Methods To Increase Self Esteem

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Boosting Your Self Esteem

It is much easier to meet life's challenges with a healthy dose of self-esteem. You do better in your work, studies, and personal relationships, and you are more likely to go after what you want out of life when you feel good about yourself. But, unfortunately, diabetes can gnaw away at your sense of self-worth. Many of our feelings of self-worth stem from the messages we were given as children (both positive and negative) and the messages we give ourselves as adults. One way to boost your feelings of self-worth is to give yourself affirming and positive messages. Recognize your good qualities and give yourself a break, even if no one else does.

Cognitivebehavioural Therapy In Diabetes And Other Somatic Disorders

Many patients do have difficulty coping with the diabetes regimen. Various group interventions have been described, aimed at helping patients to cope more effectively with their diabetes. These coping-oriented group interventions typically consist of problem-solving and or social skills training. The short and structured nature of these interventions seems to have positive effects on attendance56 and assertiveness57. Uncontrolled studies with adolescents found increases in assertiveness58 and problem-focused coping59. In controlled studies, a trend was found towards reduced depression, increased self-esteem and a greater use of emotion-focused coping60, improved glycaemic control61, improved coping abilities62, and a reduction of diabetes-specific distress63. In two recent studies, a coping skills training (CST)64 and a behavioural programme to improve adherence and stress management65 were compared to standard medical care. Both interventions had positive effects on emotional...

Benefits Of Group Psychoeducation Incorporating Coping Skills Training

The benefits of the educational programme, which incorporates the coping skills training intervention I have just described, are wide-ranging and robust. Six months after the educational intervention, programme participants improved significantly on several measures of emotional well-being (including self-esteem, diabetes self-efficacy, depression, and anxiety) several measures of self-care behaviour (including SMBG frequency, medication adherence and adjustment, diet and exercise) and glycaemic control (assessed by HbAlc assay), as compared with their levels at the outset of the program43. Improvements in glycaemic control and self-regulation behaviours (SMBG and medication adherence and adjustment) were maintained The Johns Hopkins Diabetes Center educational programme is integrated and multi-faceted, so it is impossible to determine which aspects of the intervention, alone or in combination, were responsible for the benefits I have just noted. The coping skills training component...

What are the longterm effects of exercise in the body

Regular physical activity has also been proven to decrease cardiovascular morbidity and mortality in the general population. This protective role of exercise has been attributed to various mechanisms i) the beneficial effect of exercise on the traditional cardiovascular risk factors (hypertension, dyslipidaemia, obesity, insulin resistance) and ii) the beneficial effect of muscular activity to the heart itself (increased oxygen supply, decreased myocardial oxygen needs, formation of lateral coronary circulation, electrical stabilization of the myocardium, etc.). Physical activity is also associated with a multitude of psychological and socio-economical beneficial effects, which promote feelings of energy and vitality, increased self-esteem, decreased depressive feelings and optimism, enthusiasm and productivity in daily life.

Management Of Pregnancy In Diabetes

Frustrated by the day-to-day variability in blood glucose levels that is likely to occur in insulin-dependent diabetes, regardless of pregnancy. Receiving feedback of a lowering of glycated haemoglobin can help to decrease stress levels and improve self-esteem. On the other hand, failure to improve glycaemic control can easily lead to feelings of guilt and an increase of psychological distress and, eventually, to diabetes 'burn-out'19.

Quality Of Life And Obstacles To Care

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.

Empowerment Education For Patients

After determining that they could train educators, the MDRTC next designed a study to determine whether participation in a patient empowerment programme would result in improved psychosocial self-efficacy and attitudes toward diabetes, as well as a reduction in blood glucose levels. This study was conducted as a randomized, wait-list control group trial. The intervention group received a six-session empowerment programme. Six weeks after the programme, both groups provided follow-up data. The intervention group showed gains over the control group on four of the eight self-efficacy subscales15 and two of the five diabetes attitude subscales. Also, the intervention group showed a significant reduction in glycosylated haemoglobin levels. A 6 week follow-up analysis of data from all programme participants showed sustained improvements in all of the self-efficacy areas and two of the five diabetes attitude subscales, and a continuing modest improvement in blood glucose levels14. This study...

Application Of Dcct Results In The Community

Another DCCT site has reported a research cohort study comparing 25 adolescents who chose CSII to 50 who chose MDI for intensive therapy in 1995-1998 (57). After 6 mo, the mean HbAlc fell from 8.8 to 8.1 (nondiabetic range 4.3-6.3 ) in the MDI group and from 8.4 to 7.7 in the CSII group the decrements in HbAlc were equal at 0.7 . However, by 12 mo, the mean HbAlc has risen slightly to 8.3 in the MDI group, whereas it declined further to 7.5 in the CSII group. The latter value was quite similar to that achieved by the DCCT adolescent intensively treated subjects at 12 mo. The CSII group used less total insulin dose than the MDI group (1.05 vs 1.49 U kg d) and had a lower incidence of severe hypoglycemia (76 vs 134 events per 100 patient-years) and manifestations of coma or seizure (24 vs 46 events per 100 patient-years). Both groups reported improvement in a variety of psychosocial outcomes measured, including quality of life, depression, and diabetes self-efficacy. CSII users found...

Psychotherapy In Diabetes Mellitus

Self-efficacy toward a unifying theory of behavioral change. Psychol Rev 1977 84(2) 191-215 32. Padgett DK. Correlates of self-efficacy beliefs among patients with non-insulin dependent diabetes mellitus in Zagreb, Yugoslavia. Patient Educ Counsel 1991 18 139-47 33. Hurley CC, Shea CA. Self-efficacy strategy for enhancing diabetes self-care. Diabet Educ 1992 18(2) 147-50 34. Littlefield CH, Craven JL, Rodin GM, Daneman D, Murray MA, Rydall AC. Relationship of self-efficacy and bingeing to adherence to diabetes regimen among adolescents. Diabet Care 1992 15(1) 90-94 36. Grossman HY, Brink S, Hauser ST. Self-efficacy in adolescent girls and boys with insulin-dependent diabetes mellitus. Diabet Care 1987 10(3) 324-9 69. Rubin RR, Peyrot M, Saudek CD. The effect of a diabetes education program incorporating coping skills training on emotional well-being and diabetes self-efficacy. Diabet Educ 1993 19(3) 210-14

Advice for Parents of Children with Diabetes

Your child's self image and self esteem are threatened by diabetes. Be understanding and supportive. Try to avoid unnecessary anxiety about cheating. You don't want to cause guilt feelings, or make your child think he or she is bad. Children who think are bad may act accordingly. Help your child plan ahead. No child can should be expected to assume complete responsibility for diabetes control at too early an age. But, ultimately, responsibility for eating properly, injecting insulin, testing blood sugar, and planning exercise will be the child's. Maturity, independence, self control, and self esteem will grow as your child learns self-care.

Psychosocial Development And Diabetes In The Schoolaged Child

Psychological development in school-aged children is assessed primarily with respect to the child's sense of self-esteem and the development of peer relationships. In a careful review of the early empirical psychosocial literature on children with diabetes, Johnson concluded that 'most youngsters with diabetes do not have psychological problems, but among those who do, peer relationship difficulties are quite common Among all of the personality traits assessed, the evidence for peer or social relationship problems seems the strongest' (p. 101)8. Studies of self-esteem in school-aged children with diabetes have consistently linked low self-esteem and poor social-emotional adjustment to poorly-controlled diabetes8'9. Herskowitz-Dumont and colleagues37 found a significant association between recurrent diabetic ketoacidosis (DKA) over 8 years post-diagnosis and higher ratings of behaviour problems and lower levels of social competence, as measured by psychological testing in the first...

Relaxation Training Can Improve Glucose Tolerance And Reduce Longterm Hyperglycaemia

Marrero and colleagues19 found that adolescents who participated in a series of sessions designed to improve diabetes-related coping skills were less depressed, and also tended to have higher self-esteem and more often used emotion-based coping skills, when compared with a control group. Mendez and Belendez3 evaluated the effects of a behavioural programme designed to increase treatment adherence and stress management skills in adolescents with type 1 diabetes. This invervention incorporated a variety of procedures, including instruction, blood glucose discrimination training, role playing, relaxation exercises and problem-solving strategies, among others. Improvements that were maintained at 13-month follow-up included reduced barriers to adherence and reduced severity of daily diabetes-related hassles, as well as less uneasiness in diabetes-related interpersonal situations. Anderson and colleagues23 provided separate group sessions for adolescents and their parents as a supplement...

The Process of Transition and the Eventual Transfer to Adult Care

In due course, the adolescent with diabetes who has been cared for in a pediatric environment, whether privately by a pediatric endocrinologist or in a pediatric clinic, must transfer care to an adult environment. The question of when and how will depend on a number of factors, including the perceived readiness of the young person, the availability of appropriate adult services, and the general policy of a hospital or clinic service. Most studies have suggested that from an adolescent's point of view, it is better to make the change at the end of adolescence when the young person has achieved some degree of autonomy and self-reliance (92).

Encourage Your Child to Play Video Games Really

Children who played Packy and Marlon were found to have more self-confidence about managing their diabetes and better communication with friends and care providers. During the six-month trial period, there was a 77 percent reduction in acute care visits because of diabetes.

Repercussions of DM in sexual life

The problem of erectile dysfunction considerably influences the patient's quality of life because it decreases self-esteem while at the same time creates problems in their personal life. Often the patient does not report his problem, but is willing to discuss it when asked by his treating physician. It is consequently essential, because of its frequency, that this sensitive problem is discussed discreetly, with the initiative of healthcare professionals in the diabetic clinics. Erectile dysfunction is basically diagnosed with a detailed medical history (Table 19.1) and is much less dependent on physical examination and special tests. Recently specific questionnaires with detailed questions concerning sexual activity have been developed, and if answered sincerely, they usually reveal the problem.

Psychological Models To Help Understand Selfmanagement

Some psychological models assume that self-management behaviours are under volitional control, and therefore the single best determinant of future behaviour is a person's reasoned 'intention to change'68. The Theory of Reasoned Action69 predicted that an intention to behave results from two variables (a) a favourable attitude towards the behaviour, and (b) from norms that suggest that valued others would approve of the individual engaging in the behaviour. A third variable, namely self-efficacy, or the person's belief in his her ability to carry out the behaviour was added and the model then became known as the Theory of Planned Behaviour70. The Health Action Process model71 (Figure 5.4) attempts to combine research findings and serves as the best summary to date of the relevant variables. It emphasizes the importance of outcome expectancy ( What's in it for me ') and self-efficacy ('Can I do it '). It adds an important further predictor of behaviour, namely cognitions that result in...

Psychological Aspects of Diabetes

Depression can be a serious problem for people with diabetes. Symptoms of depression include feelings of helplessness or hopelessness, loneliness, lack of self-esteem, fatigue, irritability, and changes in sleep patterns or eating habits. If you experience any of these symptoms, get help. Your doctor or diabetes educator can refer you to counselors with experience in helping people with diabetes.

Handling the Physical and Emotional Consequences of Type Diabetes

As you may expect, people with T1DM also have significant psychological and emotional needs. It's important, first of all, to realize that T1DM has been present in some very high achievers. (I name names in Chapter 6.) In addition, T1DM is not only a disease of the particular patient but also a disease of the entire family. All family members are affected in one way or another. In Chapter 6, you find out ways that family members can help themselves and help the patient to maintain his self-esteem and a high quality of life.

Eating Disorders And Depression An Introduction

The etiology of these conditions appears to be complex and multifactorial, likely involving the influence of genetic, individual, family, peer group and sociocultural factors (16, 17). In that regard, body dissatisfaction and disturbed eating behavior are more common in social or cultural contexts in which a thin, fit female ideal is highly valued, and in which obesity is considered unacceptable or unattractive in women (18, 19). Bulimia nervosa and its subthreshold variants are more common in Western countries, although their prevalence has been increasing in non-Western countries anorexia nervosa, by contrast, does not appear to be culture bound (20). Many girls and women, with and without diabetes, now experience contradictory environmental pressures regarding dietary intake. There are pervasive influences for women in many cultures to enhance their self-worth by striving for an unrealistic body weight and shape through dieting, while they are simultaneously exposed to large...

Depression And Diabetes

The term depression refers both to a mood state and, when severe, persistent, and associated with a number of other symptoms, to a clinical syndrome or disorder. Depressive disorders include major depressive disorder, bipolar disorder and dysthymic disorder, a more chronic, less severe form of depression. The term minor depression or subthreshold depression refers to depressive symptoms of at least 2 weeks duration that fall short of full diagnostic criteria for a major depressive episode or dysthymic disorder. Symptoms that meet diagnostic criteria for a major depressive episode include some or all of the following characteristics present for at least 2 weeks a sustained period of low, sad mood, a loss of interest and enjoyment, low energy, sleep disruption, changes in appetite and weight, poor concentration, low self-esteem, feelings of hopelessness and guilt, and, in some cases, thoughts about death and suicide. The lifetime prevalence of major depressive disorder in the general...

Effective treatment for eating disorders in people with diabetes

Eating disorders may be responsive to psychotherapy. Once again, the number of published intervention studies is small, and several of the studies which have been published lack rigour, statistical power, control groups and follow-up measures. With these caveats in mind, one finds in the literature some evidence that psycho-education directed toward specific cognitive distortions may be effective for individuals with mild to moderate eating disorders in the early stages83. Psycho-educational therapy is a highly structured treatment programme in which therapeutic milieu and didactic instruction are used to help patients understand the nature, aetiology and complications of disordered eating behaviours. The purpose of this intervention is to foster attitudinal and behavioural change in the patient.84 Psychotherapeutic interventions should address the complex of underlying issues which often cause and sustain eating-disordered behaviour. These issues include depression, diminished...

Guidelines For Exercise

Improved insulin sensitivity correlates with lowered cardiovascular risk. Weight loss combined with exercise and diet therapy significantly decreases intra-abdominal fat and is associated with a better sense of well-being, better mood, and higher self-esteem. The matter in which exercise is attempted is strictly the patient's preference.

Benefits Of Weight Loss

Despite the expectations of the individual, the likelihood that an obese person will achieve sufficient weight loss to reach an 'ideal' body weight is remote (25). However, this does not imply that treating obesity is fruitless, as there is evidence that even a modest weight loss of 5-10 in obese diabetic subjects can produce clinical benefits. Improvements have been noted in all modifiable risk factors such as HbA1c levels, hypertension, dyslipidaemia, self-esteem and overall quality of life. Moreover, improvements in these risk factors have a favourable effect on mortality. A retrospective study of Type 2 diabetic patients receiving standard dietetic advice showed a mean weight loss of 2.6 kg for those with a BMI 25-30 kg m2 and a loss of 6.8 kg for those with a BMI 30kg m2 after 1 year. For the average patient each kilogram of weight loss was associated with a three- to four-month prolonged survival and a 10 kg weight loss predicted the restoration of about 35 in life expectancy...

Education And Rehabilitation

Education can have a number of objectives relevant to rehabilitation. It promotes good metabolic control and behaviours that prevent further impairment and minimize disability and handicap. Furthermore, participation in education programs can foster autonomy, improve self-esteem and coping skills and reduce anxiety and depression (Rubin, Peyrotand Sandek 1989). In other words, education can reduce the psychological handicap resulting from diabetes. Support groups or self-help groups can also have a major impact on psychological rehabilitation, though it is valuable to have input from a health professional, preferably one with some training in psychotherapy (Toth and James 1992).

Psychological Aspects of Rehabilitation

It follows that an understanding of individual patients is a prerequisite for successful rehabilitation. This can be achieved only by listening, not just to the people concerned, but to others who know them intimately. Health professionals should consistently demonstrate a positive approach to patients as well as to their progress at rehabilitation. Respecting patients as people fosters a sense of self-worth and, among other things, further enhances motivation. While providing positive feedback is important, honesty and sincerity should never be compromised, and false expectations should not be generated.

Physical Activity And Fitness

Social and environmental influences are also believed to have major roles in the gender and developmental variation in physical activity (379). Understanding the psychosocial determinants of physical activity in children is critical for the treatment and prevention of childhood obesity. Strauss et al. suggested that children and adolescents are largely sedentary and that correlates of high- and low-level physical activity are different. For instance, time spent on sedentary activities is inversely correlated with moderate-level activity, while self-efficacy and social influences are positively correlated with more intense physical activity. In addition, increased high-level physical activity is an important component in the development of self-esteem in children (380).

What causes stress in diabetes

We all have a unique way ofresponding and your particular pattern of response to stress will depend on a number of things. Your upbringing, your self-esteem, your beliefs about yourself and the world, the way in which you guide yourself in your thoughts and actions - all of these things help to determine your stress response. The degree to which you feel in control ofyour life also plays an important role in this response, as does the way you feel, both physically and emotionally, and the way you get along with other people.

Beliefs Cognitions And Attitudes

Much of what we do and say is determined by the way we conceptualize and perceive our environment. It would therefore be rather surprising if our internal representations of ourselves and environment did not play a profound role in influencing our behaviour and our emotions. As a result, psychology has generated a plethora of theories (e.g. Health Belief Model, Theory of Reasoned Action, Protection Motivation Theory, Self-efficacy

Practical Implications For Diabetes Care

Moving back to the more basic issues, it cannot be assumed that adolescents have all the requisite knowledge, skills and problem-solving ability to successfully manage their diabetes. Although having this knowledge and skills does not guarantee that the young person will use them, they are essential. Similarly it should not be assumed that parental knowledge and skills will be transferred to the adolescent, no matter how long they have had diabetes. Therefore, diabetes knowledge and skills should be reviewed at least annually, and any misconceptions or deficits can then be addressed. However, knowledge should not just be factual, as much as possible encourage and support young people to solve diabetes management problems as a way to enhance their self-efficacy and competence. In consultation with young people, resist the temptation to tell them how to achieve better control. Rather, try and help them solve the problems for themselves, so that they can learn to work through problems...

What about children with diabetes

Because the school environment presents many opportunities for building self-esteem and developing socialisation skills, it is important for the child with diabetes to participate fully in all activities, with as few restrictions as possible, in order to facilitate a normal school experience. Children need to understand that, although they have diabetes, they are not 'sick' or 'abnormal'. Participation in school activities helps to minimise the child's sense of being different from peers. Some modifications in a typical school day may need to be made to accommodate diabetes safely, such as the scheduling of lunch and gym classes, but restricting the child from gym classes or school outings will only emphasise the 'difference' and may foster a sense of inferiority and lack of confidence. Over-protection. In this case, the parents are so worried about their child's health that they continue to handle most of the details of diabetes management, even when their child is old enough to...

The Patient with Myocardial Infarction

Rehabilitation programs for elderly diabetic patients. However, because of the relatively poor prognosis of myocardial infarction, this group has potentially the most to gain. At the very least, exercise programs enhance self-esteem, feelings of autonomy and self-confidence (Fentem 1994).

Impact of Diabetes on Behavior Cognition and Quality of Life

Well-being and metabolic control during adolescence are linked, with noncompliance with the treatment regimen acting as a mediating variable (47,48). It is not surprising, therefore, that the convergence of diabetes and adolescence is frequently associated with conflict and a subsequent deterioration in diabetic control (49-51). In a retrospective, longitudinal study of 118 adolescent 18-yr-olds with type 1 diabetes, studied at three-monthly intervals between 8 and 18 yr, we found a significant deterioration in metabolic control throughout the period of adolescence (52). This deterioration was most marked for females. Quality of life may also deteriorate during this time (53). Using the Child Health Questionnaire (CHQ), we surveyed 71 adolescents (12-18 yr of age). The CHQ is a parent self-report tool that quantifies disease impact upon general health, psychosocial health, and family cohesion. Parents reported that for adolescents aged 12-18 yr, general health was markedly lower,...

Theoretical Models And Diabetes Education

The concept of self-efficacy has also served in identifying strategies to enhance diabetes self-care. The Self-Efficacy Model is used to learn more about patients' convictions and beliefs in their ability to carry out recommendations for care (14). Patients might well believe in the recommended health plan but may not follow it, because it is perceived as being too difficult.

Discussing ED with your doctor

Although sexual intercourse tends to be an embarrassing topic for many men and women, if you have diabetes and have a problem in this key area of life, you need to discuss it with your doctor. Some doctors find this topic just as embarrassing as some patients. Any doctor who treats patients with diabetes should bring the topic up in the first meeting and annually thereafter. If he or she does not, it is up to you to broach the subject. If you read the explanation of the normal development of an erection and your experience differs from that, discuss it with your physician. There are so many ways to treat it, and the lack of an erection can have such a profound effect upon your self-esteem and your relationship with another person that it is sad to discover how often a new patient has been suffering in silence for years.

Disease Course And Risk Factors Implications For Clinical Practice

Adherence to the treatment regimen was also a focus of the longitudinal studies of Jacobson, Hauser and colleagues49'58'70, in which patients were followed from within the first 9 months of diagnosis. Jacobson et al.58 reported that within this patient cohort of newly-diagnosed children and adolescents, patients who were school-age at diagnosis (12 years) at diagnosis. Similarly, Jacobson et al.70 found that initial child reports of self-esteem and social functioning and adjustment predicted subsequent adherence. Data from this longitudinal study revealed that 'patterns of adherence established early in year 1 are maintained over time' (p. 523)58, although deterioration in adherence occurred as duration increased. In addition, they found that the strongest predictor of treatment adherence 4 years after diagnosis was the child-reported level of family conflict near the time of diagnosis49.

School Issues

Because the school environment presents many opportunities for building self-esteem and developing socialization skills, it is important for the school-aged child with diabetes to participate fully in all activities, with as few restrictions as possible, in order to facilitate a normal school experience. Children need to understand that, although they have diabetes, they are not 'sick' or 'abnormal'15. Participation in school activities helps to minimize the child's sense of being different from peers. Some modifications in a typical school day may need to be made to accommodate diabetes safely, such as the scheduling of lunch and gymnastics classes to prevent hypoglycaemia, but restricting the child from gymnastics classes or school outings only emphasizes differences and may foster a sense of inferiority43. Children with diabetes should also be encouraged to participate in as many extracurricular activities and sports as they chose and as scheduling permits. For all children, such...


Beliefs individuals hold about themselves and their abilities can be categorized into three broad domains value, capacity and control beliefs. Self-value beliefs, such as self-esteem and self-concept, reflect the way individuals describe or perceive themselves. These beliefs are typically measured using value judgements, self-descriptions or self-discrepancy models. However, Self-capacity beliefs refer to individuals' beliefs in their ability to perform a task, and are similar to the concept of confidence. The construct widely used here is self-efficacy, which has been consistently related to adolescents' health behaviour42'62-64, with further studies reporting an association between self-efficacy and measures of metabolic control57'65'66. A further study67 found that adolescents who perceived themselves to have the energy and will power needed to manage their diabetes were in better control. Furthermore, Grey and colleagues68 found that higher self-efficacy was associated with better...

Psychosocial Impact

Lowered self-image, heightened self-consciousness, and impaired social functioning have been noted in individuals who either become or remain obese during adolescence (103). Studies of obese adolescents have demonstrated obsession with being overweight, passivity, and withdrawal from social

Eating Disorders

Eating disorders occur among people with diabetes just as they do in the general population. Some researchers believe that individuals with diabetes may have an increased risk for eating disorders because they have to pay more attention to what they are eating. Unfortunately, in our society, the self-worth of many people comes from having a perfect body. Some people resort to extreme measures to get or stay thin.

Family Issues

Because studies suggest that participation with peers, positive self-image and regimen flexibility (especially nutritional flexibility) are critical and interrelated goals for the school-aged child with diabetes, parents should avoid unrealistic demands for adherence to a meal, insulin or monitoring schedule that restricts the elementary-school child from active participation in age-appropriate school and peer activities. The newer, revised nutritional guidelines permitting more liberal carbohydrate intake46 may obviate the social stigmatism previously experienced by these school-aged children.


Coping dispositions show a better match with DM1 self-management demands than passive, avoidant coping. Active coping corresponds with better quality of life among adults with diabetes (12), and better metabolic control among adolescents with DM1 (13). Although much of the research investigating samples of patients with DM1 are adolescent samples, these data are relevant to our discussion, as most adults with DM1 have had the condition across their adolescent years, and may have developed coping dispositions that persist into adulthood. While some studies have shown that coping training interventions for adolescents produced reductions in diabetes-specific stress but not improvements in glycemic control (14), others have produced improvements in self-efficacy as well as metabolic control that maintained for 6 months following therapy (15). Simply put, it appears that individuals who manage stress by approaching the stressful condition, attempting to control the condition, and find the...

Patient Factors

In particular, it is important to see if a patient considers lifestyle aspects of diabetes management (e.g. diet and exercise) as important as medical aspects (e.g. medication taking and glucose testing). If they do not, they will be unlikely to follow-through with the challenges of lifestyle modification. Other important and related cognitive factors are a patient's readiness to adopt different self-management guidelines66 and his her self-efficacy or confidence that he she can achieve specific goals.

Goals of treatment

The healthcare provider should be aware of the importance of negotiating and achieving agreement with the patient regarding the diabetes treatment plan. Stronger provider-patient agreements on treatment plans and strategies for achieving treatment goals correlates well with improved patient self-efficacy and diabetes self-management 5 .

New Paradigm

The patient empowerment approach to diabetes patient education seeks to maximize the self-management knowledge, skills, self-awareness and sense of personal autonomy of patients to enable them to take charge of their own diabetes self-management. Empowered patients are those that have learned enough about diabetes and themselves, so that, in consultation with health care professionals, they can select and achieve their own goals for diabetes care1. The evaluation of a patient education programme based on the empowerment approach should focus on patient achievement of self-selected diabetes care goals, improved psychosocial adaptation and enhanced self-efficacy. The MDRTC felt that most patients, once they have been adequately educated about diabetes, would choose appropriate health-related outcomes, such as improved glucose, blood pressure and lipid control and weight loss, as part of their diabetes care goals1.

Staff Attitudes

Poor levels of compliance can be difficult for staff, given both the pressure of meeting targets set by national and international bodies19 and the relentless reminder of risk from complications demonstrated in patients with whom staff may have had long and established relationships. This can result in negative and detrimental attitudes towards 'non-compliant' patients, which can have a deleterious effect on rapport, patients' self-esteem and motivation. Staff could be in danger of assuming that poor control is directly related to inferior self-management and that good control is always achieved by 'ideal' self-management. However, this is not necessarily the case, as there are constitutional and environmental factors that shape both diabetes control and the development of complications (Figure 5.1). Health professionals do not appear to have fully grasped the complexities of self-management20, as there is not a unified set of commonly agreed behaviours applicable to all people with...

Support Strategies

Clinical strategies aimed at improving diabetic control throughout adolescence have focused largely upon psychosocial support rather than clinical care. There is some evidence, however, that diabetic control is unlikely to improve from late childhood to late adolescence, and we have advocated that diabetic control needs to be optimal prior to the advent of adolescence (52). Furthermore, research in our clinic has supported the notion that early adjustment to insulin-dependent diabetes mellitus (IDDM) is predictive of longer-term outcome, with early psychological difficulties leading to ongoing maladjustment, reduced treatment compliance, and poorer health outcome (45). Early intervention is best done through identifying and addressing latent family and interpersonal issues that may be contributory to subsequent deterioration of an adolescent's psyche and their diabetes control. Such issues include parenting skills, communication, social skills, cognitive ability, self-esteem, and...

Social support

Social support is an important component of successful diabetes management. Many studies have found that individuals with higher levels of social support tend to do better, for example, in weight management programmes or keeping to their diabetes treatments. Social support may involve your family in the treatment programme, you may be required to participate in a community-based programme, or be involved in some outside social activity. Friends and family support may be particularly useful because it helps people to learn greater self-acceptance, develop new norms for interpersonal relationships and manage stressful work or family-related situations.

Weight Loss

While lifestyle modification can be challenging to achieve and maintain for many patients, it can be effective in restoring fertility in overweight women with PCOS. In obese women, a loss of 5-10 of their body weight can improve or restore reproductive function (22, 26). Diet and exercise are relatively inexpensive compared to other fertility treatments and do not carry an increased risk of multiple gestations. Improvements in mood and self-esteem that may be achieved by weight loss may also improve fertility (27). Because obese women have lower pregnancy rates and higher risks of pregnancy complications, losing weight can help improve outcomes even if fertility treatments are needed


Health-care providers must recommend exercise to their patients. The success rate is not very good for patients continuing an exercise plan, but if it is not discussed, the success rate is even poorer (13). Exercise is extremely difficult to maintain as is diet but if patients are not encouraged, they surely will not see any necessity for it. It should be addressed at every visit as a part of the visit. Sometimes hearing things over and over does eventually make a difference to a patient. Even if the motivation wears off, the patient will usually follow a plan for a while and if they are seen every 3 months, they may have more time that they exercise than they do not exercising. In a study at the Joslin Diabetes Center located at the University Health Care Center in Syracuse, NY, patients were asked to develop their own meal and exercise plan. At 2 and 6 months respectively, 89 and 92 of the participants felt that they were following the meal plan either some or most of the time. One...

Living with diabetes

Diabetic patients may experience difficulties with employment. Statutory or company policy may disbar them from certain occupations and these include train drivers, the armed forces, off-shore oil-rig work, etc. Furthermore, even when there is no risk due to possible hypoglycemia, discrimination by employers may affect hiring practices leading to loss of self-esteem and earning ability, and impacting on the patient's ability to support a family and their future quality of life.

Physical activity

Intensity exercise each day can be shown to reduce blood pressure, improve lipid profile, decrease cardiovascular risk, improve energy levels and self esteem, all in addition to aiding weight loss and hence improved diabetic care (Sarvis, 1998). It is recognized that not only does increased activity help produce weight loss, but individuals who exercise regularly are also more likely to maintain their weight loss. Advice on physical activity has not traditionally been seen as the responsibility of the general practitioner, and yet so much can be achieved by a patient motivated to become more active. Before embarking on an exercise campaign, it may be helpful for the health professional to discuss with the individual which type, and what intensity of activity would be appropriate (see Box 14.1). Patients are often resistant to increasing their activity levels for a variety of reasons. They often, wrongly, perceive that to be beneficial exercise must be intense, and involve frequent gym...

Benefits Of Activity

The psychological benefits of exercise are equally important for the obese individual with Type 2 diabetes. Reductions in anxiety levels, improved body image and higher self-esteem promote greater self-efficacy and help the individual to cope with stressful situations which often result in overeating and relapses (71,72).


Always have alcohol in the fridge or a bowl of sweets on a coffee table can be an irresistible temptation. Before a new behaviour is established, the individual may need to avoid these situations or develop the appropriate coping strategies. According to the model, 'coping' in a high-risk situation will lead to increased self-efficacy and therefore a decreased probability of relapse in the future.