2008 Clinical Practice Guidelines - Canadian Diabetes Association

2008 CLINICAL PRACTICE GUIDELINES
S26
Interventions should focus on medications (including regimen
changes and adherence), SMBG and physical activity to reduce
A1C (10). For individuals with type 1 diabetes, education
offered as part of intensified treatment interventions can result
in long-lasting improvement in metabolic control and reduction
in complications (14). Education for flexible insulin management
and dietary freedom has been shown to improve
quality of life as well as glycemic control (15,16).
EMPOWERMENT
Empowerment is an essential psychological component of
SME (17). To implement interventions using an empowerment
approach and ensure informed decision making, the educator
should engage in the following behaviours: demonstrate
acceptance (respect) for the individual’s perspectives; explore
the affective or emotional aspect of an issue; work in an
alliance or partnership with the individual; and facilitate active
participation of all parties in the education process (18).
Approaches that increase an individual’s participation and
collaboration in decision making regarding care and education
have been shown to be more effective than a didactic
approach in enhancing psychological adjustment to diabetes
and potentially preventing psychological distress (5,18-20).
SUPPORT SYSTEMS
Evidence suggests that including family members (parents,
spouses, significant others) in educational interventions is beneficial
for both children and adults in improving diabetesrelated
knowledge and glycemic control (20). Interventions
that target families’ ability to cope with stress or diabetesrelated
conflict are effective (20). Peer programs geared
toward developing self-efficacy (i.e. self-confidence in one’s
ability to carry out a behaviour), sometimes referred to as
“self-management” programs within the Chronic Disease
Model, have demonstrated small improvements in psychological
outcomes (21).
Figure 1. Process of teaching people to manage their diabetes (adapted from 28)
Self-management education
Incorporate didactic, cognitive, behavioural and social
interventions that include:
• Goal-setting
• Problem-solving
• Other motivational strategies
• Knowledge
• Psychomotor skills
Short-term outcomes
• Glycemic, BP and lipid control
• Weight
• Quality of life
• Attendance at healthcare
provider appointments
BP = blood pressure
SMBG = self-monitoring of blood glucose
Healthy self-management behaviours
• Diet
• SMBG
• Medications
• Physical activity
• Smoking cessation
Psychosocial mediators
• Motivation (beliefs, attitudes)
• Coping skills
Long-term outcomes
• Morbidity
• Mortality
• Quality of life