Empowerment and self-management

In October 2008, the IDF Task Force on Clinical Guidelines, in conjunction with the Self-Monitoring of Blood Glucose nternational Working Group, convened a workshop in Amsterdam to address the use of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes who are not treated with insulin. The recently published guidelines on the use of SMBG in people with type 2 diabetes were developed based on the findings of that workshop. A summary of the findings and recommendations is provided in this article.

Diabetes education can be delivered using a variety of methods and in a range of settings: a lecture on, say, carbohydrates and glucose monitoring; an individual face-to-face meeting with an educator or a dietitian; a group session where an educator and people with diabetes can all act as educational resources. It can take place  in a classroom, an office or under a tree, supported by professionally produced photographs and posters or hand-drawn signs.

Young people are given responsibility in different ways and at different rates across cultures and families. However, families from different backgrounds face similar challenges in supporting the self-care of a young person with diabetes. Learning to consistently carry out daily diabetes self-care tasks involves the help and support of relevant people across the lifespan: parents, siblings, friends, extended family, spouses/partners, and ultimately, children.

Diagnosed when he was 12 years old, Adam Elliot has had type 1 diabetes for nearly three years. He is currently a student at All Saints Catholic High School in Kanata, Ontario, Canada. In this article, he shares his experiences of type 1 diabetes and explains how self-management has made his life with the condition not just bearable but as he sees it ‘a real journey that I believe is providing me  with a lot of useful life lessons’.

Chronic diseases, including diabetes, represent the most prevalent problem in healthcare today. They are the most common cause of disability and consume the largest part of health expenditures internationally. Most diabetes care is provided by people with diabetes and their family or supporters. Therefore, understanding how to enhance diabetes self-management is of primary importance in addressing this growing burden. The effective self-management of type 2 diabetes is closely linked to environmental factors and a person’s lifestyle.

In recent years, many initiatives from many sources have been aimed at improving people’s ability to manage a chronic medical condition – ranging from top-down policy programmes to small-scale projects developed by individuals. Work related to the care of people with diabetes has generally been at the forefront of this type of research. Policy-related programmes tend to focus on the most effective use of health services, and initiatives coming from individuals are more likely to be about sharing experiences of an effective treatment.

Healthcare implies sound knowledge in the field of biomedicine, underpinned by evidence-based medicine. There is another fundamental dimension: the healthcare provider-patient relationship. Balint studied the gap between the professional identity of doctors and the reality of patients – an ocean of unspoken messages separates their worlds. The further dimension is that of therapeutic education, the objective of which is to help people to become more autonomous. In these three aspects of healthcare, the relationship between patients and doctors is never even.

There are various ways to improve people’s capacity to cope with the psychological burden of a chronic condition. A recent programme based on self-expression through painting demonstrated a way of discovering a person’s potential for development and self-efficacy. This report describes the structure and process of a painting workshop programme for people affected by a chronic condition. Attending one or several painting workshops, the participants used the art material to express and give shape to their inner suffering associated with their condition.

In 2005, the Government of Canada provided a renewed investment of 190 million CAD over five years to maintain and enhance the Aboriginal Diabetes Initiative. The main goal of the Initiative is to reduce type 2 diabetes and its complications through a range of culturally relevant health promotion and prevention services, delivered by trained health service providers and diabetes workers. Supported by Aboriginal Diabetes Initiative funding, Aboriginal communities across Canada are working to prevent and  manage type 2 diabetes. Amy Bell reports.

The potential threat from type 2 diabetes in  South Africa remains dangerously underestimated and its current prevalence widely unrecognized. Yet the problem is growing at an alarming rate. A series of factors that are particular to the region represent enormous obstacles to an effective response by people with the condition, healthcare providers and wider society. In this article, Noy Pullen identifies some of the key socio-economic, environmental and educational issues affecting rural South Africa.