Joe's Diabetes

Diabetes education and its discontents

 

I’ve been involved in the diabetes world for a while now, and seen some great positive changes happen since 1999: making insulin pumps more widely available, a progressively humane attitude to diabetes management (albeit from a small base), and the creation of many diabetes education courses, designed for different needs.

Having written Joe’s Rough Guide to Diabetes and been on a DAFNE course, I know how empowering learning about your condition can be. A bit of practical advice is life-changing and life-affirming. From muddling through between injections, crossing your fingers and hoping for the best, you can suddenly make diabetes work for you. It restores the freedom you lost when you were diagnosed, so that if you really want to do something as simple as eat a biscuit, or as foolish as run a marathon (as I did…), you can!

I thought that Healthcare Professionals (HCPs) were on board. They realised its power, they got it. However, having read Rosie Walker’s article* in Diabetes & Primary Care, I’m not so sure that’s the case. As she points out, diabetes education courses nationwide have less than a 30% attendance rate. In other words, over 70% of people don’t go once they’ve been signed up for one. What’s that about?

There seem to be a whole range of problems that contribute to this situation. A practical issue, for example, is that whether patients turn up to courses or not, GPs are rewarded for simply referring them. Seems like a great deal – for the GP. Not sure how that model would succeed if extended to any other form of marketing though…

Within healthcare more generally, I think there is a deeper cultural malaise. HCPs very often don’t see themselves as teachers. As Rosie points out, ‘a number of clinicians have [said] that concentrating on learning is scary and that they feel out of their “professional comfort zone”’, and that education is often seen as ‘a job tangential to “real diabetes” (i.e. medical management)’.

The combination of these practical and cultural factors means that people are often not made aware of the brilliance of such courses, they aren’t properly persuaded to attend, or that they are signed up ‘on paper’ to go – without being properly reminded or even without knowing about it. In effect, the message from health authorities is ‘diabetes education is excellent, everyone should do it’, but in reality that is not being followed through. 

At present diabetes education is being offered as a shiny red apple, but it has a rotten core. 

 

*‘Transforming the Educational Wasteland into a Learning Landscape’, Diabetes & Primary Care, Vol 17, No2, 2015, p64-66