Psychological issues

According to the 1993 US National Adult Literacy Survey, approximately 90 million people in the USA have deficiencies in reading or computational skills that prevent them from fully participating in normal daily activities – such as reading a bus schedule or entering background information on an application form. Although the Survey did not evaluate the ability to read and comprehend health-related materials,

The recent euphoria surrounding the positive effects of preventative measures with people with impaired glucose tolerance or manifest Type 2 diabetes is rarely reflected in the experience of the health-care professionals working with people with diabetes. Despite efforts to advise and inform, there is very little lasting change in health-care behaviour. Many health-care professionals report feelings of frustration and anger. They often describe the people in their care as 'difficult'.

Relatively few studies have examined the psycho-social impact of diabetes. The Diabetes Attitudes, Wishes and Needs (DAWN) Programme addressed this issue in a study involving people with diabetes from 13 countries. A key finding was that depression was much more common in people with diabetes than in those without the condition, and was associated with impaired self-management and quality of life. Other studies confirm that depression often impairs metabolic control in people with the condition.

The establishment of a practice which puts the person at the centre of care will require a change in the attitudes and beliefs of health professionals, and people with diabetes. A service which places the person with diabetes at the centre of care will undoubtedly demand the adoption of this philosophy by the organizations responsible for the delivery of diabetes care, as well as those networks serving the

It is widely agreed that people with diabetes can lead a 'normal' life. Like people who do not have the condition, people with diabetes can function fully in family, workplace, and community settings. However, it is also accepted that diabetes self-care is complex and demanding. Being obliged to balance food intake and exercise against medication, self-administer injections, and self-test blood for glucose levels is not 'normal'. The demands of diabetes self-management can impact negatively on the psychological status of people with the condition. In this article, Ruth

Results from a number of recent studies highlight the importance of psycho-social factors in diabetes management. Research shows that psychological co-morbidity is prevalent in people with diabetes. As a result, well-being, self-care and glycaemic control are adversely affected. Depression is common in people with diabetes, and

When a child is diagnosed with diabetes, the news usually comes as a shock to all family members. This often provokes a crisis which is associated with grief and sadness; a complex scenario emerges. Children with diabetes and their parents often feel overwhelmed by the amount of knowledge required to effectively manage the condition. Parents and children experience feelings of guilt. Parents sometimes feel they may have been able to prevent their child's diabetes; children may blame themselves for an illness, and perceive the condition and its treatment as a form of punishment.

In diabetes care, the principal objective is to improve health outcomes and ensure the total well-being of people with the condition. In order to achieve this, it is important to reach the person beyond the laboratory results and blood glucose

The ultimate goal of diabetes care is to enhance the quality of life of people with the condition. Quality of life is increasingly used as a factor in the evaluation of the quality of care. The results of this evaluation are used by health-care providers in order to make recommendations for future care. Only the person receiving care is capable of evaluating their quality of life during and following medical care.

In order to minimize the risk of diabetes complications, effective therapy for people with Type 2 diabetes involves lifestyle changes and poly-pharmacy targeting levels of blood glucose, blood pressure and blood fat. However, the strict targets set in recent guidelines are seldom achieved by the majority of people with diabetes. Barriers to effective diabetes therapy have been identified within the organization of health care and in the interaction between health-care providers and people with