Assuming control after system failure: type II diabetes self-management

Abstract

Type II diabetes occurs when the body’s natural blood glucose regulatory system breaks down. Elevated blood glucose can lead to disabilities, early deaths, and enormous societal expense. While medical and pharmacological science offers powerful approaches for controlling blood glucose levels and ameliorating dangerous consequences, the patient must make most critical day-to-day decisions. Diabetes self-management education is widespread and typically depends on training rules and procedures. Our research identified a pervasive gap between existing educational programs and the real, dynamic challenges that patients face. While simple, well-defined tasks can be managed with rules and procedures, dynamics ones require much more. We describe glucose level management as analogous to the regulation of other complex systems. Patients must control their diet and exercise to achieve a safe blood glucose level and must use physiological feedback and blood glucose monitoring to make corrections when facing illness, stress, or other difficulties. Our research demonstrated that people who had adopted a control model were more likely to maintain healthy blood glucose levels. They had better understanding of diagnostic tools and were able to use the information provided to maintain healthy blood glucose levels. Patients, like others who must control complex systems, are most resilient when they can detect problems, identify problem sources, monitor and interpret outcomes, and generate plausible management plans. While not all people will be able to use this approach, this study suggests that it can assist many people in managing their Type II diabetes.