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There have been a number of reports suggesting that clinician-centered care has limitations. Diabetes is a case in point, requiring patient-centered care to achieve successful management of the disease. Lifestyle changes are among the most difficult changes for a patient to make in an effort to control blood sugars.

The patient’s perspective should be considered. Lifestyle choices for diet and exercise are very personal decisions. It may take a lot more effort to change eating and activity habits than it is to take on a medication regimen. When patients first hear their diagnosis, it may take a while to sink in and they may actually go through stages often associated with death and dying, including denial, anger, bargaining, depression, and acceptance. The acceptance stage may be where the patient is ready to deal with diabetes management, although this may take some time.

Defensiveness and difficulty changing lifestyle preferences
Out of pocket costs
Complexity of therapies
Relationship issues



Because lifestyle is a choice, even if it is a choice to do nothing, patients can become defensive against the clinician’s or educator’s judgment about their lifestyle. The provider should recognize that integrating new diet and exercise or other changes in lifestyle can be difficult. If the patient doesn’t understand the rationale or doesn’t believe that they can accomplish the recommended changes, he or she may avoid the education and training opportunities offered that can improve adherence.

Costs of therapies, including office visits, medications, and laboratory or other evaluations, and therapy complexity can impact adherence to recommendations. Providers will need to understand how these issues are de-motivators to each patient--and work to overcome these barriers.

Finally, staff and health care providers should be on the lookout for signs of problems with interpersonal relationships, both in the clinic and in the family setting, that may be barriers to adherence.

Patient perspectives should be explored and acknowledged. Several recommendations have been made to improve patient adherence to lifestyle recommendations, including education to improve awareness of the rationale for maintaining blood glucose control, and adhering to recommended therapies. Patients can be referred to diabetic educators for education and individualized training on lifestyle changes that may best suited to the patient’s needs and preferences. Support groups and other resources can help to provide the needed encouragement and motivation to maintain positive changes.

In general, strategies to improve adherence should align with patient goals and expectations for outcomes. Home-based care can offers the opportunity to assess home resources and hazards as well as to individualize interventions to the patient’s home environment.


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