People with diabetes

People  with  diabetes  face  a  range  of challenges. Having the condition affects all areas of life; a number of psychological and emotional factors are involved. Recently, one of the authors of this article, Robin Wynyard, was diagnosed with type 2 diabetes. The shock of being diagnosed provoked in him and his partner, Sue Shea, negative feelings that included fear, anxiety and uncertainty – a common emotional response which often goes unreported in the related literature.

Diabetes management involves more than just medical treatment (healthcare providers prescribing insulins and other medications to people with the condition in order to avoid or postpone diabetes complications); it is far more complex. People with diabetes are required to take responsibility, with the help of professional educators, for the day-to-day management of their condition. A major challenge inherent in diabetes management is striving to become a fully participating, active, productive member of society.

Diabetes distinguishes itself from many other chronic conditions because of the complexity of its day-to-day management – both medical management and self-management, which must be carried out by people with diabetes on a sometimes hourly basis. People require self-management education in order to master these complexities. Kate Lorig discusses the complexity of diabetes self-management education, how it is currently delivered, and suggests an effective additional means of offering this education.

Nowadays, few people would question the role of a person with diabetes as the central figure in his or her diabetes care team. But ‘patient’ empowerment extends well beyond the concept of self-determination. Diabetes does not occur in a vacuum, but interacts with a variety of emotional states and exists within many cultural and social boundaries. People with diabetes hold the power to manage their condition – not their healthcare providers or their family members.

During a meeting halfway through a 24-month project for the UK National Institute for Health and Clinical Excellence (NICE), surrounded by well-known health professionals, Barbara Elster was asked her opinion on one of the subjects under discussion. Having expressed her views, she contemplated how she, a person with no formal medical training, had come to be in such esteemed medical company, involved in producing national guidelines on diabetes for the UK Government.

A culturally sensitive, intensive diabetes education service is being delivered in the community to people of ethnic-minority origin living with type 2 diabetes in Lothian, Scotland. Designed by a pharmacist, the initiative began as a research project, but the effectiveness and popularity of the programme resulted in its development and implementation as part of the local diabetes care package.

Type 2 diabetes has become the most common metabolic disorder. Its prevalence is growing most rapidly among people in the developing world, primarily due to the rapid demographic and epidemiological changes in these regions. According to IDF, India currently leads the world with an estimated 41 million people with diabetes; this figure is predicted to increase to 66 million by 2025. The diabetes epidemic is more pronounced in urban areas in India, where rates of diabetes are roughly double those in rural areas.

The onset of coeliac disease, together with type 1 diabetes, influences glycaemic control, and more precisely the development of hypoglycaemia. These conditions share a similar genotype. The main problem of coeliac disease is intolerance to gliadin, a gluten protein found in cereals such as wheat, rye and barley; the only treatment is a gluten-free diet. Spomenka Ljubic and Zeljko Metelko report on the growing body of evidence linking coeliac disease and other autoimmune disorders, including type 1 diabetes, and describe recommended procedures for its diagnosis and treatment.

Breastfeeding has numerous advantages for mothers with diabetes and their babies. Nursing mothers have lower insulin requirements and better control of their blood glucose; breastfed babies may have a lower risk of developing diabetes themselves. Alison Stuebe describes these potential benefits and highlights the special needs of breastfeeding mothers with diabetes.