Engaging and empowering patients to manage their type 2 diabetes, Part I: a knowledge, attitude, and practice gap?
- 1k Downloads
For over 20 years, the World Health Assembly has recognized diabetes (type 1 and type 2) as a serious threat to national health and economic development and called for action regarding its prevention and control. However, the prevalence of type 2 diabetes continues to rise despite a significant percentage of cases being preventable. Furthermore, data suggest that in many patients diagnosed with type 2 diabetes, glycated hemoglobin (HbA1c) levels remain above the agreed international and national target levels, despite the availability of numerous antihyperglycemic agents, the best intentions of both patient and physician, and the support of the wider healthcare team. Part I of this two-part review considers evidence that seems to suggest there is a knowledge, attitude, and practice (KAP) gap in type 2 diabetes, and that although theoretical knowledge of how type 2 diabetes should be managed exists, the attitude of patients and healthcare professionals may influence the practicalities of implementing life-enhancing changes for patients living day-to-day with the condition. Here, we consider why there may be a KAP gap, how type 2 diabetes is currently being assessed and managed, and whether these current management approaches remain valid in the light of recent studies evaluating the impact of lowering current target HbA1c levels. This article also explores how encouraging patients to self-manage their disease, as well as engaging all stakeholders in the necessary behavioral changes, can positively influence the long-term treatment outcomes of patients with type 2 diabetes.
Keywordsant ihyperglycemic agents cardiovascular risk diabetes management glycemic control patient engagement type 2 diabetes
Unable to display preview. Download preview PDF.
- 1.World Health Organization web site. WHA42.36. Prevention and control of diabetes mellitus. May 18–19, 1989. Available at: http://www.who.int/diabetes/publications/en/wha_resol42.36.pdf. Accessed Februrary 24, 2010.
- 2.United Nations web site. UN Resolution 61/225. United Nations General Assembly 61st session, December 2006. Available at: http://www.un.org/depts/dhl/resguide/r61.htm. Accessed February 24, 2010.
- 3.IDF Diabetes Atlas, 4th edition. International Diabetes Federation; 2009. Available at: http://www.diabetesatlas.org/content/diabetes. Accessed February 24, 2010.
- 4.Mybanya JC. Activity report 2006/2009. International Diabetes Federation; 2009. Available at: http://www.idf.org/webdata/docs/IDF-Activityreport-06-09.pdf. Accessed February 24, 2010.
- 6.Benhalima K, Mathieu C. Challenges in the management of hyperglycaemia in type 2 diabetes. Background paper in IDF Diabetes Atlas, 4th edition. International Diabetes Federation; 2009. Available at: http://atlas.idf-bxl.org/sites/default/files/Challenges%20of%20Type%202%20 Diabetes_0.pdf. Accessed February 24, 2010.
- 8.Nathan DM, Buse JB, Davidson MB, et al. American Diabetes Association; European Association for Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32:193–203.CrossRefPubMedGoogle Scholar
- 11.DIABESITY. Novel molecular targets for obesity and type 2 diabetes. A European Union Framework Programme VI Integrated Project. Available at: http://www.diabesity.eu/documents/pamphlet.pdf. Accessed February 14, 2010.
- 12.International Chair on Cardiometabolic Risk. The obesity and type 2 diabetes epidemics. Available at: http://www.cardiometabolic-risk.org/the-conceptof-cmr/the-obesity-and-type-2-diabetes-epidemics/index.html. Accessed March 13, 2010.
- 19.International Diabetes Federation web site. The IDF consensus worldwide definition of the metabolic syndrome. International Diabetes Federation. 2006. Available at: http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf. Last accessed April 1, 2010.
- 26.Kaiser Pemanente Colorado Region. RE-AIM.org web site. Available at: http://www.re-aim.org. Accessed March 13, 2010.
- 29.Farmer AJ, Wade AN, French DP, et al. Blood glucose self-monitoring in type 2 diabetes: a randomised controlled trial. Health Technol Assess. 2009;13:1–72.Google Scholar
- 30.NHS Diabetes. Self-monitoring of blood glucose in non-insulin treated type 2 diabetics. A report prepared by an NHS Diabetes Working Group. NHS Diabetes March 2010 Diabetes 129. Available at: http://www.diabetes.nhs.uk. Accessed February 24, 2010.
- 31.International Diabetes Foundation web site. Choosing to take control in type 2 diabetes. April 2007. Available at: http://www.idf.org/webdata/docs/ChooseControlReport.pdf. Accessed April 1, 2010.
- 33.Anderson RM, Funnell MM. Using the empowerment approach to help patients change behaviour. In: Anderson BJ, Rubin RR, eds. Practical psychology for diabetes clinicians. 2nd Edition. Alexandria: American Diabetes Association; 2002.Google Scholar
- 34.Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm. A New Health System for the 21st Century. Washington: National Academic Press; 2001.Google Scholar
- 35.The King’s Fund web site. Patient-centred care. The King’s Fund March 2009. Available at: http://www.kingsfund.org.uk/research/topics/patientcentred_care/index.html. Accessed February 24, 2010.
- 36.Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Practice. 1998;1:2–4.Google Scholar
- 40.World Health Organization web site. The Innovative Care for Chronic Conditions framework (ICCC). WHO 2010. Available at: http://www.who.int/diabetesactiononline/about/ICCC/en/index.html. Accessed February 24, 2010.
- 41.World Health Organization web site. Diabetes Action Online Overview. WHO 2010. Available at: http://www.who.int/diabetesactiononline/overview/en/index.html. Accessed March 13, 2010.
- 42.Simmons RK, Unwin N, Griffin SJ. International Diabetes Federation: an update of the evidence concerning the prevention of type 2 diabetes. Background paper in IDF Diabetes Atlas, 4th edition. International Diabetes Federation; 2009. Available at: http://atlas.idf-bxl.org/content/background-papers-pdf. Accessed April 1, 2010.
- 45.International Diabetes Federation web site. International standards for diabetes education. 3rd edition. International Diabetes Federation 2009. Available at: http://www.idf.org/internationalstandards-diabetes-education-third-edition. Accessed February 24, 2010.
- 47.American Association of Diabetes Educators AADE7™ Measurable behaviour change is the desired outcome of diabetes education. Available at: http://www.diabeteseducator.org/ProfessionalResources/AADE7/Background.html. Accessed February 24, 2010.
- 51.Angelmar R, Berman PC. Patient empowerment and efficient health outcomes. Report 3 from Sustainable Healthcare Financing: new approaches for new outcomes conference, Helsinki February 2007. Available at: http://www.drmed.org/javne_datoteke/novice/datoteke/10483-Report_3.pdf. Accessed February 24, 2010.
- 54.Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). US Department of Education. Washington, DC: National Center for Education Statistics; 2006Google Scholar