Building Competency in Diabetes Education THE ESSENTIALS

SELF-MANAGEMENT EDUCATION & SUPPORT: PROGRAM DEVELOPMENT| 11-7

• There are significant and multidirectional connections between psychological factors, quality of life (QOL) with diabetes, and glycemic control: o Psychological factors affect glycemic control and QOL. o Metabolic control affects QOL. o Patient’s autonomy and competence is linked to medication adherence and QOL. o Healthy coping improves glycemic control. • Many beneficial interventions have demonstrated positive outcomes when the following elements have been included: o General self-management skills. o Coping/problem-solving. o Stress management. o Support groups. o Interprofessional collaboration with collective goal setting. o Cognitive behavioural therapy. o Pathways (consisting of case management, problem-solving counselling and medication support for persons with depression). The authors conclude by noting that the above can be viewed as a state of disarray or a wealth of many choices. They suggest that further research is needed to guide us in how to select, integrate, combine, and sustain SME and SMS interventions and to develop them in cost effective ways. Another meta-analysis examined the integration of educational and psychological interventions in diabetes SME (12). While concluding that psychological interventions were effective in achieving lower glycated hemoglobin (A1C) (0.76%), the author stressed that cognitive-behavioural interventions should incorporate core elements of both behavioural and cognitive models of education, as well as psychotherapy. To further define the effect of cognitive interventions in SME, Klein et al. completed a meta analysis comparing how cognitive self-management strategies versus rules and procedures impacted outcomes. They concluded that the SME interventions showed a modest decline in the A1C (0.57%) as compared to the control group. The intervention groups which were most successful in attaining these results were of shorter duration and used a ‘mixed method’ approach where rules and procedures were augmented with cognitive ‘modeling’ and affective interventions (7). The successful patients were able to develop mental models of the ‘forces