Diabetes is a chronic progressive disease that usually requires lifestyle changes, especially in the areas of nutrition and physical activity.¹ People with diabetes report that making lifestyle changes is one of the greatest challenges they face in managing their diabetes.² Research has shown that self-care behaviors that result in sustained glucose control reduce comorbidities associated with diabetes.³

The American Association of Diabetes Educators (AADE) has adopted behavior change as the outcome of diabetes self-management education (DSME). The primary goal of diabetes education is to provide knowledge and skill training, as well as help individuals identify barriers, facilitate problem solving, and develop coping skills to achieve effective self-care management and behavior change.⁴ The American Diabetes Association has consistently included behavior change as a primary focus of DSME, which is reflected in the criteria for the ADA's recognition programs as well as their standards for diabetes self-management.⁵

The case study presented below illustrates lifestyle changes and self-care behaviors initiated and maintained. The result is sustained glucose control, which to date has prevented diabetes comorbidities.

Case presentation

R.W. is a 58-year-old African-American woman who presented to the endocrinology and metabolism clinic in 2001 with a history of type 2 diabetes since 1986. She has a history of hyperlipidemia and hypertension since 1998. She is a nonsmoker and does not drink alcohol.

This case presentation covers 3 years of diabetes management history for this patient. She originally presented with a hemoglobin A_1c (A1C) of 10.9% (normal range 3.95–6.1%); height of 5 feet 1 1/2 inches and weight of 171 lb (BMI 32 kg/m²); blood pressure of 147/102 mmHg; heart rate of 94 bpm; and LDL cholesterol < 130 mg/dl. The patient was on a sulfonylurea and a biguanide. Physical exam was unremarkable except for evidence of decreased vibratory response …