Improving diabetes outcomes, one patient at a time

Andi K. Weiss

MicroMass Communications, Inc.

The WHO reports that 346 million people have diabetes worldwide. Underscoring the growing problem, experts anticipate that number will escalate to a staggering 552 million by 2030.

The clear need for global diabetes education initiatives notwithstanding, independent research conducted by our company reveals that small actions at the individual level are the most effective key to disease management. Whether people have type 1, 2, or another variation of diabetes, up to 95 percent of diabetes management relies on self-care rather than professional care.

Unlike physicians — who diagnose, advise and prescribe — patients face making the right choices day in and day out. And they must understand that these “everyday” decisions can dramatically affect their health. The challenge is finding the tools that prevent this knowledge from paralyzing proactive action.

Information creates isolation

Starting at diagnosis, patients are inundated with mountains of confusing information–brochures and pamphlets about the need to change diet, instructions about the different kinds of diabetes medications, and lectures about how much weight needs to come off.

“…95 percent of diabetes management relies on self-care rather than professional care.”

Overwhelmed, patients often don’t know where to turn and can be left feeling isolated. Likewise, their healthcare providers may view the condition as equally daunting, often feeling like the time constraints of office visits or limitations on how frequently they can see patients also limits treatment efficacy.

That’s where our long-term research into what we call “the diabetes mindset” comes in. For several years, we have worked with providers, patients and diabetes-focused organizations to unravel the roadblocks posed by these confounding and conflicting factors.

Our observations yielded important findings that can help healthcare professionals get the most out of the time they do get to spend with patients. These tools and techniques can help providers make the greatest impact in ways that reach beyond the examination room and guide patients on a successful path outside of the office.

Diverse patients: same views – optimizing office visits

We found that while patients often have disparate drivers and barriers to managing their disease — along with different perceptions of diabetes and how to care for it — patients share inherent similarities in how they view and are affected by diabetes.

Understanding these common characteristics can help providers better prepare for patient appointments so they can better meet patient needs and help instill positive behavior change. Our research with diabetes patients uncovered these commonalities:

1. Patients want individualized treatment and care from their healthcare providers. We found that while disease perceptions varied, all patients want their providers to consider their individual circumstances when helping them create a disease management plan. They don’t want a cookie-cutter approach applied to them.

2. Patients want to be good at managing their diabetes, but many don’t know how or where to start. Diabetes management requires more than reminders to take medication. In addition to changing eating habits, incorporating exercise into a daily routine, and managing medications, it requires:

• Setting goals for the future

• Inspiring motivation to change, and

• Building a support network that encourages patients when they need it, acts like a shoulder to cry on, and serves as a place to celebrate victories.

3. Lifestyle change is hard, even when faced with serious consequences. Unchecked, diabetes can increase the risk of grave health problems such as:

• Heart disease

• Stroke

• Hypertension

• Neuropathy

• Kidney disease

• Retinopathy

But simply knowing these daunting risk factors doesn’t always motivate patients to take action. In fact, they can overwhelm rather than empower patients who don’t know where or how to begin managing their disease.

“…healthcare providers may view the condition as equally daunting, often feeling like the time constraints of office visits or limitations on how frequently they can see patients also limits treatment efficacy.”

The dilemma: diabetes and self image

Aside from these physical implications, diabetes also has psychological effects on how people feel about themselves. We surveyed 828 women with diabetes and found that diabetes permeates many aspects of their lives. Our investigation showed that diabetes negatively affects desire for sex, body image, and general happiness.

While respondents were confident about their ability to take medication as prescribed, this was not the case for their confidence in being able to successfully make necessary lifestyle changes such as diet and exercise.

Our findings further demonstrated the importance of a support system, as those surveyed who were in committed relationships were more likely to have a high level of confidence to manage their diabetes than their single peers.

“Patients want individualized treatment and care from their healthcare providers.”

Motivation matters

While patients do have similarities, they also have differences that often dictate how receptive, willing and able they are to adapt to living with diabetes. It falls on the shoulders of providers to successfully connect with patients and motivate this change. But, as previously stated, most providers are faced with limited time and a lack of resources to do so. Our findings support incorporating evidence-based techniques in the clinical encounter to optimize time spent with patients and help to identify patients’ unique behavioral drivers and barriers.

Personalizing the office visit

We’ve asked healthcare providers what would make connecting with patients easier, and they invariably say the same thing: they want fresh techniques and materials to more effectively reach their patients. They are looking for innovative ways to uncover the attitudes, emotions and beliefs that are holding patients back from successfully caring for their diabetes.

The patient-provider interaction should involve:

• Building rapport with the patient

• Understanding the true drivers and barriers to diabetes management

• Giving patients clear steps they can take when the appointment is over

This can all be achieved by incorporating some simple tactics into the patient encounter that will get to the heart of what’s driving or preventing behaviors among individual patients. The good news is the same types of tools and skills can be used and adapted from patient to patient. With some up-front investment, providers can integrate in-office techniques proven to uncover the psychological components of diabetes that often drive patients’ behavior.

Inspire

First, clinicians can incorporate a coaching style called motivational interviewing. Motivational interviewing can be used to build rapport with patients and help patients realize their clinicians are interested in knowing more about them than just the fact that they have diabetes. It also helps to increase patients’ commitment to change.

Self reflection

Imagery flash cards are a useful tool to elicit more emotion from patients when it comes to their diabetes, which can lead to setting realistic expectations and developing a plan that works.

Role play

Lastly, using role play to practice working through difficult diabetes-related situations with patients can be integral to their success. Role play, customized to the individual, is critical to confidence building to overcome challenges and to encourage patients to make meaningful, relevant changes.

Beyond just numbers

These strategies don’t require extensive training or time to implement. They’re designed to be executed in just a few minutes each, and will help make patients feel like they’re being treated as individuals, while allowing clinicians to truly get at the heart of what’s holding their patients back. Patients will walk away feeling that someone cares about their condition and progress, and providers will feel like they made that critical connection with patients and helped set them on a positive path forward with an individually tailored treatment and lifestyle plan.

“…those surveyed who were in committed relationships were more likely to have a high level of confidence to manage their diabetes than their single peers.”

Guiding patients to successful health outcomes isn’t just about sounding an alarm or scare tactics. Knowing the similarities and vast differences among people with diabetes – and learning how to uncover them during the clinical encounter – will allow providers to efficiently create more meaningful relationships with patients. With this personalized approach, patients are more likely to be invested in their treatment plans.

Along with finding new therapies to serve people who need them, the pharmaceutical industry has the responsibility and is perfectly positioned to provide the tools that help those on the front lines to improve the lives of a growing patient population.

About the author

Andi K. Weiss, MPH, is a senior behaviorist in the strategic services department of MicroMass Communications, a leader in applying behavioral science to healthcare marketing and education support. With her background in behavioral science and focus on improving patient outcomes, Andi specializes in developing practical ways of motivating people to make healthy, sustainable lifestyle changes.

Since 2009, Andi has helped the nonprofit organization DiabetesSisters in its quest to improve the lives of women with diabetes across the globe, and serves on the DiabetesSisters advisory council.

Andi has a Master of Public Health from the University of North Carolina at Chapel Hill and a Bachelor of Arts from the University of Pennsylvania.

For more information, email Andi at andi.weiss@micromass.com or visit www.micromass.com.

What can be done do better motivate diabetes patients?