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Diabetes education, self-management, still key
Diabetes prevention requires lifestyle and environmental changes.
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Diabetes is difficult to treat and prevent, requires lifestyle and environmental changes, includes various strategies, should be self-managed and necessitates comprehensive health care reform, according to Francine Ratner Kaufman, MD, distinguished professor of pediatrics and communications at Keck School of Medicine and Annenberg School of Communications of the University of Southern California, Los Angeles.
“Type 2 diabetes, nearly universally associated with obesity, can be prevented by healthy eating and appropriate physical activity leading to weight loss and increased fitness,” she told Endocrine Today.
Treatment of diabetes can be difficult for patients due to monitoring of blood glucose, understanding glucose targets, taking medication multiple times a day, balancing a diet, understanding the role of physical activity and a healthy weight, visiting a health care provider and avoiding risky behaviors, according to Kaufman.
“Managing diabetes successfully requires a partnership between the patient and his or her health care provider team,” she said during an interview.
The chronic care model joins the community and health systems to allow for productive interaction between informed, activated patients and prepared practice teams. Clinicians reported that use of the chronic care model was associated with lower HbA1c (P=.2); for every unit of chronic care model used there was a 0.30% decrease in HbA1c, according to results of a study cited by Kaufman during the presentation.
There are diabetes strategies and programs available that may be beneficial for physicians and patients, according to Kaufman. Diabetes self-management training entails providing patients with information and regular follow-up, encouraging them to choose healthy behaviors and be active participants, teaching them disease-specific and problem-solving skills and assisting them with the emotional impact of the disease.
Studies to date have shown the diabetes self-management training and support has led to better health outcomes, and internet support has helped with positive behavior changes, such as increased exercise time and weight loss maintenance, according to findings cited by Kaufman. – by Christen Haigh
Self-management of diabetes is a critical feature. It takes effort to live with the disease so it is important to have access to people who can guide, coach and train patients with diabetes not only in the mechanics of managing diabetes, such as how to use a meter and how to take medications, but also in discussing nutrition and physical activity choices and behavioral and psychosocial coping issues. Self-management is crucial to a self-managed disease. Diabetes is a disease of decision-making and that is what self-management is designed for. It is not the health care providers’ role to make decisions for patients; it is their role to provide support to help patients make choices.
Embedded in the chronic care model are things empowering the patient to know their active role. Certain things need to happen within the health care setting, and that is often where a good portion of the self-management training occurs; however, patients carry the guidance they have been given outside of the health care setting. It is important to pay attention to strengthening reciprocal interaction between community, which is not only a neighborhood, but also a support system, a place of worship and such.
It is not enough for patients to only receive training in a health care setting; they have to work on it, try it, live it and use it in a way that makes sense to them. Often times that requires some additional support and follow-up. There is a lot of discussion about compliance when speaking about diabetes self-management. Patients are complying with what they feel they can do; the real question is, are we equipping patients with the tools they need, and are we helping them cope, adjust and problem solve. Much of diabetes management is problem solving. Patients can manage their diabetes somewhat within the health care setting, but some management has to happen within the other parts of their worlds.
– Ann Albright, RD, PhD
Director of the Division of Diabetes Translation, CDC
For more information:
- Kaufman FR. The diabetes epidemic. Presented at: Forum on Diabetes/Broaden Your View Meeting; March 12-13, 2008; Washington, D.C.