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Patient empowerment in diabetes

Recently, a patient newly registered at the practice where I work came to me adamant that there is now a cure for type 2 diabetes. I wonder how many of you working in general practice have heard something similar from your patients?

This lady wanted my approval to try out the same programme that had apparently worked for the majority of those who had been on this trial. What she really wanted was to stop taking gliclazide as well. Before I would consent to going through with this, I advised that we needed a complete set of bloods to assess her level of wellbeing, including HbA1C, liver and kidney function and lipids. Having obtained her agreement for this, I went away and investigated what she had said.

I discovered that a very small study had been conducted by researchers from Newcastle University. By reducing daily calorie intake to 600 cal/day, the pancreatic beta cell function appeared to return to normal and the sensitivity of the liver to insulin in those with type 2 diabetes was improved. However, this is not a conclusive study, as only 11 people were this special diet. Nonetheless, my patient was very keen to try, and has now embarked on a similar diet, and I wait to see what sort of impact it makes to her diabetes over eight weeks. What would you do in such a situation?

It is apparent from my 12 years or so working with people with diabetes, that people do latch onto these sensational articles in the national press. I recall many years ago a patient having read that there was the possibility of treating diabetes with a form of lizard saliva; sure enough this is the exenatide we now use in diabetes management. Statins for the treatment of raised cholesterol have also featured in the national press, creating anxiety in patients about potential side effects.

Their expectations are that somehow, as if by magic, the nurse/GP will have the answer and prescribe something that will completely deal with the problem, and all they themselves have to do is to take the tablets.

My aim these days is to work with the patient and encourage them to make the decisions, which will hopefully improve their health.

It is also fascinating to see what will spur a patient into action. Two or three years ago, a patient of mine was confronted with the fact that his diabetes was poorly controlled, HbA1C 11.8% (as we recorded it then) and being on maximum oral medication the only option available then was insulin. He asked if there was any alternative, and I suggested that if he was able to lose some weight, he might improve his blood glucose control.

We agreed on a three month trial, after which we would review his HbA1C. He was weighed every 2-4 weeks during this 3-4 month period and during this time he lost over 5 stone and lowered his HbA1C to 5.8%. This was achieved by completely changing his way of life so that moderately vigorous exercise became a daily routine; fast food and fatty snacks were eliminated from his diet. At that point he came off most diabetes medications apart from metformin; even 6-12 months later his HbA1C had only risen to 6.8%. Whenever my GP colleagues suggested I was starting people on insulin too readily, I reminded them of this man.

How do you motivate your patients to eat a more balanced diet than they do, or encourage them to increase the amount of exercise they take? How can we empower those who lack any personal responsibility for managing their diabetes? Leave your suggestions below!