Friday, December 19, 2008

A Whole-Person Approach to Diabetes Health Education Part 1 of 4


In this series of posts, I focus on diabetes health education aimed at promoting effective self-management of this chronic condition. In particular, I discuss why a whole-person (mind-body) approach to diabetes health education is essential. After all, a good deal or research shows how glycemic (blood sugar) control in persons with diabetes may be significantly influenced by psychological factors.[1][2]

Overview: The Mind-Body Connection and Diabetes

Effective self-management of diabetes mellitus (DM) and other chronic illnesses is difficult for many individuals. Their problem stems from a powerful interaction between psychological and physiological factors. This mind-body connection is the bases for a whole-person approach to diabetes health education.

Physiological Perspective

From a physiological (body, biomedical) perspective, DM is a heterogeneous metabolic disorder characterized by hyperglycemia, a serious condition of elevated blood glucose (high blood sugar) level. Hyperglycemia is caused by defective insulin secretion, resistance to insulin action, or both.[3] The causes and treatment of hyperglycemia differ in the two types of diabetes.

Two Types of Diabetes

Type 1 diabetes is the consequence of an autoimmune-mediated destruction of pancreatic β-cells, which may be due to such things as genetics, poor diet (malnutrition), and environment (virus affecting pancreas). The result is insulin deficiency and requires insulin treatment for survival.

Type 2 diabetes, on the other hand, is typically characterized by insulin resistance, which means the body produces adequate insulin levels but cannot effectively utilize it; and in some cases, the body fails to produce sufficient insulin. This may be due to gene mutations and environmental factors, such as an inactive lifestyle or poor diet, which may act as a trigger for someone with such a genetic tendency, as well as by chronic stress and low birth weight (and associated fetal malnourishment). Treatment of Type 2 diabetes is aimed at reducing insulin resistance through diet, exercise and drug therapy, and, for some people, may eventually require regular insulin injections to keep their blood glucose levels in control.

Potential Medical Complications of Diabetes

There are many potential long-term complications of diabetes. They include loss of vision, renal failure, foot ulcers and amputation, as well as gastrointestinal, urinary, cardiovascular, and sexual problems. Effective glycemic control avoids or postpones these complications.

Psychological Perspective

From a psychological (mind, mental health) perspective, a diabetic person's knowledge, attitudes, and emotions are key. These mental functions and emotions interact to determine how well he or she is likely to manage the illness. That is, diabetic people who control their blood glucose effectively:

  • Understand proper diet, exercise, medication, self-monitoring, etc.
  • Use ongoing feedback to modify their behaviors
  • Have healthy, rational attitudes (beliefs, thoughts, and perceptions)
  • Maintain positive emotions
  • Have a sense of competence and confidence (self-efficacy)
  • Control their mental stress.
Having this knowledge, awareness, way of thinking, feelings, confidence, and coping ability gives people the proper focus and tools to successfully manage their condition. Being psychologically equipped in this manner makes them more likely to change their lifestyles in a positive way and adhere to their plans of care over the long-term. This is why a whole-person (mind-body) approach to diabetes health education is so important.

In my next post, I will offer an in-depth examination of these psychological factors.

References:
[1] Rose M, Fliege H, Hildebrandt M, Schirop T, Klapp BF. The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control. Diabetes Care. 2002 Jan;25(1):35-42. See http://care.diabetesjournals.org/cgi/content/full/25/1/35/F2
[2] Dharmalingam, M. Psychological distress and diabetes: Clinical and metabolic connections. International Journal of Diabetes in Developing Countries. 2005 25(4):92-97.
[3] Gavin III JR, Alberti KGMM, Davidson MB, DeFronzo RA, Drash A, Gabbe SG, Genuth S, Harris MI, Kahn R, Keen H, Knowler WC, Lebovitz H, Maclaren NK, Palmer JP, Raskin P, Rizza RA, Stem MP : Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997 20:1183-1197. See http://care.diabetesjournals.org/cgi/content/full/25/suppl_1/s5

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