Health Delivery

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.

The goals of diabetes education are to optimize blood glucose control, prevent chronic and potentially life-threatening complications, and optimize quality of life, while keeping costs within acceptable limits. Research has shown that with appropriate education lower-extremity amputation rates, medication costs, emergency room visits and hospitalizations are reduced. Nowadays, diabetes self- management education is an integral and critical part of any treatment plan.

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.

Diabetes is mostly managed by people with the condition. In order to do so effectively, people with diabetes need to acquire and develop a broad base of knowledge and skills, and incorporate lifestyle choices into daily living which facilitate and enhance self-care. Diabetes education is an active process that supports people in building self-management skills, and provides for shared decision making about how best to fit diabetes treatment into daily life.

In people with diabetes, optimal management of their condition, regular examinations, the use of adequate footwear, and education are the best strategies to prevent diabetes-related foot problems, such as ulceration. If foot problems cannot be prevented, these should be treated as early as possible. However, in many cases, some degree of amputation of lower limbs cannot be avoided. In people who undergo a major amputation, artificial limbs are required to enable them to continue normal daily life.

As the diabetes epidemic grows in size and complexity, there is an increasing realization that physicians alone are unable to provide the care required by people with diabetes. To help them live life to the fullest, people with the condition need the services of a range of healthcare personnel, including diabetes nurses, dietitians, podiatrists, psychologists and eye specialists. The role of most of these is well defined; the multi-disciplinary team approach benefits increasing numbers of people with diabetes worldwide.

Adolescence, the period of transition from childhood to adulthood, is a key phase of human development. It is characterized by rapid changes – physical, sexual, psychological, emotional, cognitive, and social. The psychological imbalance that prevails during adolescence is particularly significant in people with diabetes as it often leads to a decline in self-care. This brings about a deterioration in blood glucose control, and creates difficulties that hamper the development of harmonious relationships between the young person with diabetes and his or her healthcare providers.

Diabetes is a leading cause of death in most developed countries, and has become a serious epidemic in many developing and newly industrialized nations. Currently, an estimated 246 million people worldwide have diabetes. Poorly controlled diabetes is associated with disabling and potentially life-threatening complications such as eye disease, kidney disease, nerve damage and cardiovascular disease. Until recently, lowering fasting and pre-meal glucose levels was a key focus of diabetes management.

The USA ranks third in the global prevalence of diabetes, preceded only by India and China. About 7% of the population has diabetes. A third of the total number of people with the condition is believed to be undiagnosed and therefore not receiving treatment to reduce the risk of disabling and life-threatening diabetes complications. The economic costs of diabetes are enormous – estimated at 132 billion USD in 2002. The mission of the US National Diabetes Education Program (NDEP) is to reduce diabetes-related illness and death.

The objective of holiday camps for children and adolescents with diabetes is to create an environment in which they can learn to embrace their condition and its treatment. Achieving and maintaining good blood glucose control is a key aim; the camps provide excellent opportunities for young people to learn and practise diabetes skills and become familiar with the latest techniques.