The delivery of diabetes care and education has undergone a paradigm shift from giving advice and blaming the patient for failure to providing patients with the choice of aggressive, individualized treatment and an education plan tailored to their needs. This shift has melded health care providers and patients as partners in managing a devastating disease. The demands for daily self-management of diabetes are so formidable that each component of the diabetes education curriculum includes discussion of the psychosocial needs of the patient. The embarrassment of hypoglycemia and resultant fear, the social aspects of eating and dealing with well-meaning family members who comment on food choices, the
& u sense of failure associated with elevated blood glucose readings despite a sincere effort, and the frustrations of needing medication when self-image associates pill taking with the sick role are a few examples of the psychosocial complexities. Effective diabetes education begins with listening to the patient and his perception of life with diabetes.
Health care professionals can identify with patients who cannot manage to follow every single diabetes management recommendation because we cannot follow them either. Regardless of type of management, such as fee-for-service or managed care, chart reviews suggest that only about 50% of patients are asked to have their HbAlc measured even once a year, despite a recommendation for screening every 6 months. An even smaller proportion of patients are being screened on an annual basis for such complications as hyperlipidemia, retinopa-thy, proteinuria, or foot pathology. The compelling evidence that tight control of blood glucose, blood pressure, and lipids provides measurable improvement in outcomes warrants new initiatives. For both patients and health professionals, the opportunities and challenges are abundant.
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