Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-53

mental health and family situation all influence coping skills. These factors will also determine how the individual may respond to certain interventions.

The 2018 Guidelines recommend (124): • “Self-management education that incorporates cognitive-behavioural educational interventions, such as problem-solving, goal-setting and self-monitoring of health parameters and dietary modifications, and physical activity should be implemented for all able individuals with diabetes. [ Grade B, Level 2 ]”. • “Interventions that increase patient participation and collaboration of the person with diabetes in health-care decision making should be used by all health-care providers. [ Grade B, Level 2 ]”. A recent systematic review looking at facilitating healthy coping in patients with diabetes suggests that there are a variety of coping interventions that have been successfully applied to diverse populations (113). The review highlights that the person with diabetes needs physical health as well as emotional health in order to effectively cope with the chronic nature of diabetes. An important consideration is that “treatment intensification in response to poor metabolic control often improves both clinical and QOL outcomes” (113). Several studies showed that when newer technologies were used to intensify glycemic control, the QOL was also improved (113,125). These technologies include continuous subcutaneous insulin injections, continuous monitoring and phone apps, especially in the adolescent age group. Intensifying treatment in type 2 diabetes with the newer insulin analogues, glucagon-like peptide (GLP) medications and using structured self-monitoring was also shown to improve glycemic control, positively affecting the ability of the patient to cope with their diabetes (113). In the behavioural realm, there are numerous strategies that have some proven success in improving coping skills. These include diabetes SME and SMS, problem solving approaches, solution-focused communication (126), support groups and goal-setting (112,113,127). An intervention known as coping-skills training, a psycho-educational group intervention focusing on the beliefs and attitudes that underlie a person’s problem-solving orientation and patterns of self-care, has also proven effective. It includes assertiveness training and development of communication, problem-solving and conflict-resolution skills (122). Effective coping and prevention of powerlessness, as demonstrated by integration of self-care behaviors into daily life, is the goal of coping-skills training. Other interventions have been targeted to specific populations with considerable success. Family therapy has been particularly useful in youth with type 1 diabetes in resolving family conflict and encouraging adherence (51,113,128). Cognitive behavioural therapy (CBT) has