June 5, 2012

The Challenges in Self-Management of Diabetes

Even though this is a small UK study, it could apply to any developed country and fit the conditions found in this study. This study highlights many of the problems people with diabetes face on a daily basis. These problems include prejudice, ignorance, and stereotyping not only by medical professionals, but also by the society in general.

It is no wonder that even with a trend toward having individuals manage their own health; individuals are ready and able to do this, but need more support. Even in the USA, many doctors are not supporting having individuals manage their diabetes. They often feel that education is wasted on uncaring individuals and many doctors use fear to force people to use oral medications when insulin may make the individuals task of managing their diabetes easier. Plus many in the medical profession feel that for type 2 diabetes, insulin should be the medication of last resort.

If you are a person with type 2 diabetes, you invest time and effort in managing your diabetes. This includes self-monitoring of your blood glucose levels, managing your medications, and carefully following a restricted diet. On top of this, there are the challenges of not offending relatives who think they have your interests at heart. Then we all have the food police that can be rude and offensive in their instructions about what you may consume. Lastly, we have the diabetes police that want to tell you when to test and want to know what the reading is so they can advise you. If you thought life was difficult, then consider the doctors that use fear to motivate you or doctors that belittle you for not having followed orders that were never that specific in the first place.

Since the doctor cannot be with you but only 15 to 30 minutes per appointment approximately four times per year, we must learn to manage our diabetes on a daily basis. This means that for over 99 percent of the time, you are on your own in managing your diabetes.

What is interesting about this study compared to many studies, is that the researchers shadowed the participants for several periods of two to five hours while they were living their lives. They took notes of how they managed their diabetes and the challenges they faced. Trisha Greenhalgh, Professor of Primary Health Care at Queen Mary, University of London, led the study. She said, “Until now there has been very little research on what people with diabetes do and how they cope when health professionals aren’t around. We have shown that self-management of diabetes is hard work both practically and emotionally, and that many but not all people with diabetes are skilful at undertaking and co-ordinating all the different tasks involved."

It is interesting that this part was examined and the participants praised for the efforts they put into managing diabetes. They did say that for those not managing their diabetes well, it was understandable since many were cycled in family responsibilities, some had other illnesses, and some were struggling financially, or even had a combination of these factors. The researchers correctly state that these factors can limit opportunities to manage diabetes and that those who could benefit the most from self-management were the ones least able to achieve it.

The researchers did acknowledge that more needs to be known about how patients manage diabetes outside the clinic. In reality, doctors should be more aware of the efforts patients expend to self-manage their diabetes and understand the many factors that will influence how successful patients are. Until doctors are better able to assess patients and their ability to manage their diabetes, little will be acknowledged in the value of education patients receive. Doctors will continue to resist educating patients.

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