Close-ups

A Patient's Perspective

Getting Motivated Is Difficult



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Am Fam Physician. 2010 Feb 1;81(3):266.

I was diagnosed with diabetes during a routine examination when I was in my 40s. My reaction to the diagnosis was, “I'll take the medication they give me, but I'm not going to let this control me. I'm not going to change my life for it.” On a scale of one to 10 of readiness to change, I was a one. Three doctors, 40 pounds gained, and 20 years later, I still have diabetes. I don't think I feel the same way about the disease, or at least that's what I tell my doctor. Now I want to control my diabetes, but I still don't want to control it by making changes or sacrifices. I don't want to cook, I don't want to eat healthy, and I don't want to exercise. Well, maybe I don't want to control it—I want it to control itself without me having to change who I am and what I like to do. Unfortunately, my doctor tells me it doesn't work that way. My doctor says that if I continue to have blood sugar levels in the 200s, 300s, and 400s, it's going to destroy my kidneys. What does that mean to me? What do the kidneys do anyway?

After 20 years of pricking my fingers and getting nagged by my doctors, I am probably at about a five on the one-to-10 scale of readiness to change. How did I get from a one to a five? I'm not quite sure. Maybe I'm scared that I am harming my body even though I am not having any symptoms. I feel perfectly fine. And when I don't, I know what I need to do to get my sugars in control. Just last week, I felt dizzy and nauseous. My sugars were in the 300s, so I drank a soda and ate an orange. That's what I'm supposed to do, right?—M.J.

COMMENTARY

Some patients need a long time to make difficult lifestyle changes. It eventually became apparent that M.J. needed intensive education about diabetes and how to manage it. One hurdle in this process is complying with regular follow-up visits—when visits are too spread out, little time is left for counseling. Often, patients feel that taking their medications regularly is enough. Physicians can use motivational interviewing techniques to improve weight loss and healthy behaviors in patients with type 2 diabetes. The key is to maintain a level of patience, keep evaluating readiness to change, and consider other resources to help with motivation, such as nutrition counseling and the American Diabetes Association.

SUMI SEXTON, MD, and MEGAN CARROLL, MSIV

RESOURCES

For Physicians

West DS, DiLillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care. 2007;30(5):1081–1087.

Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;(2):CD003417.

For Patients

Centers for Disease Control and Prevention Diabetes & Me (http://www.cdc.gov/diabetes/consumer/index.htm)

National Diabetes Education Program, “Control Your Diabetes. For Life.” campaign (http://www.ndep.nih.gov/campaigns/Power/control_diabetes.htm)

American Diabetes Association (http://www.diabetes.org)

Close-ups is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD, and Jo Marie Reilly, MD. Questions about this department may be sent to Dr. Wellbery at afpjournal@georgetown.edu.

A collection of Close-ups published in AFP is available at http://www.aafp.org/afp/closeups.

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.



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