Preventing Diabetes - What Fresh Strategies and Perspectives?

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We have heard that the CDC has estimated that if current trends continue, an astounding 1 in 3 Americans may have diabetes in the US by 2050.¹

So, what can we do about this?

Virtually everyone knows - and has heard many times - that a healthy lifestyle is crucial to good health, including reducing the risk of developing diseases, like diabetes.

It is so easy to advise patients on therapeutic lifestyle changes. Patients have heard about these recommendations umpteen times, and a common response I hear (and I’m sure, you have as well) to an offer to have the patient see the dietitian or the diabetes educator is, “No, that’s OK. I know what to do; I just have to actually do it.”

But this isn’t something to check in with briefly during a follow-up visit once or twice a year in a few of the already time-pressed minutes in a typical follow-up appointment. It should not be the same recitation of recommendations, followed by a, “Yes, I know, but...”

It should not be, “Let’s send you to a class (we have in our system, a Preventing Diabetes Workshop that is a small, interactive group - not a lecture), yet it’s one-time and for 2 hours.”

So, what does the patient do 99% of the time they’re at work or at home? And how do we make this more real and regular?

Next: Make Daily Goals and Provide Resources

1. It is the sum of many small, daily goals.

I am certainly not suggesting we supplant clinic visits, or lose sight of the big picture. We should provide patients with tools to help them for the vast majority of the time they are not in our presence. Having the end goal - of not developing diabetes, or even prediabetes - can be too large, nebulous, and thus, potentially overwhelming. Ideally, the patient would identify 1 change, and implement it. Patients should then check-in daily, and see if they have stuck with, say, exercising daily so that they’re totaling ≥150 minutes a week of aerobic exercise.

2. We must provide or point patients to, resources.

Your patient has compelling reasons to motivate her; she is ready to change! Now what? We should gauge what other support she may need. It could be a pamphlet or several suggested websites.

Some may want to take part in a diabetes prevention workshop or class.

Maybe for this particular patient, she feels that joining a gym and working with a personal trainer would really help make a meaningful difference, where before she had started, but was knocked off course by the daily demands of life.

Next: Moving Forward

3. Moving forward. 

How do we frame much of what we discuss with patients? Too often, it is in the negative: “I recommend that you: stop smoking, cut calories, start insulin if your A1c isn’t at goal.” The list goes on and on.

Much like Martin Seligman, PhD, caused a paradigm shift in psychology by examining what could go well, and what can cause happiness, we should think in terms of moving towards something, rather than away from it. Better yet, we could use both, so that when they are ready, patients can activate themselves. Ask your patients - what are the potential benefits you hope to gain? More energy? Feeling a sense of pride that you set out to make seemingly impossible changes, and prevailed?

What have you tried? What has worked well, and what may not have landed? I encourage you to share your thoughts with colleagues, and let’s all recommit to continuing to help our patients prevent diabetes.

References:

1. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.