Your Diabetes Patients’ Goals: Keep it Realistic

Setting shorter achievable goals that are practical is more encouraging for patients than larger long-term goals, says Supneet Saluja, MD, an endocrinologist at Mercy Medical Center in Baltimore, MD. “I’ll set time periods for reaching a smaller reasonable target while working toward the larger goal based on mutual agreement with the patient,” she says.

At each visit, Dr. Saluja devotes time to talk beyond a patient’s disease condition. “We discuss their daily routine and come up with a few things that they can work on between visits,” she says. “For patients with diabetes, it’s very important to make dietary and lifestyle changes.”

For weight loss, patients are more motivated when goals are short-term. “If you tell someone who weighs 300 pounds to lose 100 pounds, that’s too large of a goal and sets them up for failure,” she says.

Instead, she’ll set a target of losing half a pound to a pound per week-or five to seven pounds in 12 weeks. “If a patient is able to achieve more weight loss than their target, they will be very proud of their achievement and encouraged to work harder,” she says. “Using baby steps is helpful when trying to achieve bigger long-term goals.”

One strategy that’s proven to be effective for weight loss is recommending portion control. She suggests picturing a plate with four quadrants. Half of the food on the plate should be something green-such as a leafy vegetable or salad, one-quarter should contain a protein source, and one-quarter can be a starch. Patients have difficulty restricting major food groups for long periods of time.

Another method for weight loss is to plan meals for the week while grocery shopping. “Many of my patients tend to eat on the go,” she says. “I am a big proponent of preparing your own meals, so you can create balanced meals and control what you’re eating.”

In terms of physical activity, it is important to recognize the individual needs of each patient before recommending goals. “Not everyone can go to the gym,” she says. “We figure out how they can increase physical activity by simply adding more steps to their day. A lot of my patients track their steps using a tracking device, in an effort to meet goals. The focus is to work toward improving their fitness and cardiovascular profile. Every individual has a unique profile and challenge, so tailoring management according to their needs is important.”

Overcoming Challenges

Dr. Saluja has found that sometimes patients have unrealistic expectations. Dietary and lifestyle changes are used as vital adjuncts to medication regimens. “I set targets at every visit and change them according to the patient’s healthcare needs.”

When a patient doesn’t meet a target, she determines what contributed to the shortcoming and tries to come up with other solutions that may work better; maybe make different goals. Consider having more frequent follow-ups so there is more reinforcement.”

“I always emphasize to my patients to continue to work toward their long- term goal and not get discouraged by minor setbacks,” she concludes. “It’s all about taking one day at a time, making good decisions one meal at a time, and moving forward toward better health and fitness.”