Steering Toward a New DAWN in Diabetes Management: Using DAWN Study Findings to Improve Diabetes Care

Supported by an unrestricted educational grant from Novo Nordisk Pharmaceuticals, Inc.

Wed August 11, 2004
12:30 – 2:30 PM

Program Faculty:
Richard R. Rubin, PhD, CDE
Martha M. Funnell, MS, RN, CDE
Mark F. Peyrot, PHD
Linda M. Siminerio, RN, PHD, CDE

Reviewed by Joelle Escoffery, PhD

The Diabetes Attitudes, Wishes, and Needs (DAWN) Study is the largest study of its kind. This study assessed psychosocial variables related to diabetes in 5426 patients, 2705 physicians, and 1122 nurses from 13 different countries. The results of this study confirmed many smaller-scale psychosocial diabetes studies that have been conducted.  In general, patients rated themselves to be more adherent to treatment than physicians rated them to be. Approximately three-fourths of health care providers surveyed acknowledged that psychosocial variables such as depression and quality of life can play an important role in adherence to self-care regimens, but many health care providers feel that they lack the appropriate resources to handle patient psychological concerns. Psychological conditions are relatively common, with approximately 40% of patients reporting poor psychological well-being, approximately 60% reported that they lack the family support that they need, and approximately 40% to 60% of patients reporting anxiety or depression at the time of diagnosis. Further, negative reactions at diagnosis are predictive of poorer adherence, less perceived control over diabetes, poorer quality of life, and more diabetes-related distress. In short, there is a tremendous gap between patient psychosocial needs and health care provider ability to fill those needs.

Patient psychosocial concerns need to play a higher priority in diabetes care, as reducing these needs may improve diabetes outcomes. One strategy for better addressing patient psychosocial concerns is to reject the more traditional approach to patient care, which emphasizes “experts” who “tell” the patients what to do, in favor of an experimental approach to patient care, in which the health care provider encourages the patient to take an active role in determining the most optimal self-care plan. Similarly, the acute model of diabetes care does not accurately portray the reality of diabetes self management. Diabetes treatment based on a chronic care model that incorporates self-management education is key to improving patient psychosocial concerns. Methods for improving self-management education include greater emphasis on team-based care and greater access to a nurse educator.  Research has shown that even minimal access to a nurse educator can improve self-monitoring and goal setting behaviors, as well as overall satisfaction with care.