the challenges of self management of type 2 diabetes

April 23, 2012

The Challenges for the Self-Management of Diabetes

People with diabetes invest a lot of time and effort managing their

condition including not only monitoring the level of sugar in their blood,

organizing their medication and following a restrictive diet, but also

social challenges such as negotiating relatives' input and gaining access to

doctors when they need to....

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The primary strategy for helping patients is a short educational course on

how to self-manage the condition. The new research suggests that this

approach is unlikely to succeed in isolation because it ignores the many

factors that are outside the patients' control such as food labeling in

restaurants, local availability of healthy foods and the expectations and

behavior of other people including family members, at school and at work.

Only around one per cent of a diabetic person's time is spent in the company

of health professionals. The remaining 99 per cent of the time, the patient

is managing their own diabetes.

The research was an 'ethnographic' study which looked in depth at a small

group of 30 people with diabetes. Their ages ranged from 5 to 88 and they

included different ethnic groups to reflect the fact that diabetes is

particularly common in South Asians. Researchers shadowed the people for

several periods of between two and five hours while they were going about

their daily lives, noting how they managed their condition and the

challenges they faced.

Trisha Greenhalgh, Professor of Primary Health Care at Queen ,

University of London, led the study. She said: " Until now there has been

very little research on what people with diabetes do and how they cope when

health professionals aren't around. We have shown that self-management of

diabetes is hard work both practically and emotionally, and that many but

not all people with diabetes are skilful at undertaking and coordinating all

the different tasks involved. "

The research showed that people with diabetes and their families devoted a

lot of time and hard work to managing their disease. For those who were not

managing well, the reasons tended to be that they were overstretched by

family responsibilities, had other illnesses, were struggling financially or

a combination of these. Many had other medical conditions, some very

serious, for example, paralysis following a stroke, visual impairment or

heart failure. These factors severely limited people's opportunities to

manage their condition, meaning that those who would benefit most from

self-management were also those least able to achieve it.

Lack of food labeling in cafes and restaurants also proved challenging

because it made calculating the correct dose of insulin difficult.

Some but not all health professionals were enthusiastic about people

acquiring advanced knowledge about their diabetes and learning how to

self-manage.

Professor Greenhalgh added: " There is a trend towards encouraging

individuals to look after their own health. This study highlights that

whilst many people with diabetes are ready and able to do this, health

professionals and wider society could be doing more to support them. Sadly

there is still a great deal of ignorance, stigma and stereotyping. "

" We need to know a lot more about how patients manage their disease outside

of the clinic. In the meantime, doctors should be aware of the work their

patients put in to self-management and understand that many factors will

influence how successful they are at controlling their diabetes. "

The research is published in BMC Health Services Research. Queen ,

University of London

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