Controlling Diabetes: Secrets to Success

Health Writer

If you have prediabetes or diabetes, you probably received strict marching orders from your doctor along with the initial diagnosis: Start eating right, get regular exercise, try to lose some weight and, if you have diabetes, check your blood glucose levels regularly.

Like many people, you may have started out highly motivated to make the necessary lifestyle changes that could help limit your need for medication and prevent the condition from worsening. And it’s possible that your efforts were rewarded in the form of lower hemoglobin A1c levels and better management of other key factors, such as blood pressure and cholesterol.

But in time, you may have grown weary of your new diet and exercise regimens, reverting back to eating too much and exercising too little. If so, you’re not alone.

Research shows that about six months after a diagnosis of diabetes, hemoglobin A1c levels often creep back up and improvements in other health indicators diminish.

Losing motivation to maintain healthy habits isn’t unique to people with diabetes, of course. The phenomenon has been well studied in people trying to quit smoking cigarettes or drinking alcohol, for instance.

Although it hasn’t been proven, some psychologists believe that staying motivated is a challenge because humans may be equipped with a limited capacity for “self-regulation.”

Even if that’s true, it doesn’t mean it’s okay to stop trying to change your behavior for the better, particularly since prolonged deviations can lead to higher blood glucose levels and an increased risk for serious diabetes complications.

The good news is researchers have identified a number of strategies that can help you get back on track—and stay there.

A crucial key to success

A few key messages have emerged from research on motivation and diabetes self-management. One is that individuals are more likely to succeed when they enlist the aid of others for support.

Another important take-away message is that learning more about diabetes seems to inspire people to follow recommended guidelines for controlling the condition.

The need for support and education overlap, which is probably why many people who work with a diabetes educator achieve long-term success managing the disease. A diabetes educator is a healthcare professional who works with patients to help them achieve and maintain behaviors that help control diabetes, such as forming better diet and exercise habits, as well as taking medications properly, and monitoring blood glucose levels.

Diabetes educators are primarily nurses, though dietitians, pharmacists, and other healthcare professionals with the appropriate expertise may serve in this role as well. Research shows that individuals who work closely with a diabetes educator can attain and sustain significant reductions in hemoglobin A1c levels.

In one study, reported in the Annals of Internal Medicine, researchers randomly assigned 138 adults with diabetes (most of whom had type 2 diabetes) into one of two groups. Members of one group saw their physicians regularly, but weren’t required to do anything else.

The rest of the participants had routine checkups and met regularly with a nurse case manager who was also a certified diabetes educator. Participants in this group were also required to attend a five-week, 12-hour diabetes-education program.

A year later, the difference between the two groups was striking. People in the first group lowered their A1c levels by 0.6 percent, on average. By contrast, those who worked with a diabetes educator and took the five-week classroom program more than doubled that improvement, reducing their A1c levels by 1.7 percent.

Other research underscores the potential benefits for people with diabetes who receive comprehensive education, support, and encouragement. For example, in a study from Israel, researchers recruited 165 people with type 2 diabetes who also had elevated blood pressure and cholesterol levels.

All of the participants saw their doctors regularly, but half (the “education group”) also attended a pair of two-hour sessions in which instructors taught them how to achieve good glucose control and modify other risk factors. In addition, they received a personalized plan that included a fitness program and advice for making lifestyle changes.

Participants were also instructed to measure their blood pressure once a week and keep a record of all lab tests. If their blood glucose, cholesterol, or blood pressure wasn’t well controlled, they were encouraged to ask their doctors to adjust their medication dose.

Finally, members of this group were free to contact their instructors if they needed advice about managing their diabetes.

All of that education and support appeared to go a long way toward preventing diabetes complications: After eight years, people who took part in the education program had 35 percent fewer heart attacks and other cardiovascular problems than those who didn’t, 40 percent less retinopathy (which can rob vision), and a 50 percent lower risk for kidney disease.

The findings, which were reported in the journal Diabetic Medicine, also showed that the education group’s A1c levels, blood pressure, and LDL cholesterol (the unhealthy kind) were significantly lower at the end of the study.

If you’d like to meet with a diabetes educator, ask your healthcare provider for a referral or check with your local hospital or the American Association of Diabetes Educators.

Medicare covers up to 10 hours of initial diabetes self-management training and up to two hours of follow-up training each year if your doctor orders it and the training meets certain criteria. Many private insurance providers also cover such visits.

Getting support, setting goals

You may want to consider joining a diabetes support group. Not only do support groups offer education on managing diabetes, but meeting and learning about the experiences of others with the condition can be a boost, too.

A 2012 review of 21 studies found that people participating in diabetes-education groups achieved a 0.87 percent reduction in A1c levels over a two-year period. Moreover, people in these studies reported feeling more confident in their self-management skills.

Ask your doctor if she or he knows of a diabetes support group in your city or town. If an in-person group isn’t available or isn’t right for you, consider an online support group. Go to The American Diabetes Association website, which offers a number of message boards, and click on "Connect with Others".

If you prefer a one-on-one relationship, peer coaching is an option to consider. A peer coach is a person, typically a volunteer, who is successfully managing his or her diabetes and has undergone formal training to learn how to help others improve their disease-management skills and to provide support and encouragement.

Studies have shown that working with a peer coach can help improve glucose control. Although not widely available, peer coaching is becoming increasingly common. Your doctor or local community health center may be able to connect you with a peer coach.

A peer coach or diabetes educator can help with another step proven to keep you motivated: setting goals. Several studies have found that people with diabetes manage the disease more successfully if they identify specific, realistic goals for themselves; for example, how many minutes they plan to exercise each week or how much weight they want to lose in a month.

A 2011 study in the Archives of Internal Medicine found that people who worked with a diabetes educator to create structured behavioral goals for diet, exercise, medication adherence, and blood-glucose monitoring, reduced their A1c levels by an average of 0.8 percent after one year, compared with 0.4 percent for those who didn’t set goals.

Family and friends as motivators

Of course, you can enlist family and friends to help you stay motivated, too. Just make sure they understand how to take the right approach.

Research suggests that shame and guilt are not successful motivators, so a partner who scolds and criticizes you for eating a cheeseburger, drinking a soda, or skipping a workout may actually make matters worse. On the other hand, a good listener who offers nonjudgmental encouragement can help reinforce your motivation to stick with your management plan and make it easier for you to achieve your glycemic goals.

Read more about how resistance exercises can help you manage your diabetes.