Stay Healthy

When 24-year-old Erin learned that she had type 2 diabetes she simply could not believe it was true. This could never happen to her, she felt. The diagnosis must be wrong. During the next few weeks Erin was prescribed appropriate treatment, and given advice on self-managing her condition, to control symptoms and reduce the risk of long-term problems. But before too long it became clear that Erin was continuing to suffer symptoms. Her diabetes was clearly not under control.

Erin was eventually referred to our clinic, where we discovered why the standard therapeutic approach was not working for her. Deep down, she still did not believe that she had diabetes. When faced with pressures in her daily life – Erin had recently moved to another country to take up a demanding job – she would feel overwhelmed and simply stop managing her diabetes, which seemed much less important than the immediate issues facing her. We helped Erin to recognize and understand this pattern of behavior, and to learn to cope with her disease. She has now finally accepted that she has diabetes, and understands clearly that she can benefit by taking responsibility for her treatment, complying with instructions and adopting a healthy lifestyle.

Erin's case is by no means unique. Studies suggest that less than 50 percent of patients with a chronic disease follow their management plans correctly, for a wide variety of reasons. Many people with diabetes, for example, do not adhere to their prescribed diet or take their prescribed medication, resulting in poor metabolic control and a high risk of developing long-term complications.

Two major external factors influence the course of diabetes in an individual patient. Healthcare professionals control one of these when they establish a management plan, involving specific treatments, lifestyle modifications and regular assessment. The other factor, controlled by patients, is their ability to self-manage the disease, adapting the plan according to daily circumstances.

Few people – if any – will have this ability when diagnosed, and it is the responsibility of health professionals to help patients develop the necessary knowledge and skills. Patient education is widely recognized as vital for effective long-term care. However, its implementation is often inadequate, and too often it involves little more than putting information in front of the patient. Key issues for the patient, such as understanding the implications of the disease and learning how to incorporate its management into their day-to-day life, are sometimes not addressed.