Assessment And Clinic Flow

As discussed below and depicted in Figure 6.3, there are many factors that influence diabetes self-management and its outcomes. The left side of Figure 6.3 illustrates the multiple levels of factors that influence diabetes self-management. The centre of the figure contains the various components of diabetes self-management. These component tasks are listed separately to illustrate that there is usually little relationship between the extent to which a patient follows one aspect of the regimen and his/her level of self-care in other areas. Finally, the right-hand side of the figure depicts the consequences of self-management, including physiological, quality-of-life and health care utilization outcomes. It is important to stress that self-care and diabetes control are not the same; self-management is one of the multiple determinants of health outcomes (along with genetics, regimen and medication prescriptions, stress, co-morbidities, disease severity and other vari-ables)54-56 The point is that one cannot judge a patient's level of self-management from his/her HbA1c level. Poor metabolic control indicates that something is wrong, but it does not give specific information about what is wrong13. A second important point is that good diabetes outcomes and adjustment involve more than just low HbA1c levels: variables such as the patients cardiovascular risk factors (smoking status, blood pressure, lipids), mental health status, and social, physical and role functioning (i.e. health-related quality of life) are equally or more important outcomes57-61.

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