A critical success factor in diabetes is the self-management capacity of persons with diabetes. Because diabetes requires extensive self-care, the capacities of patients to manage their own illness and care process are considered as a key determinant of treatment outcomes. To enhance these capacities, education of persons with diabetes is an integral part of good care. It enables patients to play an essential role in the treatment of and dealing with diabetes.
Self-management involves the person with diabetes engaging in activities that protect and promote health, monitoring and managing the symptoms and signs of the illness, managing the impact of diabetes on functioning, emotions and interpersonal relationships and adhering to treatment regimes. Other definitions also add that self-management is about making informed choices, adapting to new perspectives; about generic skills that can be applied to new problems as they arise, to practise new health behaviours, and to maintain or regain emotional stability. Self-management requires a change in behaviour of the person with diabetes in getting increasingly a leading role in the process.
In self-management and behavioral change seven self-care behaviors are generally distinguished: healthy eating, being active, monitoring, taking medication, problem solving, reducing risks and healthy coping. Making healthy food choices, understanding portion sizes and learning the best times to eat are central to managing diabetes. Regular activity is important for overall fitness, weight management and blood glucose control. Daily self-monitoring of blood glucose provides the information people need to assess how food, physical activity and medications affect their blood glucose levels. Diabetes is a progressive condition. Depending on what type a person has, the healthcare professional will be able to determine which medications are necessary and help people understand how their medications work. A person with diabetes must keep their problem-solving skills sharp because physical changes or sickness will require them to make rapid, informed decisions about food, activity and medications. Effective risk reduction behaviors such as smoking cessation, and regular eye, foot and dental examinations reduce diabetes complications and maximize quality of life. The final self-care behaviour is healthy coping. Health status and quality of life are affected by psychological and social factors. Psychological distress directly affects health and indirectly influences a person's motivation to keep their diabetes in control.
Diabetes self-management and diabetes self-management education depend on various patient characteristics. Apart from age, sex and ethnicity, the level of health literacy plays a key role. Health literacy is linked to self-management. It entails people's knowledge, motivation and competences to access, understand, appraise, and apply health information in order to take decisions in everyday life concerning management of diabetes and choices about risks to maintain or improve quality of life during the life course. Low health literacy has been linked to poor health outcomes for diabetes. However, while low literacy is likely to impede self-management, its moderating role in improving self-management behaviours in persons with diabetes has not yet been systematically investigated. Providing patients with literacy-appropriate diabetes education materials may be an effective strategy for imparting skills necessary for diabetes self-management.
(Reference: Self-care behaviors adapted from AADE7)