Clinical Perspectives on Motivational Interviewing in Diabetes Care

Abstract

During the past two decades, prolific development has occurred in the areas of medication and self-management technology options for people with diabetes. No other time period since the introduction of insulin therapy in the 1920s has seen such significant improvements in diabetes care. However, despite these improvements, there are still sizable gaps in quality outcomes for people with diabetes. These gaps in care are manifested in research reflecting that overwhelming numbers of people with diabetes do not meet guidelines for glycemic control, blood pressure, and lipid levels.1,2 These care gaps are also accompanied by challenges clinicians experience in facilitating behavior change across the entire spectrum of diabetes care: physical activity, diet, weight loss, regular use of medications, and the use of well-established algorithms linking self-monitoring of blood glucose to medication and lifestyle self-management. We, as clinicians, experience pain and frustration when our patients with diabetes develop complications that could have been delayed or prevented by enhanced self-management. But few of us received training to prepare us for the seemingly daunting tasks of working with the ambivalence, resistance, depression, and burnout that many experience living with diabetes. Few illnesses affect as many aspects of life as diabetes.3 For decades, I practiced in primary care with a special interest in diabetes. After pursuing additional training, I transitioned my practice several years ago to working exclusively in diabetes care with a special interest in the behavioral aspects of self-management. My practice now is populated by referrals from other clinicians to see people who are struggling with or completely neglecting their diabetes self-management. In this article and a second one that will be published in the next issue of Diabetes Spectrum , I will share perspectives on motivational interviewing (MI). This collaborative approach to diabetes care offers clinicians who are …