DIABETES-MELLITUS - LESSONS FROM PATIENT EDUCATION

The education of diabetic patients, proposed as an essential therapeut ic tool since the early 1920s and accepted as such by official medicin e only in the 1970s, has generated great enthusiasm over the last deca de, with increasing concern for greater effectiveness by improved moti vation of both patients and doctors. Structured education depends on t he precise definition of agreed, short-term objectives, whose attainme nt shall be verified. Educational objectives may be set at different l evels: knowledge of the disease, skills required for treatment, capaci ty to integrate therapy in everyday life,... The most relevant objecti ves however are the therapeutic goals of each individual patient, i.e. most often, prevention of acute complications, near-normoglycemia to prevent late complications and foot care to prevent disabling conseque nces of the latter. This can only be attained through a global approac h to the patient, at once medical, educational and psychological. Medi cal science has definitively confirmed the importance of near- normogl ycemia and proposes more effective insulin regimens and new recommenda tions for diet and exercise. Education demands a lot from health care providers: specific training, teaching skills, good communication, sup portive attitude, readiness to listen and to negotiate. Patients' moti vation to learn and adhere to treatment is also greatly influenced by individual factors, both psychological and environmental, that need to be taken into account.