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Patient Education: Education and Compliance Tips for Patients with Diabetes

In July 2008, PCMG conducted a contest among PCMG members on education and compliance tips for patients with diabetes. We asked you to share some of your more innovative approaches to helping your patients comply with their treatment and lifestyle modifications as well as educating your patients on the progressive nature of diabetes. We received lots of wonderful tips and suggestions and wanted to share them! We hope you find these tips useful and practical to your everyday primary care practice. 

In July 2008, PCMG conducted a contest among PCMG members on education and compliance tips for patients with diabetes. We asked you to share some of your more innovative approaches to helping your patients comply with their treatment and lifestyle modifications as well as educating your patients on the progressive nature of diabetes.

We received lots of wonderful tips and suggestions and wanted to share them! We hope you find these tips useful and practical to your everyday primary care practice.

Tips on Patient Education and Compliance for Patients with Diabetes

Tip 1
"Keep a diary of all PO intake and one of energy expenditure  such as exercise. Teach them how to assign a caloric value to both intake and expenditure and look at the the disparity. This may help them to lessen intake and increase activity and ultimately improve compliance."

Tip 2
"10,000 steps with pedometer daily. DM complication explanation. DM education classes. Patient to patient reference and their own experience exchange. DM natural pathogenesis and disease progression discussion with patients."

Tip 3
"Use a large empty laundry detergent container for disposal of used lancets and needles. When full MARK this as medical waste and appropriately dispose of it. This is SAFE  without charge and a terrific way to recycle."

Tip 4
"I ask then to bring in menus of restaurants they frequent and show them what is healthy on the menu to pick or how to modify what they usually like to order so it will be healthier to eat. i.e. order chicken grilled not fried. I ask them what goal they want to set at each 3 month follow-up visit instead of telling them what they must do; this empowers them. When a patient is scared to start insulin I ask them what is their greatest fear about taking insulin injections. Often they envision a long needle similar to IM immunization needles. When I show then an ultrafine needle I see the fear dissipate. I follow that up with telling them that the abdomen is less sensitive then the fingers so that the injection should hurt much less than poking their finger to use their glucometer."

Tip 5
"I have come up with this guide which I ask my patient to do everytime they come to the clinic for their follow up.
4-MY DOCTOR - I ask my patients to bring to my attention 4 questions that need to be addressed regarding their concerns or problems in self managing their diabetes ex. medications  blood sugar monitoring lab.results diet exercise  ect. I focus  my patient education and intervention on these four questions on that particular visit and follow up the outcome on the next visit. Patients are more motivated  involved and with an incentive to keep their next appointment."

Tip 6
"Most of my patients are very elderly and many are forgetful or confused.  So I keep it simple by stressing that the dinner or lunch plate should have more  greens or vegetables than anything else."

Tip 7
"We do point of service A1c testing with an office based CLIA waved machine. I am able to give patients their A1c's at the time of the visit. I did not seem to be getting much traction with the patients until I tried something. I bought a package of Gold Stars at a local craft store. If your A1c is at ACE goal or if you have made significant improvement in your A1c since your last visit  you get a gold star. Patients seem to really like it. It helps them remember their value. They talk to other patients about their gold star and they even ask me when I walk in the room if they have achieved  Gold Star status  for this visit. It has been a great motivator for patients to make medication and behavior change in their lives."

Tip 8
"I write my patients a  prescription for treats . I order  them to have something they are craving at least once a week.  Of course we discuss moderation and activity or medication to cover the treat but if I tell them they can have something wonderful on occasion  it makes it easier for them to battle against temptations the other days of the week. I have even written these prescriptions and mailed them to each of one of an elderly patient's children so that they would know that her weekly tamales were OK with me. She cried when I told her it was OK. She hadn't had one in over 2 years and missed them desperately. Even with the addition of the high carb food once a week  her A1c remained under 7.0 at her next visit 6 mos later!"

Tip 9
"Provide patients with a log book that they can record glucose levels BPs comments and sx if hypoglycemic.  Patients must bring the log to clinic visits. I have developed a table for use as an electronic log that patients can complete and email to me. I have a process where I have them email me back after I review their electronic logs that they have received and understand my instructions regarding changing insulin dosing  etc. and when they are to send the next log for my review. Bring wife/family member to visit to be included in patient teaching."

Tip 10
"I draw a pie chart on the examining table paper dividing a dinner plate as follows 1/2-veggies and salad (unlimited) 1/4-6-8 oz lean protein 1/4-whole grains/starch (approx. 1/2-3/4 cup serving). If this balance is maintained consistently meal to meal it should achieve goals of diabetic DASH and low cholesterol diets."

Tip 11
"Providing patients with copies of their labs to put on the refrigerator doors so they visually will have something to look at daily as a reminder everytime they open the door to take something out. Also provided patients with pedometers and had them keep track of the daily amount they are walking in a log. This becomes a personal challenge to continue and beat themselves."

Tip 12
"Exercise is an important component of diabetes management however it is difficult to get sedentary patients to become active. Health Canada recomends 60 minutes a day. Patients always argue that they don't have 60 minutes to do so. I always get my patients to start slow and gradually increase however I still get complaints: I'm just too tired or too busy to exercise. For those patients I recommend trying the 5 minutes rule: if you're still too tired after 5 minutes then go back home. Almost all of my patients have told me that once they get ready to go walking/exercise they fullfill their entire walk/exercise. They say that once they get their exercise clothing on and actually start exercising it makes them feel good and have more energy. This works well because all patients will admit they have 5 minutes to exercise but once the patients get exercising they want to continue!"

Tip 13
"At each visit ONE behavioral goal is addressed (ie - eat protein at breakfast, walk 10 minutes per day, test glucose each morning). Patients achieve success when not overwhelmed with many life style changes at once."

Tip 14
"The most important to change regarding this issue is the patient health belief model towards the disease and treatment. It was found that positively changing wrong health beliefs of the patient towards the susceptibility to disease and its severity as well as its possible complications (especially therapeutic lifestyle changes) helped to remove any possible barriers towards this desirable change. These changes could be internal such as habits and traditions or externally such as lack of health education facilities. These would positively affect the diabetic patient compliance."