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Part One of Three
The piece of cake sits there on the plate, daring you to eat it. The blood sugar meter rests on your nightstand, an obstacle formed of lancets and test strips. Life with diabetes is a parade of challenges, from diet temptations to healthcare hassles. You know--we all know --that the only way to say "no" to the cake and "yes" to the blood sugar check is through consistent self-motivation.
But how do we find that motivation? And what benefits does self-motivation offer us? Scientific studies and the everyday experiences of people with the disease offer some answers.
Diabetes -- both type 1 and type 2 -- is notoriously difficult to manage consistently. The reason is simple: It's a chronic disease, and humans are not built to handle chronic problems. Acute, or short-term, illnesses fit our mental make-up best. When we have a broken bone or gaping wound, we immediately know that something is wrong. We take action. We go to the emergency room and address the problem.
But diabetes affects us slowly. The complications and health risks accumulate over years, sometimes decades. Our immediate instincts are much less helpful when dealing with a lengthy time scale. When profound complications or health problems finally arrive, much of the damage has already been done.
We have to take a more rational and sustainable view of our health if we're to reduce these long-term risks. A couple of studies from the last few years demonstrate the benefits and challenges of this approach. We'll look at one of the studies in this piece and the second in a follow-up article.
In March 2005, the Journal of the American Society of Nephrology published a study that followed 141 patients with type 2 diabetes and other cardiovascular risk factors. The patients were divided into two groups -- those who simply visited the doctor once a year, and those who received more intensive, lengthy training sessions that produced individualized plans. The researchers followed the patients for eight years. Notably, they did not prescribe any course of treatment--they simply observed.
The two groups did not receive significantly different advice. Cholesterol and blood pressure-lowering drugs were prescribed for both groups, and all patients were urged to keep their A1C, cholesterol, and blood pressure at healthy levels.
But the patients who received more intensive coaching did much better. They saw their healthcare providers more often -- an extra visit a year, on average -- and made those visits because they wanted to achieve the previously set goals. They also received higher doses of helpful drugs, prescribed as part of a more aggressive treatment regimen.
The results speak for themselves. There were 80 "cardiovascular events" in the standard group, as opposed to 47 in the motivated group. Those events killed eight people in the first group, as opposed to five in the second. The first group saw 17 strokes, while the second group saw eight. And 14 patients in the first group developed kidney disease, while seven in the second group did.
It's important to note that both groups saw overall improvement in health: Dropping by the doctor for a quick visit once a year is better than nothing. But extra education and individual attention had clear and lasting benefits.
The researchers wrote: "Every intensive intervention has a dual effect: A direct effect of the trial intervention itself and an indirect, perhaps not less powerful, effect of improved general motivation and compliance. The present study isolates and highlights the indirect effect because there was no direct pharmaceutical intervention in either of the groups."
The study was conducted by Rita Rachmani, Inna Slavacheski, Maya Berla, Ronni Frommer-Shapira and Mordchai Ravid of Tel-Aviv University and Meir Hospital, both in Israel.
Simple, right? Extra attention and time produces better results. Motivation is simply produced with more and better healthcare. Perhaps not. In the next article in this series, we'll look at a more recent study that highlights some of the challenges of staying motivated.
If you've found any ways of staying motivated, please let us know about them in the comments section.
9 comments - Aug 12, 2011
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.