Diabetes - self-management and self-care

The person with diabetes needs to manage their diabetes on a day-to-day basis. How they manage their diabetes can impact on their quality of life and influence the risk of developing complications. People will need different levels and kinds of support. 

These resources provide guidance and ideas to support self-management and self-care. There is also a section on telecare as this is becoming a more widely used method of delivering support for self-management.

For further resources see also patient education and  patient information.

The following resources were last accessed on 1 November 2012. Some of them are in PDF format - see how to access PDF files. They are arranged under the following headings.

• Support for self-management
• Telecare

Support for self-management 

BMC Endocrine Disorders: Self-care coping strategies in people with diabetes: a qualitative exploratory study
This study explored patient perceptions of diabetes self-care” with particular reference to the burden of self-care and coping strategies among patients”. The study identified different patient types and different self-care coping strategies “influenced by their self-care health value” and suggests that self care protocols should be tailored to complement the different patient types”.

Department of Health: Long term conditions
This area of the Department of Health’s website provides information on long term conditions policy. News, events, policy documents, non-clinical guidance, links and other resources. This includes resources on self care. Guidance includes:

• Your health, your way - a guide to long term conditions and self care (2009)
  The core aims of Your health, your way are to empower and support people with long term conditions to understand their own needs and be able to make an informed choice about the self care support they wish to access from the resources available.
• Supporting people with long term conditions to self care: a guide to developing local strategies and good practice (2006)
  A comprehensive self care guide which sets out to help local organisations develop local strategies to deliver self care support for people with long term conditions.
• Supporting self care - a practical option: Diagnostic, monitoring and assistive tools, devices, technologies and equipment to support self care (2006)
  This report and summary report provides a review of research on tools, devices and technologies to support self care.
• Self care support: a compendium of practical examples across the whole system of health and social care (2005)
  This document sets out to draw together evidence from service models in the UK and elsewhere, together with published articles and reports, to consider how self care support models might be more widely transferred and used.

Diabetes UK (2009) Improving supported self-management for people with diabetes
In this document Diabetes UK present what they condsider to be the essential components that make up good supported self-management.

Diabetes UK Scotland: Diabetes and Me
Information about a project run by Diabetes UK Scotland to encourage people from the South Asian community to self manage their diabetes with links to documentation used.

Health Foundation (2011) Helping people help themselves: a review of the evidence considering whether it is worthwhile to support self-management
"Evidence suggests that supporting self-management works. Supporting people to look after themselves can improve their motivation, the extent to which they eat well and exercise, their symptoms and clinical outcomes and can even change how they use health services”. The report highlights the range of intervention from passive information provision to more technical and active interventions, and suggests that the more active goal setting and behavioural change interventions are necessary. “There is also emerging evidence that strategies co-created by service users and professionals or co-led by service users have positive outcomes.” 

Health Foundation Newsletter October 2012: Self management support for long-term conditions
This includes the following articles.

• What does good self management support look like? Interview with two advisers on the government's QIPP (Quality, Innovation, Productivity, Prevention) long-term conditions programme for England.
• How to use agenda setting and confidence rulers. Mavis Dwaah a Psychological Wellbeing Practitioner from Wandsworth talks about these techniques and how to use them.
• Self management: it's easy isn't it? Tracy Watts, Lead for Patient Education at Addenbrooke's Hospital, talks about the impact of integrating self management support into existing patient education programmes and the importance of maintaining skills gained when there is no longer the support of a structured programme. 

Joint British Diabetes Societies for Inpatient Care Group (2012) Self-management of diabetes in hospital (PDF 2.6MB)
The guidance emphasises that the choice to continue to self-manage during admission should lie with the patient and should remain with the patient at all stages unless there is a specific reason not to. It looks at how the decision can be integrated with the rest of hospital care to provide safe and effective management of diabetes in hospital. Nine recommendations are made.The guidance is made available on the NHS Diabetes website.

NHS local
NHS local is based in Birmingham and is an NHS-owned service provided by people from a number of different organisations. It is aimed at people with long-term conditions and includes resources to support self-care and self-management and improving health and wellbeing. It includes resources specific to diabetes.

NHS Scotland: My diabetes my way
This site has been developed in Scotland to provide information and support to people who have diabetes and their families, carers and friends. The site enables users in Scotland to access their own diabetes related clinical data online based on information collected from their GP computer records, hospital clinic computer record and other computer systems such as the national retinopathy screening system.

Selfmanagement.co.uk
This is a resource centre for all those involved in the self-management community.  It includes information about training materials and courses, discussion forums and a library of self-management resources including Self care resources.

NHSScotland: Supporting self management in practice toolkit
The toolkit “is a repository of high quality resources to enable support for self management in daily practice”. It has a primary care focus and is intended to help staff in NHSScotland and partner agencies in supporting people with Long Term conditions to self manage. It has sections on principles and models of self management and relevant Scottish policy; getting started for supporting self management; developing the skills of workers; peoples experiences. The last section includes guiding principles on collecting stories. This resource is made available through The Knowledge Network in Scotland as part of one of the portals dedicated to specific topics.

Telecare

3 million Lives
"WSD results for telehealth demonstrate telehealth can deliver reduction in A&E visits, emergency admissions, elective admissions, bed days and tariff costs." The Department of Health (DH) believes that at least three million people with long term conditions and/or social care needs could benefit from the use of telehealth and telecare services. Implemented effectively as part of a whole system redesign of care, telehealth and telecare can alleviate pressure on long term NHS costs and improve people’s quality of life through better self-care in the home setting.
Two papers have now been published reviewing the WSD trial:

Nuffield Trust: The impact of telehealth and telecare: evaluation of the Whole System Demonstrator project
The Nuffield Trust is part of a major randomised controlled trial to assess the impact and effectiveness of these technologies. It is leading one strand of an evaluation of the Whole System Demonstrator trial, concerning the impact of telehealth on use of hospitals and mortality. The initial findings have now been published in the research summary: The impact of telehealth on use of hospital care and mortality. This report evaluates the impact of telehealth on hospital use and mortality from the Department of Health’s Whole System Demonstrator pilots.

Articles about and other commentary on the Whole System Demonstrator project include:

• BMC Health Services Research: Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study.
• BMJ: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial
• Telehealth for long term conditions. The accompanying editorial provides further comments on the study [you will need to access this via an individual or library subscription].
• Guardian: Telehealth is moving too fast for a peer-reviewed academic report

RCN: eHealth web pages
These web pages have been developed to provide the nursing community with information and guidance about eHealth. The pages include three core areas: electronic patient records; education and training and telehealth and telecare.

RCN: Telehealth explained
This learning area provides a deeper understanding of what telehealth is all about and the major influence it will have on health care provision in the future. [This resource is for RCN members, please use your RCN membership number to access this resource].