Activity 7: Motivating Change in Patients with Diabetes

Recommendation #1: It is reasonable to include assessment of the patient's psychological and social situation as an ongoing part of the medical management of diabetes.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: E 

Recommendation #2: Psychosocial screening and follow-up may include, but are not limited to, attitudes about the illness, expectations for medical management and outcomes, affect/mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence:

Recommendation #3: Consider screening for psychosocial problems such as depression and diabetes-related distress, anxiety, eating disorders, and cognitive impairment when self-management is poor.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: C 

Recommendation #4:  A patient-centered communication style should be employed that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to care.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: B 

Recommendation #5: For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short term (up to 2 years).
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence:

Recommendation #6: Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: B 

Recommendation #7: People with diabetes should be advised to perform at least 150 minutes per week of moderate-intensity aerobic physical activity (50%–70% of maximum heart rate), spread over at least 3 days per week with no more than 2 consecutive days without exercise.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence:

Recommendation #8: In the absence of contraindications, people with type 2 diabetes should be encouraged to perform resistance training at least twice per week. 
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: A

Recommendation #9: A goal systolic blood pressure less than 130 mmHg is appropriate for most patients with diabetes.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: C

Recommendation #10: Patients with diabetes should be treated to a diastolic blood pressure less than 80 mmHg.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63. 
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: B

Recommendation #11: In individuals without overt cardiovascular disease (CVD), the primary goal is a low-density lipoprotein (LDL) cholesterol less than 100 mg/dL.
Source: Standards of Medical Care in Diabetes—2012. Diabetes Care 2012;35(Suppl 1):S11-63.  
Website: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Strength of Evidence: A

Download PDF of EB Recs

American Diabetes Association. Food and Fitness: http://www.diabetes.org/food-and-fitness/food/

Presentation Slides for Motivating Change in Patients with Diabetes

Motivating Change in Patients with Diabetes: References

American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care 2012;35(Suppl 1):S11-63.

DiClemente CC, Prochaska JO. Toward a comprehensive, transtheoretical model of change: stages of change and addictive behaviors. In: Miller WR, Heather N, eds. Treating Addictive Behaviors. 2nd ed. New York, NY: Plenum; 1998.

Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: Guilford Press; 2002.

The Effectiveness of Motivational Interviewing: References

Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol 2003;71:843–61.

Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction 2001;96:1725–42.

Erickson SJ, Gerstle M, Feldstein SW. Brief interventions and motivational interviewing with children, adolescents, and their parents in pediatric health care settings: a review. Arch Pediatr Adolesc Med 2005;159:1173–80.

Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol 2005;1:91–111.

Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005;55:305–12.

Alcoholism

Jones BT, McMahon J. Alcohol motivations as outcome expectancies. In: Miller WR, Heather N, eds. Treating Addictive Behaviors. 2nd ed.New York, NY: Plenum; 1998. 

Hypertension

Ogedegbe G, Chaplin W, Scoenthaler A, Statman D, Berger D, Richardson T, et al.  A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens 2008;21:1137-43.

Changing Behavior for Your Health (Figure 1 from Zimmerman GL, Olsen CG, Bosworth MF. A ‘stages of change’ approach to helping patients change behavior. Am Fam Physician 2000;61(5):1409-16.):
http://www.aafp.org/afp/2000/0301/p1409.html#afp20000301p1409-f1

 

 

 

 

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