A Desktop Guide to
Type 2 Diabetes

Assess whether the person with diabetes :

• has the knowledge and behavioural skills necessary for optimum self-care
• makes early and effective responses to everyday problems
• has the confidence to obtain the best input from the diabetes health-care team

Ensure that empowerment is :

• a primary objective of your consultations and education programme
• supported by availability of diabetes publications and other information sources
• the active policy of your diabetes service

Provide

• positive encouraging responses to requests for information and understanding
• a copy of the European Patients' Charter
  or a similar national or local statement of rights and roles
• a copy of the person's diabetes health-care record
• information on the results and meaning of all investigations

6.2 Patient education - Assessment

Use :

• review of diabetes skills ( self-monitoring, food identification )
• biomedical measures ( changes in body weight, glycated haemoglobin ( Targets ) )
• evidence of appropriate behaviours ( footwear, physical activity,
  smoking cessation, membership of diabetes associations )
• assessment of life-style, emotional adjustment, and perceptions of barriers
  to life-style activities and self-care
• perceptions of desired short-term goals ( glucose control, weight ), and
  long-term vulnerability ( to arterial disease )
• knowledge ( as a basic measure )
• diabetes-specific well-being and health profile assessments (as global measures)

Perform assessment :

• as part of routine care visits, by direct enquiry
• more formally, as part of Annual Review, or on first contact

( Top of 'Patient education' )

6.3 Patient education - Goals

Aim to optimize :

• knowledge of diabetes, its progressive nature, and the aims of its management
• ability to define personal health-care targets
• motivation and attitudes to self-care
• behaviours which interact with diabetes management
• empowerment in using the skills of health-care and other professionals

Aim to provide skills to:

• manage nutrition and physical activity
• understand and agree health-care targets, and develop strategies for meeting them
• manage complications of therapy including hypoglycaemia
• use the professional members of the diabetes care team effectively
• respond to new problems in diabetes care
• monitor and use the results of therapy
• avoid self-destructive behaviours and deal adequately with stress
• ensure appropriate use of glucose-lowering therapies
• empower self-management during intercurrent illness
• cope appropriately with the late tissue damage of diabetes

6.4 Patient education - Provision

Integrate education into regular clinical care by providing your own curriculum and programme

Ensure that the diabetes team has personnel adequately trained in patient education

Assess special needs of each individual ( see above )

Be aware of needs of special groups ( language problems, physical / mental disabilities )

Provide education within three time frames :

• At and shortly after diagnosis :
• basic information on healthy eating, physical exercise, and smoking cessation
• supportive information on the nature and outcomes of diabetes
• the minimum skills to obtain control over the new situation
• In the months following diagnosis :
• a comprehensive coverage
• topics covered previously, plus
• targets of therapy, eating at home and away
• complications of diabetes, arterial risk factors, foot care
• employment, insurance, driving and travel ( Lifestyle issues )
• In the long term :
• reinforcement periodically after annual evaluation ( see above )

Include carers and family members as appropriate

Use group education to uncover problems and provide solutions and behavioural change through peer example

Review, evaluate, and improve the impact of your education programmes regularly

( Top of 'Patient education' )

6.5 Patient education - Life-style issues

6.5.1 Assessment

Ask regularly about diabetes interfering with :

• employment
• social and leisure activities
• travel

6.5.2 Topics

6.5.2.1 Employment

Provide :

• individualized advice
• counselling and contacts for those affected by a change to insulin therapy

Provide advice :

• on the need for valid travel insurance
• on special health risks in visited countries
• as appropriate for those using insulin ( see Desktop Guide to Type 1 Diabetes, 1998 )

Review coping skills for acute illness, especially gastroenteritis, and hypoglycaemia

( Top of 'Patient education' )

TYPE 2 DIABETES - 6 - PATIENT EDUCATION

TYPE 2 DIABETES - 7 - SELF-MONITORING

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7 SELF-MONITORING OF BLOOD GLUCOSE CONTROL

7.1 Use and assessment of self-monitoring

Advise use of self-monitoring for :

• education on effects of diet and physical activity on blood glucose
• assurance of satisfactory blood glucose control
• coping with illness and new situations
• insulin dose adjustment and hypoglycaemia management where relevant

Assess skills ( and meters if used ) yearly or if problems with self-monitoring

Evaluate reliability of self-test results ( if indicated ) by :

• consistency with the results of glycated haemoglobin estimation ( Targets )
• comparison with acute results obtained at consultation
• review of the quality of self-test record diaries

Use

:

• for all people with Type 2 diabetes
• blood reagent strips / meters, or self-urinalysis according to individual need

Provide appropriate training and regular review of technique

Recommend :

• results are recorded ( with date and time )
• different patterns of testing according to need :
• urine glucose post-prandially 1-7 times a week if results consistently negative
  and glucose control targets met
• blood glucose 1-4 times a day according to need if glucose control is deteriorating
  or if using insulin therapy ( see Desktop Guide to Type 1 Diabetes, 1998 )
• blood glucose 4-8 times a day during illness, life-style changes, in pregnancy
• tests 1-2 h after meals and not just pre-prandially
• testing to cope with variations in eating or activity
• urine glucose testing if blood glucose monitoring is indicated but not possible,
  or if the patient does not wish to continue with it

( Top of 'Self-monitoring' )

TYPE 2 DIABETES - 7 - SELF-MONITORING

( Top of page ) ( Guidelines contents list ) ( Guidelines index )