Patient Education

Assessment of patient education (needs and achievements)

Use :

		review of diabetes skills ( self-monitoring, injections, hypoglycaemia management, food identification )
		biomedical measures ( changes in body weight, glycated haemoglobin )
		evidence of appropriate behaviours ( footwear, use of injection sites, 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 late tissue damage )
		knowledge ( as a basic measure )
		diabetes-specific well-being and health profile assessments (as global measures)

Perform :

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

The aims of education and training are to provide information in an acceptable form, in order that people with diabetes develop the knowledge to self-manage their diabetes and empower them to make informed choices in their life

Patient education targets

Aim to optimize :

		knowledge of diabetes, and the aims of its management
		motivation
		attitudes to self-care
		behaviours which interact with diabetes management
		empowerment in handling health-care and other professionals

Aim to provide skills :

		to ensure optimal and appropriate use of insulin therapy
		to deal with the social and life-style consequences of insulin therapy
		to be able to detect and manage hypoglycaemia and other complications of therapy
		to be able to monitor the results of therapy and act appropriately on the results
		to manage effectively nutrition and exercise
		to enable appropriate self-management during intercurrent illness
		to be able to formulate and agree health-care targets and strategies for meeting them
		to use the professional members of the diabetes care team effectively
		to understand and cope appropriately with the late tissue damage of diabetes
		to make appropriate responses to unpredicted and new problems in diabetes care
		to avoid self-destructive behaviours and deal adequately with stress

Provision of education

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

Ensure your diabetes team has adequately trained personnel

Assess special needs of each individual ( see above )

Be aware of needs of special groups ( young people, pregnant women, the elderly )

Provide education within three time frames :

At and shortly after diagnosis :

the minimum skills to obtain control over the new situation
supportive information on the nature and outcomes of diabetes
basic information on self-injection, self-monitoring, hypoglycaemia, dietary carbohydrate distribution

In the months following diagnosis ( on a one-to-one basis ) :

a comprehensive coverage
topics covered previously, plus
coping with illness, targets of insulin therapy, healthy eating
complications of diabetes, associated risk factors, foot care
employment or schooling, insurance, driving and travel
pregnancy, genetic counselling, contraception

In the long term :

reinforcement periodically after annual evaluation ( see above )

Include family members and significant others as appropriate

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

The tools of diabetes care can only be used effectively and optimally when combined with the process of patient education and with continuing evaluation of the outcomes of care

Self-monitoring of Blood Glucose