The NHS’s Action for Diabetes has made it clear that in order to improve the health outcomes of those living with diabetes, education around self-management of the condition need to be improved and individuals have to become empowered to take charge of their own care. Studies have shown that wellness coaching is able to bridge the gap between clinical intervention and patient self-management at all three stages of diabetes.
Stages of diabetes
When blood glucose levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes, a patient is in the prediabetic stage. At this stage, type 2 diabetes can still be avoided. Weight loss of as little as 5% is enough to significantly reduce the risk of progression to type 2 diabetes.
Type 2 diabetes
The risk of contracting type 2 diabetes is increased if a person is overweight or obese. Type 2 diabetics have insulin resistance, meaning the body doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin. The effects of type 2 diabetes can potentially be reversed and definitely managed with a healthy diet, exercise and weight loss. Insulin is often prescribed for type 2 diabetic patients. There is no permanent cure, but the condition can be prevented and put into remission by losing weight.
Type 1 diabetes
The risk of contracting type 1 diabetes is not affected by lifestyle or weight. It is an autoimmune condition where the body is unable to produce any insulin. Management is through insulin injections, testing of blood glucose levels, counting carbohydrates, regular exercise and maintaining a healthy balanced diet. There is no permanent cure.
How coaching can help
In all stages of diabetes, patients need knowledge, the skills to make lifestyle changes and the confidence to participate in their own care and management of their condition. Research supports coaching as a feasible way to help patients make the necessary behavioural changes. Because prediabetes is a precursor to diabetes, it is of critical importance that any treatment program should also include modification of lifestyle behaviours in order to reduce the risk of developing type 2 diabetes.
A study by Ramona S. DeJesus of the Mayo Clinic found that a 12-week wellness coaching program for prediabetic adults delivered by certified coaches, led to significant improvement in levels of exercise and healthy eating choices. Changes occurred as early as 6 weeks, with continued improvement at 12 weeks and sustained results at 24 weeks. 50% of the participants increased aerobic exercise time from 117 minutes to 166 and 199 minutes at 6 and 12 weeks respectively. Similar trends were also observed with self-efficacy and quality of life measures.
Unlike the study by Ramona S. DeJesus and many others that focused on nutrition and exercise alone, Mariam Kashini also integrated management of stress and sleep in her study. Patients received 14 personalised in-person or telephonic coaching sessions. Of the 107 prediabetic participants, 49 % showed normal blood glucose levels after 6 months irrespective of weight loss. Significant improvements were also made in blood pressure, fasting insulin, perceived stress levels, diet and participants reported feeling less tired.
According to Dr. Heather D. Bennett health coaching encompasses five principal roles. We will look at each if these roles in the context of diabetes as a long-term condition.
Five principle roles of the health coach
1. Self-management support
Diabetic individuals can make a dramatic impact on the progression of their disease by participating in their own care. Disease-specific skills such as monitoring and responding to glucose levels, administering of insulin and limiting carbohydrate intake are essential parts of self-management that patients have to perform in their day to day lives. Coaches are able to train patients in these skills as well as provide information, promote behavioural change and teach problem-solving skills. A coach would also help co-create a wellness plan for the patient, set goals and make the patient accountable, thereby encouraging them to be active participants in their own healthcare.
2. Link between clinician and patient
It is easy for a disconnect to occur between a doctor and patient, e.g. in the prescription of insulin. The doctor prescribes medication, but can’t ensure that the patient will take the medication. A coach can assist by helping the patient overcome barriers or resistance that is preventing them from taking the medicine. For instance, a coach would follow up with the patient after a doctor appointment to make sure that he/she collected the medication and ensure that the patients understands how to take the medication.
3. Navigation of health care system
NSH doctors and hospitals have long waiting times and appointments are rushed. Diabetics, especially newly diagnosed, can easily feel overwhelmed and be left with unanswered questions and concerns. A wellness coach can help the patient to prepare key questions before doctor appointments, and help the patient to feel empowered and confident enough to raise any concerns with their doctor.
4. Emotional support
Living with diabetes can be emotionally challenging. It is no surprise therefore that the chances of developing depression are twice as high for those living with diabetes. Being depressed can interfere with a person’s ability to participate in self-care activities such as monitoring, being active, eating healthy and taking medication; thereby perpetuating the cycle of depression and mismanagement of the diabetes condition.
A study by the American Association of Diabetes showed that mental health coaching was able to significantly ease depression and reduce blood sugar levels. Researchers used the the Patient Health Questionnaire (PHQ9) to measure anxiety and depression scores prior to and after intervention. Scores decreased by 49% on average after three months. Blood sugar levels dropped from an average of 8.8% to 7.7%. Those who received mental health coaching reported it was “life-changing, life-saving and helped them feel better and happier than they had in a long time”.
Diabetes UK recommends Cognitive Behavioural Therapy as an effective way for diabetics to learn techniques to cope with stress, triggers and negative thoughts.
5. Continuity figure
Coaches are able to connect with patients not only during in-person visits, but also between visits with telephone calls, text message and emails thereby creating a better sense of familiarity and continuity.
The very nature of wellness coaching is perfectly suited to help patients self-manage diabetes. Coaches facilitate a patient-directed process of evaluation and assessment, tracking and accountability. In the process of co-creating with the client, a coach can empower patients to self-manage their condition and bring about the lifestyle changes needed for a healthier life.
*This blog post is based on the assignment I completed for Module 2 of my Integrated Resilience & Wellness Coaching studies. Citations were included in the submitted assignment.*