title: Alliance not compliance: coaching strategies to improve type 2 diabetes outcomes.
abstract: OBJECTIVE
  To explore strategies for improving patient outcomes in type 2 diabetes.
  
  
  METHODS
  The literature related to type 2 diabetes management, behavior change, communication, diabetes self-management, and coaching.
  
  
  CONCLUSIONS
  The strategies currently suggested for improving patient outcomes, e.g., increasing provider adherence to evidence-based management guidelines, streamlining practice systems, and promoting patient lifestyle changes through intensive education, have produced mixed outcomes. Of the many complexities involved in managing type 2 diabetes, motivating patients to change behavior may be the most challenging. A suggestion for improving patient self-management of type 2 diabetes is to use coaching communication within a framework of behavior change in the context of the primary care encounter between nurse practitioners (NPs) and their patients.
  
  
  CONCLUSIONS
  Given the varied outcomes of current strategies, coaching by NPs may provide a feasible alternative for improving patient outcomes in type 2 diabetes. Coaching communication can be implemented during office visits as an intervention without cost. To effectively implement this approach, however, practicing NPs and NP students need more formal education in this expected but underdeveloped NP role competency. NPs are called upon to contribute to the body of knowledge needed to validate the merits of coaching for their patients.
authors.affiliation: School of Nursing, University of Massachusetts, Amherst, Massachusetts, USA. efhayes@nursing.umass.edu
authors.forename: Eileen
authors.initials: E
authors.lastname: Hayes
authors.forename: Cynthia
authors.initials: C
authors.lastname: McCahon
authors.forename: Margaret Reeve
authors.initials: MR
authors.lastname: Panahi
authors.forename: Taryn
authors.initials: T
authors.lastname: Hamre
authors.forename: Karen
authors.initials: K
authors.lastname: Pohlman
mesh_terms: D003142:Communication; D003299:Cooperative Behavior; D003376:Counseling / Q000458:organization & administration*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control / Q000523:psychology; D006293:Health Promotion / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D009042:Motivation; D009722:Nurse Practitioners / Q000193:education / Q000458:organization & administration* / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D011320:Primary Health Care; D012648:Self Care / Q000523:psychology