Facilitating Patients ’ Diabetes Self-Management A Primary Care Intervention Framework

A quality primary care framework for diabetes self-management (DSM) is presented on the basis of prevalent office setting changes. Recent DSM research and literature are reviewed concerning (a) patients ’ DSM perceptions and office visit experiences and (b) more effective office-based DSM programs. This quality primary care framework enables nurse clinicians to more consistently assess and integrate individual patient factors using typically limited clinic resources into office visits to optimize DSM patient outcomes. Key words: diabetes self-management, diabetes management supports, primary care, quality care framework MORE THAN 180 million people in theworld have been diagnosed with dia-betes, with this number likely to more than double by 2030.1 Because of the increasing mortality and morbidity associated with dia-betes, improving the primary care manage-ment of patients ’ diabetes-related needs is an emerging international challenge.2 Although office-based diabetes care pro-cesses vary considerably, the constraints placed on many nurse clinicians attempt-ing to meet the complex needs of many adults with diabetes during office visits have worsened.3,4 Currently, diabetes care guidelines recommend 3 to 4 office visits each year, totaling less than 2 hours of formal diabetes care. During the remaining annual 8764 hours, patients must manage most of their own diabetes-related needs.5 Successful diabetes self-management (DSM) generally requires that adults maintain a regime