In the Beginning: Setting the Stage for Effective Diabetes Care

One of the most difficult aspects of a clinician's job is delivering bad news to patients. Although there is worse news than a diagnosis of diabetes, the Diabetes Attitudes, Wishes, and Needs (DAWN) study showed that 85.2% of patients experienced negative emotions at the time of diagnosis.¹ Even symptomatic patients, who may be initially relieved that the news is not as bad as they feared, are likely to experience distress as the daily realities of caring for diabetes hit home.

Patients often ask, “What does this mean?” Trying to understand this question from the patient's perspective will ultimately make your task easier. Although it is tempting to provide a complete explanation of diabetes, the underlying questions patients are really asking are, “Why is this happening to me?” and “How will diabetes affect my life?” At the time of diagnosis, most patients do not really want a comprehensive review of the “pancreatic mechanics” or the pathogenesis and other clinical aspects of diabetes. Offer a simple explanation of diabetes and relate it to the patient's particular situation, both clinically and environmentally. Describing diabetes as an insulin deficiency or defect (and not as a “sugar problem”) will help to set the stage for future treatment.

Admittedly, there is no one best way to provide this news. However, there are seven key messages that patients need around the time of diagnosis that may make it easier for them to incorporate diabetes into their lives and help you to create a working (and more successful) partnership with them.

1. Diabetes is self-managed.

   Although most health professionals expect that patients will actively manage their diabetes, we rarely discuss the fundamental importance of their self-management role with them. Patients who are mostly accustomed to dealing with acute illnesses may be expecting that the illness will go …