Compliance: The Diabetes Educator – Client Challenge

By Patty Colombe, R.N. posted in Professionals & Educators

nurseCompliance is a common challenge faced by health professionals in all areas of healthcare. Diabetes management is an area in which continuous reinforcement is essential since the development and outcome of many other chronic illnesses weigh heavily on blood glucose control.

Strategies to achieve and maintain compliance vary greatly with populations involved. Different people have different reasons to maintain euglycemia which, in turn, leads to optimal health.

Developing a plan of care for each client requires an individual needs assessment. During this process, keep these questions in mind:

  • What are some useful strategies?
  • How can the diabetes management team determine which is best?
  • Will more than one strategy be necessary to ensure success?

Throughout the process of developing strategies to improve self management skills, my initial goal is to identify:

  • Each client’s ability to manage their own health
  • The client’s personal goals
  • The incentive which gives the client motivation to obtain these goals and maintain optimal quality of life.

The diabetes management team can begin to develop a plan of “can” once it is determined the client can effectively manage him or herself. Their ability can be assessed during the initial interview process. Many feel education and literacy level is the key. In my experience, I have witnessed that people with limited literacy skills are able to cope quite well with many areas of self management. Acceptance is usually the catalyst or the barrier to a person’s ability to manage themselves.

Goals of clients will vary. Something which may be of great importance to one person may not be significant to another. As well, the educator must distinguish their own goals from those of the client. This does not mean the diabetes management team will not strive to reach the optimal result. The goals of the client must be incorporated first. As each is achieved, a more advanced goal can be discussed. This process will give him or her a greater sense of ownership and an incentive to reach to a higher level.


Incentive is an important factor. For many people, success in their endeavors is of the ultimate importance. This includes their health. For others the need to succeed hinges on its importance to their significant others, occupation, faith or appearance. It is important to never downplay any of these incentives, but instead, to build on them.

Always keep in mind, as an educator, YOUR goal is to inform, advocate and offer support. The decision to make healthier choices is that of your client. Attempting to force your ideals onto a client most often will fail. They must have a desire to adopt these ideals as their own. Their compliance level is often greater if he or she knows it is their own decision.

One of the strategies I use is to facilitate the client in choosing his or her own goals utilizing diabetes management guidelines. I keep in perspective that guidelines are exactly what they are – a path to follow which may have to be modified to reach a particular goal. This I achieve in a prudent manner by adhering to the standards of diabetes care. I review with each person the optimal goals which achieve optimal results. Many will strive to reach the optimal while others may not be ready. I discuss with them areas which need modification and they choose which areas they are ready to change. There may only be one of several which is chosen, but it is a step forward into lifestyle change.

Another strategy I use is to place the responsibility for their health back into their hands. All new referrals, and occasionally I will reinforce this with longtime clients, will hear my speech which begins with, “ 99.9% of your diabetes control is in your hands. Ultimately, the outcome is up to you.” The responsibility of the educator is to reach their own goal to inform, advocate and support each client. If these goals are followed through prudently, each educator has performed their task well. Successes, compromises and challenges belong to the client. Educators facilitate how each person deals with it.

Occasionally, a client will opt to do nothing at all. The educator is responsible to give each person referred as much information as possible to enable he or she to make an informed decision on the most appropriate plan of care to be followed at this particular time. If the client foregoes the opportunity to learn to better manage their diabetes, the prudent educator will inform his or her family doctor of this decision. Include in this correspondence, any information given at the time of assessment. Also, keep the lines of communication open between the clinic and the newly referred client by impressing on them they may return when the time is right for them.

Health care providers are responsible to provide accurate and appropriate information to the people they provide a service to. How each person decides to process this information is ultimately their own responsibility. Many who appear to have no interest may still be in the denial phase. When they begin to accept the need for lifestyle change, they will return, but this time with a desire to make changes because now it’s their own choice.

I incorporate the above two strategies with my clients on a regular basis. They are regularly modified to meet the needs of each individual, but remain the baseline from which I begin. Our clinic has been successful through empowering clients and guiding them through the decision making process. My personal goal is to have my clients understand their diabetes well. Thankfully, it’s a goal I’ve reached often. It isn’t necessary for each person to know everything about diabetes, but that they know as much as possible of how diabetes affects them.

About the Author

Patty Colombe has been a Registered Nurse for 19 years and for the past 13 years, has been in diabetes education. She currently works in Stephenville, NF. One of her projects has been working with their clinical dietitian to transform their rural DEC into a structured program which focuses on self-management.