Overview

• Patient-centred priority setting and supported self-management form the modern approach to diabetes care

• Control targets should be tailored to the individual

• Patients are more likely to adhere to treatment plans that they have formulated themselves

• Self-efficacy and 'ownership' of the condition should be nurtured through structured education

Introduction

Living with diabetes is a long personal journey. Throughout the journey patients require information, education, support and self-management skills. They also require prescribed medication, monitoring, surveillance and regular review. This journey is a joint venture between the individual, their carers and a multidisciplinary team of health professionals (Box 3.1).

Box 3.1 Aims of treatment of diabetes

• Absence of symptoms

• Avoidance of severe hypoglycaemia

• Control of blood glucose to patient-centred targets

• Control of other cardiovascular risk factors

• Prevention, early detection and effective treatment of complications

• Lifestyle sufficiently flexible to suit the person's needs

• Normal life expectancy

Patient-centred priority setting

In the past, patients were expected to passively follow the doctor's instructions. Those who failed to reach targets were simply not complying. This approach was never very effective in diabetes, but it is increasingly insufficient in the modern world of patient autonomy, access to information, and personal responsibility for health. We now know that individuals are much more likely to adhere to decisions they have formulated themselves. The emphasis of diabetes care should be self-management, supported by a team of health professionals (Figure 3.1).

Shared decision making

The Autonomous Patient: Ending paternalism in medical care by Angela Coulter (2002) suggests three models of clinical decision making (Table 3.1).

The shared decision making model is increasingly used in primary care, where patients are usually not acutely ill. The clinician must provide and share information, whilst the patient

Figure 3.1 Discussing treatment goals.

Table 3.1 Models of clinical decision making.

Professional

Shared decision

Consumer choice

choice

making

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