[Therapeutic education of the diabetic patient].
Therapeutic education is a patient centred approach focused on patients' needs, values and strategies. It allows not only to increase patients' knowledge and skills on the disease, but also on their treatments. It brings a better quality of life, an increased therapeutic compliance, and decreases complications. The most difficult part of therapeutic education occurs when patients must change their behaviour. Motivational interviewing techniques are of great support and allow to prepare and support patients in "step by step" progressive changes. It is essential to work on resistance to change. The ambivalence in the choice of a new lifestyle must be measured, discussed and negotiate. Patients become partners and health care providers become coaches. To negotiate objectives must allow patients to choose their own strategies which should cost them minimum psychological efforts and bring them maximum benefits. The efficacy of therapeutic education has not to be proved any more: 80% less of amputations at 10 years in diabetic patients, 50% of stable body weight after weight loss at 5 years, etc. In conclusion, therapeutic education is part of a humanist medicine centred on patients which allow them to take care of their own treatment, in order to improve their quality of life, therapeutic compliance and potential complications. The health care providers teach, train, negotiate, motivate and accompany their patients in the long-term follow-up of their diseases.
Golay
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Service d'Enseignement Thérapeutique pour Maladies Chroniques--3HL, Département de Médecine Communautaire, Hôpitaux Universitaires de Genève--1211 Genève 14. Alain.Golay@hcuge.ch
Lagger
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Chambouleyron
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Lasserre-Moutet
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D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000534:rehabilitation* / Q000628:therapy*; D015438:Health Behavior; D006808:Humanism; D006801:Humans; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011788:Quality of Life; D012944:Social Support