Educating Your Patient With Diabetes is a part of Humana Press's "Contemporary Diabetes" series, and it offers diabetes educators, nurses, and clinicians a concise and well-constructed reference for providing comprehensive education to patients with diabetes. As seasoned diabetes experts based at the Joslin Diabetes Center in Boston, editors Weinger (a researcher) and Carver (an advanced practice nurse) have assembled a collection of articles that address diverse components involved in diabetes treatment, ranging from culture, health literacy, and behavior change in chronic disease management to the pathophysiology and treatment of various aspects of diabetes such as diabetic complications, diabetes in pregnancy, geriatrics, and prediabetes.
The predominant diabetes education model in the United States is derived from the American Association of Diabetes Educators (AADE), whose AADE7 Self-Care Behaviors framework (healthy eating, being active, taking medication, monitoring, problem solving, healthy coping, and risk reduction) is commonly used to guide diabetes education. The book also provides reviews of additional models for diabetes education, including Glasgow's 5A's model (ask, advise, agree on goals, assist, and arrange follow-up), Wagner's chronic care model, and the RE-AIM model (reach, effectiveness, adoption, implementation, and maintenance). The 5A's and RE-AIM models are similar in their basic description of a cycle for evaluating, implementing, and reevaluating diabetes education, skills, and outcomes, something that may be more applicable at the educator/patient level. The chronic care model's 6 components of systemic change (organizational support, improved delivery system design, evidence-based practice-based decision support, self-management support, clinical information systems, and community resources) are helpful for the retooling of practice frameworks that seek to better serve the chronically ill, including patients with diabetes. In my own practice (a community health center Patient-Centered Medical Home), Wagner's chronic care model has informed our work as a primary care team that seeks to provide better follow-up and care management to our diabetic and chronically ill patients; within that framework, we use an electronic record, integrated specialty care, and, mostly, AADE7 tools and behavior change elements (motivational interviewing; stages of change) to help diabetic patients identify attainable goals and work toward them.
As diabetes educators are increasingly involved in diabetes program development and evaluation, data collection, and outcome measurement, the chapters on these topics ("Measuring Diabetes Outcomes and Measuring Behavior" and "Diabetes Education Program Evaluation") will be especially useful. The former section distinguishes which clinical metrics are required across various practice settings, and since diabetes educators often move between inpatient and outpatient locations, it is useful to see both the differences and similarities in data required by facility type. Much to the relief of many in clinical practice, there has been interest in the quality management/public health community in standardizing data collection across agencies to decrease the burden of distinguishing the requirements and inclusion/exclusion criteria of multiple data sets.
The chapters specific to various diabetic populations will be useful to clinicians working anew with certain populations, particularly since diabetes education is often limited to a particular practice population (ie, adults and not pediatrics, or diabetes in the obstetric setting). Clinical vignettes in the chapter on challenging diabetic patients are especially helpful and illustrate the interplay between physical and psychological health in chronic illness and the need for educators to be sensitive to the holistic needs of diabetic patients.
Educating Your Patient With Diabetes is a useful reference spanning multiple aspects of diabetes education practice and program development, offered by experts in its research and treatment. It is highly recommended for diabetes educators and clinicians, both new and seasoned.
-Siana Wood, BSN, RN
Nurse Care Manager
Thundermist Health Center
Wakefield, Rhode Island