The program helps people with diabetes gain the knowledge, skills, and support needed for diabetes self-care. This study shows that receiving diabetes education is an important part of diabetes care.

It discusses the importance of:. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Diabetes Education Linked to Better Diabetes Self-Care. Minus Related Pages. Learn More. Mental illness are known to exacerbate diabetes in many people and lead to poor management [ 13 , 14 ].

People who do not have proper stress management skills may not behave appropriately. Studies have shown that stressful life events can make diabetes treatment and management less effective [ 15 , 16 ]. Stressful life events in patients can negatively affect problem-solving skills and lead to poor self-management behavior [ 17 ].

Therefore, adaptive coping strategies are important for people with diabetes. There is evidence that diabetics experiencing stress and depression have negative effects on self-care behaviors, affecting health status [ 18 , 19 ].

Self-managing behavior requires problem-solving skills at all levels. There is evidence that diabetes management is significantly associated with perceived stress and problem-focused coping styles [ 20 ]. Applying stress management techniques is effective in improving diabetes management and behavioral control [ 15 , 21 ].

Stress management plays an important role in the self-care of chronically ill patients [ 22 ]. Emotional support is associated with better diabetes self-care, and people with diabetes need help finding the optimal adaptive strategies to improve their quality of life.

Stress management plays an important role in self-care for chronically ill patients [ 22 ]. Emotional support is associated with better diabetes self-care, and people with diabetes need help finding the optimal adaptive strategies to improve their quality of life [ 23 ].

Additionally, managing diabetic stress is important for people with diabetes as it can lead to improved self-care. Stress management techniques should be integrated into diabetes care and delivered at all levels of the healthcare system.

There is evidence that stress management programs promote stress management strategies and self-efficacy [ 24 ]. To our knowledge, no studies have investigated the association between stress management behaviors and diabetes self-care practices in Ethiopia.

Therefore, the aim of this study was to examine the association between stress management behaviors and self-care practices. In addition, this study provides relevant information for evidence-based decision-making and design of appropriate community interventions, as well as planning and design of future behavioral promotion strategies and interventions.

Additionally, the results of this study will help people with diabetes and their healthcare providers plan appropriate interventions to ensure optimal health.

The facility-based cross-sectional study design was employed at public hospitals in the North Shoa Zone from March 2 to 29, North Shoa is one of the thirteenth zones of the Amhara region located in northern Ethiopia.

There are 24 districts, 3 municipalities, and 13 hospitals. All public hospitals have diabetes care and follow-up services. The sample size was determined using single population proportion formula that considers a proportion of self-care practice of This study included consenting patients between the ages of 20 and 70, while patients those who were unable to participate in the study based on physician judgment e.

Eight out of 13 hospitals were randomly selected to participate in the study. Sampling frames were created for each selected hospital using registration log book. Study participants were recruited after being proportionally allocated to each hospital.

Study participants were selected using a simple random sampling method. Since each patient had at least one appointment within a month, we waited up to a month for a selected study participant.

A total of four nursing bachelor data collectors participated in the data collection process. Data collectors and supervisors are trained in the data collection process, including research objectives, questionnaire content, and maintaining confidentiality and privacy during data collection.

All authors and supervisors are checked daily for completeness, accuracy, and consistency of the data. The questionnaire was tested for content validity and reliability. To validate the content of the tool, all survey questions were reviewed by two public health experts and physician from Debre Berhan University.

Questions were evaluated for readability, understandability and content validity and recommendations were made. Each collected questionnaire was checked on daily basis for completeness. Additionally, the internal consistency of the tool was checked using the Cronbach alpha test for self-care and stress coping behaviors in diabetes.

The main outcome of this study was diabetic self-care practice. Diabetes self-care practices are measured using the Diabetes Self-Care Activity Summary tool, which includes four areas: diet, foot care, exercise, and blood glucose self-monitoring [ 25 , 26 ].

Respondents marked the number of days the specified behavior occurred on an 8-point Likert scale ranging from 0 to 7 days. An overall average score was calculated and the above averages indicate better self-care practices in people with diabetes.

Stress coping behavior was measured using eight items adapted from stress coping techniques and tools [ 27 , 28 ]. An overall average score is calculated, with scores above the average indicating better stress management behaviors.

Data were entered into Epi Data version 3. Descriptive analysis was used to describe the frequency distribution of each variable in the study. Associations between independent and outcome variables were analyzed using a binary logistic regression model. More than half of the respondents The majority of respondents Additionally, the majority of participants received formal education.

Overall, more than half of the patients demonstrated stress management behaviors, As shown in Table 2 , the most common reported actions taken by patients were take some time for relaxation each day In the study, the overall self-management behavior of patients with type 2 diabetes was The mean diabetes self-management behavior score was The purpose of this study was to investigate the relationship between stress management behavior and diabetes self-care in the North Shao Zone.

This study found that stress management behaviors were associated with diabetes self-care X 2 , Previous studies [ 14 , 29 ], support this finding and suggest that adequate stress management improves self-care in people with diabetes.

On the other hand, improving diabetes self-care habits can effectively reduce stress in people with type 2 diabetes [ 30 ]. Therefore, educational programs and usual care services as stress management techniques should be considered as usual therapeutic services.

In this study, stress management led to significant improvements in self-care practices. Patients with good stress management skills were twice more to exercise diabetic self-care. Diabetes self-care necessitates a high level of stress-coping skills as well as problem-solving ability.

Therefore, stress-coping behaviors are important for patients with type 2 diabetes. Even if stress management activity had a positive effect on diabetic self-care, over half of the patients in this study To enhance self-care behaviors and stress management, it is necessary to implement stress coping strategies and problem-solving skills.

The most common stress reduction measures used in this study were getting enough sleep, focusing on happy thoughts in bed, and relaxing daily after the activity. The adoption and implementation of different stress management approaches is a priority as stress management techniques improve self-care behaviors of diabetics [ 15 , 21 ].

In this current study, patients with good perceptions are more likely to practice diabetic self-care. One reason could be that when patients have good insight, it can help them understand their health status and avoid confusion when taking diabetes self-care measures.

In this study, patients with good family support were more likely to have self-management behavior. Diabetes self-management behavior can be significantly improved with increased family support. Studies have shown that diabetes-specific supportive and family behaviors have a positive impact on individual self-management behaviors [ 31 , 32 , 33 ].

Therefore, to improve the health of adults with diabetes, it is important to support families who are committed to self-management of their diabetes. We need to build proper support and foster healthy relationships among all family members. The current study has some limitations, including the possibility that self-reported measures may be biased in response and overestimate behavioral performance.

This tool also needs more attention for accurate and reliable data. Practicing stress management and coping skills is the preferred strategy for improving diabetes management behavior. This has been demonstrated in previous studies [ 15 , 21 , 22 , 24 ] and in this study.

Since stress management behaviors and coping skills are associated with diabetes self-management, diabetes professionals should consider these aspects when discussing diabetes self-management.

In addition, the results indicate that stress management programs may have significant clinical benefits for patients with type II diabetes. Therefore, routine care and education programs should address diabetes self-care activities and coping skills that influence health-related behaviors and decision-making.

In summary, the following key program areas attract the attention of policymakers and service providers; 1 As a routine therapeutic or therapeutic service, stress management strategies and coping skills should be integrated into existing systems.

The study results showed that stress management behavior significantly improved diabetes self-management behavior and had a positive association with it. Patients with good stress management behaviors are more likely to engage in diabetes self-management activities.

In addition, patients with good awareness and patients with family support were more likely to have diabetes self-care. All data generated in this study are included in the manuscript. Datasets are available upon reasonable request from the corresponding author. World Health Organization. Diagnosis and management of type 2 diabetes HEARTS-D.

Geneva]: World Health Organization; Licence: CC BY-NC-SA 3. Google Scholar. International Diabetes Federation. IDF Diabetes Atlas, 9th Edition International Diabetes Federation, Bishu KG, Jenkins C, Yebyo HG, Atsbha M, Wubayehu T, Gebregziabher M.

Diabetes in Ethiopia: a systematic review of prevalence, risk factors, complications, and cost. Providers and staff should help patients set stepwise goals toward meeting the recommended exercise targets. As individuals intensify their exercise program, medical monitoring may be indicated to ensure safety and evaluate the effects on glucose management.

See the section physical activity and glycemic control below. Recent evidence supports that all individuals, including those with diabetes, should be encouraged to reduce the amount of time spent being sedentary—waking behaviors with low energy expenditure e.

Participating in leisure-time activity and avoiding extended sedentary periods may help prevent type 2 diabetes for those at risk , and may also aid in glycemic control for those with diabetes.

A systematic review and meta-analysis found higher frequency of regular leisure-time physical activity was more effective in reducing A1C levels A wide range of activities, including yoga, tai chi, and other types, can have significant impacts on A1C, flexibility, muscle strength, and balance , — Flexibility and balance exercises may be particularly important in older adults with diabetes to maintain range of motion, strength, and balance Clinical trials have provided strong evidence for the A1C-lowering value of resistance training in older adults with type 2 diabetes and for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes If not contraindicated, patients with type 2 diabetes should be encouraged to do at least two weekly sessions of resistance exercise exercise with free weights or weight machines , with each session consisting of at least one set group of consecutive repetitive exercise motions of five or more different resistance exercises involving the large muscle groups For type 1 diabetes, although exercise in general is associated with improvement in disease status, care needs to be taken in titrating exercise with respect to glycemic management.

Each individual with type 1 diabetes has a variable glycemic response to exercise. This variability should be taken into consideration when recommending the type and duration of exercise for a given individual Women with preexisting diabetes, particularly type 2 diabetes, and those at risk for or presenting with gestational diabetes mellitus should be advised to engage in regular moderate physical activity prior to and during their pregnancies as tolerated However, providers should perform a careful history, assess cardiovascular risk factors, and be aware of the atypical presentation of coronary artery disease, such as recent patient-reported or tested decrease in exercise tolerance, in patients with diabetes.

Certainly, high-risk patients should be encouraged to start with short periods of low-intensity exercise and slowly increase the intensity and duration as tolerated.

Providers should assess patients for conditions that might contraindicate certain types of exercise or predispose to injury, such as uncontrolled hypertension, untreated proliferative retinopathy, autonomic neuropathy, peripheral neuropathy, and a history of foot ulcers or Charcot foot.

Those with complications may need a more thorough evaluation prior to starting an exercise program , In some patients, hypoglycemia after exercise may occur and last for several hours due to increased insulin sensitivity. Hypoglycemia is less common in patients with diabetes who are not treated with insulin or insulin secretagogues, and no routine preventive measures for hypoglycemia are usually advised in these cases.

Intense activities may actually raise blood glucose levels instead of lowering them, especially if pre-exercise glucose levels are elevated Because of the variation in glycemic response to exercise bouts, patients need to be educated to check blood glucose levels before and after periods of exercise and about the potential prolonged effects depending on intensity and duration see the section diabetes self-management education and support above.

If proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy is present, then vigorous-intensity aerobic or resistance exercise may be contraindicated because of the risk of triggering vitreous hemorrhage or retinal detachment Consultation with an ophthalmologist prior to engaging in an intense exercise regimen may be appropriate.

Decreased pain sensation and a higher pain threshold in the extremities can result in an increased risk of skin breakdown, infection, and Charcot joint destruction with some forms of exercise.

Therefore, a thorough assessment should be done to ensure that neuropathy does not alter kinesthetic or proprioceptive sensation during physical activity, particularly in those with more severe neuropathy.

Studies have shown that moderate-intensity walking may not lead to an increased risk of foot ulcers or reulceration in those with peripheral neuropathy who use proper footwear All individuals with peripheral neuropathy should wear proper footwear and examine their feet daily to detect lesions early.

Anyone with a foot injury or open sore should be restricted to non—weight-bearing activities. Autonomic neuropathy can increase the risk of exercise-induced injury or adverse events through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and greater susceptibility to hypoglycemia Cardiovascular autonomic neuropathy is also an independent risk factor for cardiovascular death and silent myocardial ischemia Therefore, individuals with diabetic autonomic neuropathy should undergo cardiac investigation before beginning physical activity more intense than that to which they are accustomed.

Physical activity can acutely increase urinary albumin excretion. However, there is no evidence that vigorous-intensity exercise accelerates the rate of progression of DKD, and there appears to be no need for specific exercise restrictions for people with DKD in general Results from epidemiologic, case-control, and cohort studies provide convincing evidence to support the causal link between cigarette smoking and health risks Recent data show tobacco use is higher among adults with chronic conditions as well as in adolescents and young adults with diabetes People with diabetes who smoke and people with diabetes exposed to second-hand smoke have a heightened risk of CVD, premature death, microvascular complications, and worse glycemic control when compared with those who do not smoke — Smoking may have a role in the development of type 2 diabetes — The routine and thorough assessment of tobacco use is essential to prevent smoking or encourage cessation.

Numerous large randomized clinical trials have demonstrated the efficacy and cost-effectiveness of brief counseling in smoking cessation, including the use of telephone quit lines, in reducing tobacco use. Pharmacologic therapy to assist with smoking cessation in people with diabetes has been shown to be effective , and for the patient motivated to quit, the addition of pharmacologic therapy to counseling is more effective than either treatment alone Special considerations should include assessment of level of nicotine dependence, which is associated with difficulty in quitting and relapse Although some people may gain weight in the period shortly after smoking cessation , recent research has demonstrated that this weight gain does not diminish the substantial CVD benefit realized from smoking cessation One study in people who smoke who had newly diagnosed type 2 diabetes found that smoking cessation was associated with amelioration of metabolic parameters and reduced blood pressure and albuminuria at 1 year In recent years, e-cigarettes have gained public awareness and popularity because of perceptions that e-cigarette use is less harmful than regular cigarette smoking , However, in light of recent Centers for Disease Control and Prevention evidence of deaths related to e-cigarette use, no individuals should be advised to use e-cigarettes, either as a way to stop smoking tobacco or as a recreational drug.

Diabetes education programs offer potential to systematically reach and engage individuals with diabetes in smoking cessation efforts. Including caregivers and family members in this assessment is recommended.

B Monitoring of cognitive capacity, i. Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being.

Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life Emotional well-being is an important part of diabetes care and self-management. There are opportunities for the clinician to routinely assess psychosocial status in a timely and efficient manner for referral to appropriate services , A systematic review and meta-analysis showed that psychosocial interventions modestly but significantly improved A1C standardized mean difference —0.

There was a limited association between the effects on A1C and mental health, and no intervention characteristics predicted benefit on both outcomes. However, cost analyses have shown that behavioral health interventions are both effective and cost-efficient approaches to the prevention of diabetes Key opportunities for psychosocial screening occur at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, during significant transitions in care such as from pediatric to adult care teams , or when problems with achieving A1C goals, quality of life, or self-management are identified 2.

Patients are likely to exhibit psychological vulnerability at diagnosis, when their medical status changes e. Thus, screening for social determinants of health e. Providers should also ask whether there are new or different barriers to treatment and self-management, such as feeling overwhelmed or stressed by having diabetes see the section diabetes distress below , changes in finances, or competing medical demands e.

In circumstances where individuals other than the patient are significantly involved in diabetes management, these issues should be explored with nonmedical care providers Standardized and validated tools for psychosocial monitoring and assessment can also be used by providers 1 , with positive findings leading to referral to a mental health provider specializing in diabetes for comprehensive evaluation, diagnosis, and treatment.

Diabetes distress is very common and is distinct from other psychological disorders , , The constant behavioral demands of diabetes self-management medication dosing, frequency, and titration; monitoring of blood glucose, food intake, eating patterns, and physical activity and the potential or actuality of disease progression are directly associated with reports of diabetes distress High levels of diabetes distress significantly impact medication-taking behaviors and are linked to higher A1C, lower self-efficacy, and poorer dietary and exercise behaviors 5 , , DSMES has been shown to reduce diabetes distress 5.

It may be helpful to provide counseling regarding expected diabetes-related versus generalized psychological distress, both at diagnosis and when disease state or treatment changes occur An RCT tested the effects of participation in a standardized 8-week mindful self-compassion program versus a control group among patients with type 1 and type 2 diabetes.

Mindful self-compassion training increased self-compassion, reduced depression and diabetes distress, and improved A1C in the intervention group An RCT of cognitive behavioral and social problem-solving approaches compared with diabetes education in teens aged 14—18 years showed that diabetes distress and depressive symptoms were significantly reduced for up to 3 years postintervention.

Neither glycemic control nor self-management behaviors were improved over time. These recent studies support that a combination of approaches is needed to address distress, depression, and metabolic status. Diabetes distress should be routinely monitored using person-based diabetes-specific validated measures 1.

If diabetes distress is identified, the person should be referred for specific diabetes education to address areas of diabetes self-care causing the patient distress and impacting clinical management. Diabetes distress is associated with anxiety, depression, and reduced health-related quality of life People whose self-care remains impaired after tailored diabetes education should be referred by their care team to a behavioral health provider for evaluation and treatment.

Other psychosocial issues known to affect self-management and health outcomes include attitudes about the illness, expectations for medical management and outcomes, available resources financial, social, and emotional , and psychiatric history.

Indications for referral to a mental health specialist familiar with diabetes management may include positive screening for overall stress related to work-life balance, diabetes distress, diabetes management difficulties, depression, anxiety, disordered eating, and cognitive dysfunction see Table 5.

It is preferable to incorporate psychosocial assessment and treatment into routine care rather than waiting for a specific problem or deterioration in metabolic or psychological status to occur 34 , Providers should identify behavioral and mental health providers, ideally those who are knowledgeable about diabetes treatment and the psychosocial aspects of diabetes, to whom they can refer patients.

The ADA provides a list of mental health providers who have received additional education in diabetes at the ADA Mental Health Provider Directory professional. Ideally, psychosocial care providers should be embedded in diabetes care settings. Although the provider may not feel qualified to treat psychological problems , optimizing the patient-provider relationship as a foundation may increase the likelihood of the patient accepting referral for other services.

Collaborative care interventions and a team approach have demonstrated efficacy in diabetes self-management, outcomes of depression, and psychosocial functioning 5 , 6. Situations that warrant referral of a person with diabetes to a mental health provider for evaluation and treatment.

Clinically significant psychopathologic diagnoses are considerably more prevalent in people with diabetes than in those without , Inclusion of caregivers and family members in this assessment is recommended. Diabetes distress is addressed as an independent condition see the section diabetes distress above , as this state is very common and expected and is distinct from the psychological disorders discussed below 1.

Refer for treatment if anxiety is present. Anxiety symptoms and diagnosable disorders e. The Behavioral Risk Factor Surveillance System BRFSS estimated the lifetime prevalence of generalized anxiety disorder to be Common diabetes-specific concerns include fears related to hypoglycemia , , not meeting blood glucose targets , and insulin injections or infusion Onset of complications presents another critical point in the disease course when anxiety can occur 1.

People with diabetes who exhibit excessive diabetes self-management behaviors well beyond what is prescribed or needed to achieve glycemic targets may be experiencing symptoms of obsessive-compulsive disorder General anxiety is a predictor of injection-related anxiety and associated with fear of hypoglycemia , Fear of hypoglycemia and hypoglycemia unawareness often co-occur.

Interventions aimed at treating one often benefit both Fear of hypoglycemia may explain avoidance of behaviors associated with lowering glucose such as increasing insulin doses or frequency of monitoring. If fear of hypoglycemia is identified and a person does not have symptoms of hypoglycemia, a structured program of blood glucose awareness training delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness , If not available within the practice setting, a structured program targeting both fear of hypoglycemia and unawareness should be sought out and implemented by a qualified behavioral practitioner , — History of depression, current depression, and antidepressant medication use are risk factors for the development of type 2 diabetes, especially if the individual has other risk factors such as obesity and family history of type 2 diabetes — Elevated depressive symptoms and depressive disorders affect one in four patients with type 1 or type 2 diabetes Thus, routine screening for depressive symptoms is indicated in this high-risk population, including people with type 1 or type 2 diabetes, gestational diabetes mellitus, and postpartum diabetes.

Regardless of diabetes type, women have significantly higher rates of depression than men Routine monitoring with age-appropriate validated measures 1 can help to identify if referral is warranted Adult patients with a history of depressive symptoms need ongoing monitoring of depression recurrence within the context of routine care Integrating mental and physical health care can improve outcomes.

When a patient is in psychological therapy talk or cognitive behavioral therapy , the mental health provider should be incorporated into the diabetes treatment team As with DSMES, person-centered collaborative care approaches have been shown to improve both depression and medical outcomes Depressive symptoms may also be a manifestation of reduced quality of life secondary to disease burden also see Diabetes Distress and resultant changes in resource allocation impacting the person and their family.

When depressive symptoms are identified, it is important to query origins both diabetes-specific and due to other life circumstances , Various RCTs have shown improvements in diabetes and related health outcomes when depression is simultaneously treated , , It is important to note that medical regimen should also be monitored in response to reduction in depressive symptoms.

People may agree to or adopt previously refused treatment strategies improving ability to follow recommended treatment behaviors , which may include increased physical activity and intensification of regimen behaviors and monitoring, resulting in changed glucose profiles.

Estimated prevalence of disordered eating behavior and diagnosable eating disorders in people with diabetes varies — For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior , ; in people with type 2 diabetes, bingeing excessive food intake with an accompanying sense of loss of control is most commonly reported.

For people with type 2 diabetes treated with insulin, intentional omission is also frequently reported People with diabetes and diagnosable eating disorders have high rates of comorbid psychiatric disorders People with type 1 diabetes and eating disorders have high rates of diabetes distress and fear of hypoglycemia When evaluating symptoms of disordered or disrupted eating when the individual exhibits eating behaviors that appear maladaptive but are not volitional, such as bingeing caused by loss of satiety cues , etiology and motivation for the behavior should be evaluated , Mixed intervention results point to the need for treatment of eating disorders and disordered eating behavior in the context of the disease and its treatment.

More rigorous methods to identify underlying mechanisms of action that drive change in eating and treatment behaviors, as well as associated mental distress, are needed Adjunctive medication such as glucagon-like peptide 1 receptor agonists may help individuals not only to meet glycemic targets but also to regulate hunger and food intake, thus having the potential to reduce uncontrollable hunger and bulimic symptoms.

Caution should be taken in labeling individuals with diabetes as having a diagnosable psychiatric disorder, i. Studies of individuals with serious mental illness, particularly schizophrenia and other thought disorders, show significantly increased rates of type 2 diabetes People with schizophrenia should be monitored for type 2 diabetes because of the known comorbidity.

Disordered thinking and judgment can be expected to make it difficult to engage in behavior that reduces risk factors for type 2 diabetes, such as restrained eating for weight management. Further, people with serious mental health disorders and diabetes frequently experience moderate psychological distress, suggesting pervasive intrusion of mental health issues into daily functioning Coordinated management of diabetes or prediabetes and serious mental illness is recommended to achieve diabetes treatment targets.

In addition, those taking second-generation atypical antipsychotics, such as olanzapine, require greater monitoring because of an increase in risk of type 2 diabetes associated with this medication — Because of this increased risk, people should be screened for prediabetes or diabetes 4 months after medication initiation and at least annually thereafter.

Serious mental illness is often associated with the inability to evaluate and utilize information to make judgments about treatment options.

When a person has an established diagnosis of a mental illness that impacts judgment, activities of daily living, and ability to establish a collaborative relationship with care providers, it is wise to include a nonmedical caretaker in decision-making regarding the medical regimen. Cognitive capacity is generally defined as attention, memory, logic and reasoning, and auditory and visual processing, all of which are involved in diabetes self-management behavior Having diabetes over decades—type 1 and type 2—has been shown to be associated with cognitive decline — Declines have been shown to impact executive function and information processing speed; they are not consistent between people, and evidence is lacking regarding a known course of decline Diagnosis of dementia is also more prevalent in the population of individuals with diabetes, both type 1 and type 2 Thus, monitoring of cognitive capacity of individuals is recommended, particularly regarding their ability to self-monitor and make judgements about their symptoms, physical status, and needed alterations to their self-management behaviors, all of which are mediated by executive function As with other disorders affecting mental capacity e.

When this ability is shown to be altered, declining, or absent, a lay care provider should be introduced into the care team who serves in the capacities of day-to-day monitoring as well as a liaison with the rest of the care team 1.

Cognitive capacity also contributes to ability to benefit from diabetes education and may indicate the need for alternative teaching approaches as well as remote monitoring. Youth will need second-party monitoring e.

Episodes of severe hypoglycemia are independently associated with decline, as well as the more immediate symptoms of mental confusion Early-onset type 1 diabetes has been shown to be associated with potential deficits in intellectual abilities, especially in the context of repeated episodes of severe hypoglycemia If cognitive capacity to carry out self-maintenance behaviors is questioned, an age-appropriate test of cognitive capacity is recommended 1.

Cognitive capacity should be evaluated in the context of the age of the person, for example, in very young children who are not expected to manage their disease independently and in older adults who may need active monitoring of regimen behaviors.

Suggested citation: American Diabetes Association Professional Practice Committee. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes— Diabetes Care ;45 Suppl.

Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation.

Previous Article Next Article. Diabetes Self-Management Education and Support. Medical Nutrition Therapy. Physical Activity. Smoking Cessation: Tobacco and e-Cigarettes. Psychosocial Issues. Article Navigation. Standards of Care December 16 Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes— American Diabetes Association Professional Practice Committee American Diabetes Association Professional Practice Committee.

This Site. Google Scholar. Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Table 5. Effectiveness of nutrition therapy 5.

E Energy balance 5. A Eating patterns and macronutrient distribution 5. Eating plans should emphasize nonstarchy vegetables, fruits, and whole grains, as well as dairy products, with minimal added sugars.

Therefore, carbohydrate sources high in protein should be avoided when trying to treat or prevent hypoglycemia. B Dietary fat 5. B Micronutrients and herbal supplements 5. The importance of glucose monitoring after drinking alcoholic beverages to reduce hypoglycemia risk should be emphasized.

B Sodium 5. B Nonnutritive sweeteners 5. Overall, people are encouraged to decrease both sweetened and nonnutritive-sweetened beverages, with an emphasis on water intake. View Large. To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve overall health and: achieve and maintain body weight goals attain individualized glycemic, blood pressure, and lipid goals delay or prevent the complications of diabetes To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and existing barriers to change To maintain the pleasure of eating by providing nonjudgmental messages about food choices while limiting food choices only when indicated by scientific evidence To provide an individual with diabetes the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods.

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Cancel Continue. DSMES programs provide both education and ongoing support to control and manage diabetes. These programs help people learn self-management skills and provide support to sustain self-management behaviors. DSMES programs have helped people with diabetes lower blood sugar glucose levels, prevent complications, improve quality of life, and reduce healthcare costs.

The Stanford Diabetes Self-Management program is an evidence-based approach designed to improve diabetes self-management practices, and delivered by certified educators. While it is important for people with diabetes to develop and engage in self-management practices, self-management can also involve family members, friends, or other caregivers.

These individuals can offer emotional support, model healthy behaviors, participate in exercise activities, help monitor blood sugar glucose levels, administer insulin or other medications, and open communication around effective self-management practices. Enhanced social support from family and friends can help build self-efficacy for diabetes self-management.

Self-efficacy, related to diabetes self-management, is an individual's belief in their ability to successfully manage their own health needs. Self-efficacy is important for effective diabetes self-management.

It is important that patients understand the benefit of diabetes self-management activities. Programs can encourage healthcare providers to speak openly with patients about self-management and refer patients to self-management programs.

Patients with diabetes should be encouraged to ask questions and be reminded that these activities can help them to achieve successful disease management.

Diabetes Self-Management Education and Support in Rural America Website An overview of the benefits of diabetes self-management programs. Describes different types of diabetes self-management education and support programs available to communities. Organization s : Centers for Disease Control and Prevention CDC.

Diabetes Self-Management Education and Support Website Provides links to resources and tools to help communities develop, promote, implement and sustain diabetes self-management education and support DSMES programs. Includes a DSMES toolkit, technical assistance guide, policies, reports, and several case studies.

Diabetes Self-Management Program DSMP Website Describes the Stanford self-management model, an evidence-based program delivered by certified trainers, designed to improve diabetes self-management practices.

The trainers are non-health professionals who may have diabetes themselves and have completed the master training program. Includes educational resources that supplement the program curriculum.

Organization s : Self-Management Resource Center. My Diabetes Self-Management Goal Document A worksheet helpful to individuals when managing their diabetes and setting personal health goals.