Diabetes education aims to promote self-management through behavior change and understanding how lifestyle factors impact blood glucose levels. The document discusses the role of diabetes educators in facilitating learning to manage diabetes. It also outlines some key challenges for educators, such as availability of education programs, perceptions of diabetes as non-serious, and the cost of education. Strategies to address these challenges include lobbying governments to increase funding and recognition of diabetes as a serious disease.

1. Dr. Riyad Banayot, MDDr. Riyad Banayot, MD

2. The need for diabetes education
Aims of diabetes education are:
 Change behavior and
 promote Self-management
 A person with diabetes will understand the impact of
factors such as food intake, exercise, stress and
medication on blood glucose
 Make appropriate adjustments to maintain glucose
within a target level.
 Diabetes education provides tools and support to
patients so as to manage their disease.
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3. The need for diabetes education
 Role of the diabetes educator has changed
 from Expert gives out information
 to Facilitator helps people to learn what
they need to know and supports them through
the changes required to manage their
diabetes.
 The diabetes educator has a complex role that
combines the clinical, educational and
psychological components of diabetes care.
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4. The need for diabetes education
 Diabetes educators provide support and
counseling through life changes after
diagnosis (such as changes in routine with
a new school or a new job, in an ongoing
education process) .
 Diabetes educators can help the individual
to develop the positive psychosocial
adaptation needed to achieve effective
self-management of diabetes.
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5. Diabetes educators – Who ?
 Healthcare professionals, most often nurses,
dietitians, pharmacists and social workers.
 Physicians, psychologists and physical
therapists may also refer to themselves as
diabetes educators, if they have a specific
interest in diabetes.
 Lay people, who have had training in teaching
and in diabetes management, can also be
diabetes educators.
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6. Diabetes education – Where ?
 Can be provided in a number of different
institutions, depending on the needs and resources
available in the region.
 Hospitals
 Inpatient setting
 Outpatient services
 Local diabetes associations
 Local pharmacies
 Home care nurses
 Individual's home
 Community centers
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7. Challenges facing educators
 Vary from country to country, and even
within countries.
 Rural and urban communities have different
issues
 Vary among different cultural groups.
 However; Common core issues are:
 Availability of education
 Perceptions of the disease
 Cost of diabetes education
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8. Challenges facing educators
Availability of education
Availability of diabetes education
 The need for more diabetes educators to serve the
numbers of people with the disease is a common
challenge. In urban areas up to 30-40% of people can be
reached through a diabetes education facility. However,
in rural this number may drop to zero. People in rural
areas may have to travel for days to access specialist
services.
 The sheer number of people with diabetes may
overwhelm the resources available for treatment and
education. Similarly, the demand for normo-glycemia
may place impossible expectations on healthcare
professionals and patients alike.
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9. Challenges facing educators
Perceptions of the disease
Diabetes is not seen as a serious disease
 Poor appreciation of the seriousness of diabetes
is found amongst healthcare professionals and
patients.
 Physicians and healthcare providers who tell their
patients that "your sugar is a little high, just watch
what you eat" or use terms such as “borderline” or
“mild diabetes” are demonstrating a lack of
awareness of the disease that is passed on to the
patients.
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10. “TIME” called
the disease an
“epidemic that
keeps on
raging”
“What alarms
public health
experts the
most is the
speed at
which diabetes
has spread”
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11. Challenges facing educators
Perceptions of the disease
Diabetes is not seen as a serious disease
 This attitude is also apparent in the care provided
where patients are not aggressively managed in
order to achieve target blood glucose levels.
Delays in starting people with Type 2 diabetes on insulin
once oral glucose-lowering agents have failed can have
far-reaching implications.
 Patient empowerment can also be neglected.
People are often not referred to diabetes
education until they have a problem, where an
earlier referral might have avoided it altogether.
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12. Challenges facing educators
Perceptions of the disease
Diabetes is not seen as a serious disease
 Psychosocial issues and patient attitudes to the
disease are largely overlooked, but these are
important in putting the education received into
practice.
 Patients and their families may consider Type 2
diabetes to be less serious than other diseases if
they receive this impression from their physician.
This can add to the inertia of making difficult lifestyle
changes, particularly where symptoms of diabetes and its
complications are not yet present or significant.
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13. Challenges facing educators
Cost of education
 Cost is a major issue in diabetes management.
For the patient, expenditure on pharmaceuticals,
insulin, glucose meters and test strips can be
substantial, which can hamper optimal self-
management. The cost of diabetes education can
also be an issue.
 For the healthcare provider, a key issue is the
lack of trained educators. This can be linked to
the lack of resources, ability and/or facilities for
training diabetes educators. Funds for hiring a
diabetes educator and for setting up an
education program have to be sourced.
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14. Strategies for challenges
Availability
 Must encourage governments to recognize
diabetes as a serious disease and to develop
national strategies for the management of
diabetes.
 This can be done through partnership with
organizations, such as the World Health
Organization and the International Diabetes
Federation.
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15. Strategies challenges
Perceptions of the disease
Promoting diabetes as a serious disease
 The need to educate physicians and pharmacists
and other healthcare professionals about
diabetes, but more needs to be done by diabetes
associations to increase awareness of diabetes
and increase membership.
 As awareness of “diabetes as a serious disease”
increases in the general public, consumers will
insist their physicians know more about the
disease.
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16. Strategies for challenges
Funding/Cost
 Another key role for diabetes associations is to
continue to lobby governments on funding issues.
Efforts from members of national organizations
may prompt education to be part of the national
health insurance
 The government may have to provide essential
supplies, such as test strips, syringes and needles,
to people with diabetes at reduced cost.
 However, the government and insurance agencies
need to be lobbied further to increase funding for
diabetes supplies and education.
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17. Issues addressed in education
 One of the major issues in diabetes education is
recognition that diabetes is a serious disease in
all ages and stages of the disease.
 The goal of diabetes education therefore is to
assist people to develop the skills and strategies
they need to manage diabetes.
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18. Issues addressed in education
 Promoting self-management
 Glycemic control
 Insulin use
 Lifestyle changes
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19. Issues addressed in education
Methods used to promote self-management
 Increasing knowledge
 People with diabetes need a basic level of information
in order to manage their diabetes
 Providing skills
 The most important skill that the diabetes educator
can teach is how to apply this knowledge in their daily
lives
 Changing attitudes and behavior
 Diabetes educators should empower people with
diabetes to take charge of their own disease.
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20. Issues addressed in education
Glycemic control
 Diabetics should be made aware of the
importance of glucose control in delaying or
preventing cardiovascular disease and other
complications.
 They often given schedules of when screening for
complications should take place. They should ask
their doctor for tests to be done.
 Prevention of complications is a key part of the
discussion the educator will have with the
individual with diabetes.
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21. Issues addressed in education
Insulin use
 Insulin use should be discussed in detail with IDDM
patients
 Individuals should be encouraged to learn to adjust their
own insulin for changes in day to day activity.
 Improved therapy is recognized by most healthcare
providers in most countries, yet, actual implementation
is difficult since rapid acting insulin, insulin pens and
pumps for delivery are not available in all regions.
 Insulin management for people with Type 2 diabetes is
often not discussed as soon as it should be. When a
person with Type 2 has done well on oral agents, and is
not at target blood glucose levels, the switch to insulin
should be made.
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22. Issues addressed in education
Lifestyle changes
 Lifestyle issues and negotiating for change are part of
the discussion between the educator and the patient.
The educator will help individuals to recognize areas for
change and then support them through these changes.
 Different concepts and theories are used to determine
practice; the most widely accepted theories are:
 Empowerment, which recognizes the right of the diabetic to be
the primary decision maker in the management of their
condition
 The Trans-theoretical Model of Change that focuses on initiating
an appropriate intervention for the readiness of the individual to
make a change
 The Health Belief Model, which relates to the belief patterns of
the individual. 22

23. Strategies and tools
 The new trend in diabetes education is
“Pattern management”.
 Patients are taught to look for patterns in
their lives and adjust their meals, activity and
medication to achieve the best blood glucose
levels possible.
 It is based on blood glucose meter test
results.
 Patients are encouraged to test, to interpret
the results and make adjustments to plans.
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24. Strategies and tools
 Diabetes educators are moving from telling
diabetics what to do to a more collaborative
model where the individual decides what he
or she wants to do.
 The educator responds by helping the person
with diabetes to discover if the chosen
activities allow him or her to maintain target
blood glucose levels.
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25. Summary
 Diabetes education is a key component of diabetes
management.
 The main aims of diabetes education are to enhance
knowledge and foster behavior change in order to
promote self-management.
 The diabetes educator's role is to help people with
diabetes learn to manage their disease.
 The main challenges for diabetes educators are common
to most regions and include the availability of education,
disease perceptions and the cost of diabetes education.
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26. THANK YOU
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