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Diabetes Management and Team Care
Tools for health care providers and patients can be found on the NDEP Web site at ndep.nih.gov. The NDEP Team Care monograph, available at ndep.nih.gov/diabetes/pubs/TeamCare.pdf* (28), can tell you more about the advantages of team care and how to form a team, and gives examples of effective team care. For information on the link between diabetes and cardiovascular disease, see ndep.nih.gov/campaigns/BeSmart/BeSmart_overview.htm.
Self-management Support Self-management support relies on principles of self-efficacy (confidence in one’s ability to perform a task successfully), short-term action plans, realistic goal setting, and proactive identification of barriers to optimal diabetes control. Self-management support involves asking the person with diabetes to identify an accomplishable action he or she would like to take in changing a behavior (e.g., walking 10 minutes a day before dinner starting tomorrow), not telling the individual what to do. Self-management support also includes trouble-shooting about missed appointments, establishing routines around daily activities such as dental hygiene, foot care or blood glucose testing, and helping people overcome the barriers to receiving regular screening exams for eye, foot and oral health. 
Self-Management SupportAt each visit, the provider and patient need to consider the following patient self-management tasks. How to:
Source: www.betterdiabetescare.nih.gov/WHATpatientcentereddimensions.htm.
Self-management support does not replace traditional patient education but complements it. Because diet and physical activity patterns are important in both diabetes control and prevention, it is important that all providers participate in patient self-management support for healthy food choices and regular exercise. Prompting a patient to consider and plan for challenging events is self-management support. Problem solving discussions can help prepare the patient to deal effectively with self-management issues. 
Self-management Support ExampleA 50-year-old man with diabetes and obesity has been told he would benefit from a less calorie-dense diet, but he confesses to you that he just doesn’t think he can do it. You are not a dietitian—how can you help him make such a change?
In this example, the man might identify eating dessert as a challenge, and a change in portion size (e.g., eating one scoop of ice cream instead of two) as one thing he can do differently. This is an acceptable short-term goal. It is a step in the right direction. All health care providers can contribute to self-management support by helping patients plan and troubleshoot the many daily decisions they must make for diabetes control.
Self-management support also involves follow up: asking about progress Psychosocial considerations and comorbid conditions such as depression can adversely influence self-management behaviors. Multi-disciplinary team care includes working closely with social services, certified diabetes educators, and mental health specialists who can help address these concerns. More information can be found in the NDEP Team Care monograph available
*PDF files require the free Adobe Acrobat Reader application for viewing. May 2007 |
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People with diabetes can take action to lower their risk for heart attack, stroke, and other diabetes complications by controlling the ABCs, following an individualized meal plan, engaging in regular physical activity, avoiding tobacco use, and taking medicines as prescribed. A multidisciplinary team approach is critical to success in diabetes care and complications prevention. Medical nutrition therapy education by a dietitian is critical to developing an individualized meal plan. A certified diabetes educator not only teaches factual information about diabetes but also provides self-management support, enabling the patient to gain skills in problem solving and self-care. All health care providers can help by discussing how self-management and diabetes control relate to preventing complications.
Patient self-management support is important in helping people achieve goals in both diabetes control and prevention. In contrast to traditional patient education, in which information is delivered to the person with diabetes, self-management support involves teaching the behavioral skills needed to make decisions about diabetes management in daily life. Self-management support is a partnership between patient and health care provider. It involves collaborative goal-setting, problem-solving, and individualized behavior-change plans that address concerns identified by the patient as highest priority. All health care providers can provide self-management support, reinforcing patient problem-solving skills and giving consistent, proactive health care messages.
Includes information about managing the ABCs of Diabetes. Also features information for people with diabetes who are eligible for Medicare benefits.
Learn how to prevent or delay type 2 diabetes through small steps.