The Science of Diabetes Self-Management and Care

Individuals with diabetes on insulin for at least one year, were studied in regard to styles of coping with stress and metabolic control of their disease. Those in good control used self-con trolling and avoiding styles of coping; whereas, those in poor control more often used fight/anger reactions to stress. Findings suggest self-controlling behaviors might be enhanced and anger/fight reactions to stress reduced through self-management programs. Such programs would be designed to increase self-efficacy through setting of achievable short-term goals with rein forcement of positive behaviors, modeling of successful coping styles, and attention to relaxation and stress reduction techniques.

State-of-the-art educational and clinical management services for chronic illness are generally found in referral centers. In Minnesota, those referral centers are based in metropolitan areas and are not easily accessible to people living in small communities or rural areas. In 1979, a pro gram was developed to work with community health pro fessionals to provide and support pediatric diabetes care in nonmetropolitan areas. In the past five years, the Minne sota Diabetes in Youth Program (MDYP) has provided an innovative approach to community-based care for children with diabetes. It emphasizes education for families to help them deal more effectively with diabetes management.

Teaching the older patient with dia betes presents unique challenges. The difficulties commonly associated with diabetes education become more pro nounced. In addition, there frequently are special problems that can interfere with desired learning outcomes. This article addresses these obstacles and offers practical suggestions for dealing with them.

During a five year period, informa tion was collected on fifty pregnant women with diabetes mellitus who had been referred to the Diabetes Education Program. Half were man aged in a high risk obstetrical clinic; half were managed by private physi cians. In both the clinic and private set ting, the trend over the last five years has been toward tighter control. Methods to achieve better control of diabetes are described; statistical data and outcomes of the two groups are presented and discussed.

A retrospective chart audit revealed improvement in documentation of quality team care, especially of the nurse educator's role, but a lack of documentation of follow-up telephone consultations.

The literature on anxiety and learn ing, especially as it relates to the newly diagnosed hospitalized adult diabetic patient, was reviewed. The concept that the diabetes diagnosis does consti tute an anxiety-producing event was well substantiated, as well as the con cept that such anxiety can and does interfere with learning. The literature suggests that the deterrent effect of this anxiety may be modified by proper timing of the teaching as well as knowledge of other environmental stressors. Useful strategies for the health educator to employ in such situations are suggested.

The nutritional aspect of diabetes treatment is often the most difficult component of care for the patient and the health professional. The demands imposed by major alter ations in lifestyle, the artificiality of therapeutic eating pro grams, and the lack of available and proven counseling are possible causes of poor patient compliance. "Diets" may also be socially stigmatic to patients with diabetes. While advances have been made in many areas of nutrition and diabetes, there has been relatively little change in the traditional nutritional counseling methods, intended to lead to an understanding and adherence to a sound nutritional program.

The evolving definition of the general goals of nutri tional therapy and the lack of success with traditional ap proaches to nutritional care of diabetes have recently stimu lated the search for alternate nutritional regimens. These programs have been called "flexible diets. " They all base food selection upon the quality of food content rather than food group as in the exchange diet. Indiuidual counseling is important and is directed primarily to modify present eat ing habits rather than radical changes. The continued de velopment of flexible diets may be an exciting area of nutri tional development in the future.

The newly-diagnosed person with diabetes may respond to the diagnosis with feelings of grief, a reaction that interferes with patient learning of self-management and results in poor disease control. Recognition of patient grief moves the focus of effective diabetes teaching from the hos pital to the community setting.