The ideal care for a person with diabetes includes a close and lasting relationship between the person with diabetes and their diabetes care provider team. This allows the team to tailor treatment goals towards suitable and realistic targets, typically catered around a person's background and different stages in life. Ongoing relationship between the person with diabetes and their care providers also allows them to leverage on the person's strengths while working on improving other areas of care.
Decision cycle for patient-centric management in type 2 diabetes. Image from American Diabetes Association (click on image to zoom).
The treatment of diabetes is unique in a way that it depends heavily on the shared decisions and joint management between the diabetes care providers and the person with diabetes. Many daily activities can affect blood glucose, especially in people who are insulin-deficient. Even in people who are treated with oral medications, diet, exercise, fasting, travel, sick day plans, pregnancy planning, and other issues still need to be addressed. Understanding diabetes and how it can be affected by daily activities is one of the key component for successful treatment for diabetes.
The process of teaching self-management and providing support to a person with diabetes is called diabetes self-management education and support (DSMES). Typically DSMES is provided by the team of diabetes care provider, consisting of a doctor, an educator nurse, a dietitian, a pharmacist, a psychologist or behavioural therapist, and sometimes peer support groups.
DSMES sessions are recommended at these critical time periods:
1. At the time of diagnosis of diabetes
2. Annually, or whenever treatment target is not reached
3. When complicating factors develop
4. During transition periods of life or transition of care
Critical time periods for DSMES; at diagnosis, annually and/or when not meeting treatment targets, when complicating factors develop, and when transitions in life and care occurs. Image from American Diabetes Association (click on image to zoom).
Important factors that can complicate diabetes treatment include hypoglycaemia, treatment side effects, polypharmacy, costs, as well as diabetes complications itself, whereas important transition periods include transition from childhood to adolescence, from adolescence to adulthood, from adulthood to older age, pregnancy and breastfeeding, Ramadan fasting, change of life or work environments, and initiation of insulin or other injectable treatment for diabetes.