A practical model of diabetes management and education

This article discusses an evolving conceptual model of diabetes self-management and patient education. The model contains three primary levels or stages: 1) social environment and contextual factors, which have received little research attention; 2) patient-health care provider interactions, self-management behaviors, and short-term physiological outcomes, which constitute an ongoing cycle of care feedback system; and 3) longer term health and quality-of-life outcomes, which include the major societal costs of treating diabetes complications. The assessment and intervention implications of factors within each of these levels are discussed, with emphasis on both low-cost system-wide activities appropriate for all patients and higher cost activities and resources (e.g., intensive management à la the Diabetes Control and Complications Trial) for appropriately targeted or higher risk patients. I hope that such a systems approach to diabetes management can help reduce victim blaming (whether the victim is the noncompliant patient or the insensitive provider). Such conceptual models, if practically oriented, may help accelerate the development, evaluation, and dissemination of programs that facilitate both patient and health care team adherence to recommended guidelines for diabetes care.