Empowerment and Self-Management of Diabetes

Funnell MM, Anderson RM. Clin Diabetes. 2004;22:123-127.

The US healthcare system is based on an acute model of care, in which physicians are responsible for diagnosis, treatment, and outcomes, and patients have little input into their own care. Although this model is suited for acute, symptom-driven conditions, there is evidence—particularly in terms of treatment noncompliance—that this physician-centered model is not suited for chronic conditions such as diabetes. Because optimal diabetes management largely relies on a patient’s daily self-care behaviors, a patient-centered model of care may be more appropriate, in which patients are empowered through education to play a central role in their care.

Self-management education is the foundation of this approach. Patients learn about diabetes and diabetes-related complications as well as different treatment strategies and the advantages and costs of each. They understand how to manage diabetes on a day-to-day basis, and how to implement, assess, and maintain behavioral change, thereby increasing their ability to take responsibility for their own care. An essential part of patient empowerment is having patients actively participate in setting treatment goals so they feel greater responsibility for them and will therefore be more likely to achieve them. Several strategies for health care professionals include actively listening to patients about specific problems or issues they may have; helping patients to monitor, review, and revise treatment goals; and emphasizing the central role patients play in the day-to-day management of their condition.

Practitioners may be reluctant to implement this new model of care, as it entails giving up a traditional authoritative role and fostering a relationship with patients that is one of supportive collaboration and equal partnership. However, this model of care has a number of advantages. Office visits are more efficient, as less time is spent making suggestions patients will not implement or recommendations that are irrelevant to their lives. Further, the concept of success or failure in patient compliance gives way to a concept of opportunities for behavioral changes with specific health benefit outcomes. Finally, professional satisfaction may increase as responsibility for health outcomes shifts from the health professional to the patient.