care, including family and peer support, addressing psychosocial issues, behavior change, diabetes devices, and strategies to sustain self-management efforts (21,24,65,72–78). The ADCES7 Self-Care Behaviors (i.e., healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem solving) is an evidence-based framework and outline to provide and document diabetes care and education that can be used in conjunction with the chosen curricula (79). A DSMES curriculum must include the following core content areas, and content must be prioritized to meet the individual PWD’s current needs and goals (3,15,80,81):

Pathophysiology of diabetes and treatment options

Healthy coping

Healthy eating

Being active

Taking medication

Monitoring

Reducing risk (treating acute and chronic complications)

Problem solving and behavior change strategies