[From Monologue to Dialogue: The Evolution of Diabetes Self-Management Education]

Diabetes is a chronic disease. Patients with diabetes must actively change their eating and exercise habits and cannot rely solely on medication. Moreover, these patients need to control high blood glucose, high blood pressure, and high blood cholesterol, commonly known as control of the "three highs". As the current state of diabetes control is not ideal in the United States and Taiwan, disease-related complications such as blindness and the need for dialysis is expected to continue to increase in these countries in the future. This article highlights the possible factors of poor control of the "three highs" such as the therapeutic inertia of physicians (also known as clinical inertia), patient adherence, and current challenges in diabetes self-management education. In the past, courses in health education at our institution have been frequently delivered in monologue format. In recent years, we have tried a form of group therapy known as shared medical appointment (SMA) in order to encourage dialogue among patients and minimize didactic teaching. The preliminary results have been promising. In recent weeks, we began to discuss targeting SMA therapy on the topics of food metabolism and the typical effects and side effects of new and old drugs. We hope this will ease our introduction of shared decision making (SDM) in the near future. Promoting time-consuming procedures such as SDM is difficult in Taiwan because national-insurance health insurance payments to the healthcare provider are based on volume rather than value. We hope that the Health Insurance Bureau begins to recognize and appreciate the contribution of nurse educators and dietitians in the care of patients with diabetes and approve compensation for their hard work.