Activity 7: Motivating Change in Patients with Diabetes

Program Overview

Dealing with a diagnosis of diabetes has been likened to going through the grieving process.1 Individuals initially mourn the change in their quality of life resulting from dietary restrictions, blood glucose self-monitoring, and administration of insulin.2 The ability of the physician and others on the health care team to motivate and support patients in adopting and maintaining necessary lifestyle changes plays a key role in the patient’s acceptance of the diagnosis and successful self-management.

In this second activity, Motivating Change in Patients with Diabetes, the faculty focuses on proven strategies for facilitating behavior change. The activity begins with a review of the science behind behavior change. Then two real patient encounters are presented and critiqued by a family physician and a clinical psychologist to highlight effective strategies for motivating behavior change in the context of the physician-patient relationship.

  1. Rubin R, Biermann J, Toohey B. Psyching Out Diabetes: A Positive Approach to Your Negative Emotions. 3rd ed. New York, NY: McGraw-Hill; 1999.
  2. Edelman D, Olsen MK, Dudley TK, Harris AC, Oddone EZ. Impact of diabetes screening on quality of life. Diabetes Care 2002;25:1022-6.

Intended Audience

This continuing medical education program is intended for family physicians and other primary care providers who care for patients with diabetes.

Learning Objectives

After completing this activity, family physicians will be better able to:

  • Describe the key elements of the Stages of Change model put forward by DiClemente and Prochaska.
  • Outline skills and interventions used in motivational interviewing.
  • Identify potential communication barriers within physician-patient relationships that may contribute to sub-optimal management of diabetes and cardiovascular risk.
  • Outline target blood pressure and cholesterol goals for patients with diabetes.
  • Recommend at least one behavioral change aimed at reducing cardiovascular risk.


Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Philadelphia, PA
Associate Director, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Chante DeLoach, Psy.D
Clinical Psychologist
Associate Professor
The Chicago School of Professional Psychology
Chicago, IL

Amy Clouse, MD
Associate Director, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Brent Beddis, MD
Resident, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Christine Stroka, MD
Resident, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Phuong Tien, MD
Resident, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

CME Accreditation

This enduring material activity, Motivating Change in Patients with Diabetes, has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. This activity conforms to the AAFP criteria for evidence-based CME clinical content. AAFP accreditation begins May 8, 2012. Term of approval is for two year(s) from this date with the option of yearly renewal.

The evidence-based CME clinical content developed for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Introduction and Opening Remarks
Module 1. The Science Behind Behavior Change
Module 2. Overcoming Patient Barriers to Self-Management
Module 3. Cardiovascular Risk: Encouraging Behavior Change
Closing Remarks


It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, they are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.

The AAFP and MedEd Architects, LLC staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Drs. Beddis, Clouse, DeLoach, Stroka, and Tien returned disclosure forms indicating that they have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material. Dr. Skolnik returned a disclosure form indicating that he has served as a consultant or advisory board member for AstraZeneca, Boehringer Ingelheim, MannKind, Merck, and Purdue; he has also served on speakers’ bureaus for AstraZeneca, Merck, and Purdue. Dr. Skolnik is the owner of Redi-Reference, Inc.


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