Diabetes Attitudes, Wishes, And Needs Research Articles

Impact of Anti-Diabetic Medications on Quality of Life in Persons with Type 2 Diabetes Mellitus.

Introduction:Type 2 diabetes mellitus (T2DM) has been found to be associated with poor quality of life (QOL). The aim of this study was to measure QOL in T2DM patients and examine if the patients’ socio demographic, diabetes-related clinical characteristics and insulin usage are associated with better quality of life.Materials and Methods:This clinic based cross-sectional study analyzed data from outpatients with T2DM attending a referral clinic between January and June 2016. Association between Diabetes Attitudes, Wishes and Needs (DAWN) QOL and few demographic, socioeconomic, clinical and biochemical predictors were examined using multivariate logistic regression model. A total of 518 patients completed the interview.Results:The HbA1c level of insulin ± oral anti-diabetic (OAD) cohort was significantly lower (7.89 ± 1.98) than the OAD cohort (8.79 ± 1.96), P < 0.001. Compared to their counterparts in the OAD cohort, patients on insulin were older with longer duration of diabetes mellitus. Co-morbid confounders like obesity, hypoglycemia, and blood pressure control or socio demographic confounders like income, education were almost similar in both the cohorts. The incidence of hypertension, coronary artery disease (CAD) and statin usage was significantly higher in the insulin cohort. The overall composite DAWN QOL scores of the insulin ± OAD cohort (25.42 ± 4.35) was marginally higher than that of the OAD cohort (23.62 ± 5.06) (P = 0.067). Analog insulin users were also found to have significantly higher composite DAWN QOL scores compared to human insulin users (25.77 ± 5.73 vs.24.13 ± 4.88, P = 0.037).Conclusions:The insulin cohort, despite being older and having longer duration of diabetes, had significantly higher diet compliance score, and enhanced QOL owing to better diabetes-related knowledge and treatment adherence characteristics than non-insulin users. Questionnaires-based evaluation of QOL can provide better understanding of the patient's experience of the illness, self-care, psychological and emotional functioning, and choice of therapeutic modality enhancing the quality of care.

Psychological well-being and diabetes-related distress in states of type 2 diabetes in the first multi-national Diabetes Attitudes, Wishes and Needs (DAWN) Study

Purpose. To examine well-being and diabetes-related distress across several common states differentiated in the course of type 2 diabetes. Material and methods. Random samples of adults with type 2 diabetes were obtained from multiple co- untries in the first DAWN (Diabetes Attitudes, Wishes, and Needs) Study (n = 3432). All data were obtained during structured interviews. Criteria for defining states of diabetes included time since diagnosis of diabetes, the timing and nature of anti-hyperglycaemic medication regimens, and the timing and number of complications. Results. Duration of diabetes closely corresponded to a set of typical states based on the criteria. Using analysis of covariance to control for confounding factors, diabetes-related distress and psychological well-being were significantly (p &lt; 0.05) worse for persons with diabetes with more complications and more intense medication regimens. Longer duration of insulin use was significantly associated with more diabetes-related distress. Worse distress and well-being were significantly associated with the accumulation of complications over time, but were more strongly associated with recently diagnosed complications than with more distally diagnosed complications. Conclusions. Well-being and distress varied over sta- tes as defined by the nature and timing of diagnoses and medications. The observed patterns were more complex than a linear model of disease staging would suggest.

MON-171 Diabetics' Perceptions about Insulin Are Major Barriers to Its Early Initiation: A Cross-Sectional Study

Diabetes mellitus is a chronic progressive illness that causes considerable morbidity related to macro and micro vascular complications, resulting in an ever growing healthcare burden globally. Early Initiation of Insulin has significant impact on improving both long term health outcomes and quality of life among diabetics in comparison to oral medications alone. But both patients and physicians often resist early initiation of therapy, a phenomenon known as “Psychological Insulin Resistance” (PIR). Objective of study was to assess such barriers among diabetic patients in Pakistan. We selected 300 patients both type 1 and 2 through convenience sampling from diabetic clinics of 2 tertiary care hospitals. Data was collected through structured questionnaires and analyzed using SPSS version 17. A p-value <0.05 was considered statistically significant. (1)Variables i.e. embarrassment about injecting insulin in public, expense, affordability and side effects ( skin reactions, injection site pain) of insulin, frequent shots and interference with social activities when cross tabulated with gender of participants, educational status and duration of disease, were found statistically significant (p-value <0.05) proving them possible barriers to early initiation of therapy. Results were comparable to a study conducted on type 2 diabetics in Mexico to assess insulin adherence. (2). It was also observed that people with longer (>5 years) and advanced disease were more satisfied about their glycemic control with insulin and willing to recommend it to others but at the same time, feared about its lifelong commitment once started, with all these variables having statistical significance (p-value<0.05) .Although only patients perceptions were assessed but results were comparable with DAWN study in which belief in insulin efficacy was stronger among patients with poor control of disease and more distress. Concluded that patient’s perceptions and misconceptions arise from lack of primary education about long term benefits of insulin and prove major barriers to its early initiation. Patients consider insulin efficacious and last resort when they develop complications. Such perceptions tend to prevail more in areas of poor socioeconomic background and high illiteracy rate. Reference: (1) Bermeo et al., Insulin Adherence in Type 2 Diabetes: Jul 15; 2018 (2) Peyrot et al., Diabetes Attitudes, Wishes, and Needs (DAWN) study. 2005; 28 :2673-79

How psychosocial outcomes impact on the self-reported health status in type 2 diabetes patients: Findings from the Diabetes Attitudes, Wishes and Needs (DAWN) study in eastern China.

IntroductionThe deleterious effects of psychosocial outcomes on diabetic patients’ health have not been fully investigated yet. This study was aimed to explore how psychosocial outcomes impacted on the health status of Chinese patients with type 2 diabetes.MethodsA mix of stratified sampling and typical sampling were used to select diabetic patients in Jiangsu Province to conduct individual interviews. Health status was measured by EuroQol Visual Analogue Scale (VAS). Psychosocial outcomes were measured by instruments used in the Diabetes Attitudes, Wishes and Needs survey, including psychological well-being, diabetes distress, patient empowerment, self-management, and patient reported healthcare provision. Clinical characteristics measured included diabetes comorbidities, complications and treatment. OLS regression analyses were used to estimate how health status varied with different characteristics.ResultsAltogether 1614 patients with type 2 diabetes aged 18–65 years from 6 districts/counties in Jiangsu Province were included in the study. With general characteristics and clinical factors controlled for, psychological well-being among all psychosocial outcomes had the most significant association with health status, with a difference of 9.2 in VAS scores between likely depression and good well-being. VAS scores were also significantly lower in patients with high diabetes distress and significantly higher in those more frequently conducting physical activities. Other psychosocial outcomes were not significantly associated with health status.ConclusionsLikely depression and diabetes-related distress are negatively associated with health status while frequently conducting physical activities are positively associated with health status of type 2 diabetes patients aged 18–65 years from 6 districts/counties in Jiangsu Provinces. These findings underscore the necessity of undertaking routine assessment for depression and diabetes distress and prioritizing interventions on promoting regular physical activities in diabetic patients to improve health management and achieve better health outcomes.

Impact of patient attitudes and beliefs to insulin therapy upon initiation, and their attitudinal changes after initiation: the DAWN Japan study

Objective As a part of the Diabetes Attitudes, Wishes and Needs (DAWN) Japan study, a multi-center, questionnaire-based survey conducted between 2004 and 2005, this analysis aimed to (1) explore patients’ attitudes and beliefs contributing to their decision to start insulin therapy, and (2) assess the changes in their attitudes and beliefs after actual initiation.Methods Insulin-naive patients with type 2 diabetes who were recommended to start insulin therapy (n = 149) were invited to answer a 21-item questionnaire consisting of five clusters assessing their attitudes and beliefs toward insulin therapy. The questionnaire was administered twice: first upon insulin recommendation, and then 1 month after insulin initiation for those who started and 4 months after for those who did not.Results Of 130 patients included in the analysis, 74 patients (56.9%) started insulin therapy. ‘Negative image of injections’ and ‘Positive image toward insulin therapy’ were significantly associated with patient decision to start insulin therapy (odds ratios [95% CI]: 0.49 [0.32–0.76] and 2.58 [1.51–4.42], respectively). After insulin initiation, ‘Negative image of injections’, ‘Positive image toward insulin therapy’, ‘Feelings of guilt regarding diabetes self-management’, and ‘Negative image toward insulin therapy’ decreased significantly (P < 0.001 for all). ‘Social/interpersonal effects’ did not change after insulin initiation.Conclusions This study demonstrated that patients who started insulin therapy were less likely to have negative images of injections and more likely to have positive images toward insulin therapy. Starting insulin therapy did not deteriorate the patient’s overall impression of therapy. The key limitation is the relatively small sample size (n = 130). The results suggest that education about the benefits of insulin therapy may help patients who are not ready to initiate insulin overcome their barrier to early insulin initiation and practical support may help those who have already started therapy to maintain its use.

Implementation of quality of life monitoring in Dutch routine care of adolescents with type 1 diabetes: appreciated but difficult.

Monitoring quality of life (QoL) improves well-being and care satisfaction of adolescents with type 1 diabetes. We set out to evaluate the implementation of the program DAWN (Diabetes Attitudes Wishes and Needs) MIND-Youth (Monitoring Individual Needs in Young People With Diabetes) (DM-Y), in which Dutch adolescents' QoL is assessed with the MIND Youth Questionnaire (MY-Q) and its outcomes are discussed. Successful implementation of DM-Y warrants close study of experienced barriers and facilitators as experienced by diabetes care teams as well as adolescents and parents. The study was conducted in 11 self-selected Dutch pediatric diabetes clinics. A mixed methods approach was used. Ten diabetes teams (26 members) were interviewed; 36 team members, 29 adolescents, and 66 parents completed an online survey. Two of 10 teams successfully implemented DM-Y. Whereas 92% of teams valued DM-Y as a useful addition to routine care, most clinics were not able to continue because of logistical problems (lack of time and manpower). Still, all teams had the ambition to make DM-Y integral part of routine care in the nearby future. Seventy-nine percentage of the parents and 41% of the adolescents appreciated the usage of MY-Q, same percentage of adolescents neutral. DM-Y is highly appreciated by teams, as well as adolescents and parents, but for most clinics it is difficult to implement. More effort should be paid to resolve logistic problems in order to facilitate dissemination of DM-Y in care nationwide.

Diabetes and Mental Health

Diabetes and Mental Health

Psychosocial support for people with diabetes: past, present and future

Psychosocial support for people with diabetes: past, present and future

WHO-5, a tool focusing on psychological needs in patients with diabetes: The French contribution to the DAWN study

In 2001, the international Diabetes Attitudes, Wishes and Needs (DAWN) programme was launched to evaluate the psychosocial impact of diabetes. In France, DAWN experts carried out an observational study to further understand the impact of diabetes on the psychological well-being of people with diabetes, using the French version of the WHO-5 questionnaire. The WHO-5, a unidimensional five-item questionnaire that measures positive psychological well-being, was completed by 2213 patients (1670 with diabetes). A total sum score was calculated, ranging on a scale from 0 to 25. A score less than 13 indicated impaired well-being and a score less than 8 reflected likely depression. The mean total well-being score for the whole study population was 14.1±5.5, and 14.3±5.5 for patients with diabetes and 13.5±5.4 for patients with other chronic diseases. The average score for patients with diabetes only (15.1±5.2) was higher than those for the other subgroups (P=0.005), whereas the average scores for those using insulin (14.8±5.2) and women with diabetes (13.2±5.6) were significantly lower compared with the whole diabetic group (15.6±5.1 [P=0.03] and 15±5.2 [P<0.001], respectively). The WHO-5 questionnaire showed satisfactory psychometric properties in a large sample of French diabetic patients. The scale is unidimensional and highlighted differences in well-being, which was lower in diabetic women, in patients with other chronic diseases and in those treated with insulin.

Good practice recommendations on paediatric training programmes for health care professionals in the EU

Part of the SWEET Project: EU (European Union), Better Control in Paediatric and Adolescent Diabetes: Working to Create Centres of Reference, was specifically to examine the training of health care professionals (HCPs) across the EU. Several types of information were collected during 2009, and these included a literature search, workshops of the SWEET members, examination of the data collected by the Hvidøre Study Group and the Diabetes Attitudes, Wishes, and Needs (DAWN) Youth initiative, and a questionnaire distributed to SWEET members and professional colleagues who cared for children and young people (CYP) with diabetes. It was clear from the information collected that there was no European or global consensus either on a curriculum for the training of the paediatric diabetes multidisciplinary team (MDT) or individual professions in paediatric diabetes. A minority of countries had well-established training but, for the majority, there was little standardisation or accreditation. Moreover, most countries did not have available courses for training the diabetes MDT and training was not mandatory. Of the courses that were available more were accredited for doctors and nurses but fewer for the other professions. As a consequence, the majority of HCP posts in paediatric diabetes do not demand prior experience in the specialty. Standardised accredited training and continuous professional development (CPD) opportunities are severely limited. The SWEET Project supports a standardised, accredited approach to training and CPD of the MDT and for individual professions. As a consequence, a curriculum for the training of the MDT was developed, and this is now ready for implementation.

A New Dawn for Diabetes in Canada

This paper is intended to highlight the need for diabetes healthcare professionals to better address psychosocial issues in diabetes by summarizing selective evidence that identifies the important psychosocial needs and issues of those living with diabetes. The main purpose of this paper is to draw the attention of Canadian diabetes professionals to a specific international psychosocial initiative called the Diabetes Attitudes, Wishes and Needs (DAWN) program. The DAWN program began with the DAWN study, a large-scale psychosocial study conducted at an international level but not including Canada. This is a relevant study for 2 reasons. First, the results of DAWN can guide Canadian diabetes healthcare providers by virtue of the fact that multiple knowledge translation tools have been developed and can be directly accessed by Canadian providers. Second, DAWN2, a follow-up study, has recently been launched and Canada is one of 18 participating countries. Increasing the awareness of Canadian diabetes healthcare providers about the results of DAWN and the launch of DAWN2 can further advance knowledge translation for the management of psychosocial factors in diabetes.

An Exploration of Barriers to Insulin Initiation for Physicians in Japan: Findings from the Diabetes Attitudes, Wishes and Needs (DAWN) JAPAN Study

ObjectiveInsulin is recommended as an appropriate treatment in type 2 diabetes patients with suboptimal glycemic control; however, its initiation is often delayed. We therefore conducted the DAWN (Diabetes Attitudes, Wishes and Needs) JAPAN study in an attempt to identify specific patient- and physician-related factors which contribute to delay of insulin initiation among Japanese patients with diabetes. In this report, we explored barriers for physicians which prevent timely insulin initiation.MethodsThe DAWN JAPAN study is a multicenter, questionnaire-based survey, conducted between 2004 and 2005. Participating physicians were categorized as follows based on their expertise: Japan Diabetes Society (JDS) certified specialists (n = 77), JDS-affiliated physicians (n = 30), and non-JDS-affiliated physicians (n = 27). To assess physician barriers to insulin initiation, we have used a newly developed 27- item questionnaire.ResultsThe mean age of patients (n = 11,656) treated by participating physicians was 64.1 years. The mean duration of diabetes was 121.6 months, and their mean HbA1c was 7.5%. Insulin was used in 27.4% of total patients. With regard to physician barriers to insulin initiation, the biggest differences in concerns expressed by JDS-certified specialists and non-JDS-affiliated physicians were observed in the following items with statistical significance: “I do not have staff (nurse, pharmacists) who can assist with explanations” (1.3% vs 55.5%, respectively), “I have concerns about the use of insulin therapy in elderly patients” (38.1% vs 81.5%), and “It is difficult to provide guidance and education on insulin injection to patients” (16.9% vs 55.5%). The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7%; however, they would reduce this level to 8.2% if they themselves required insulin.ConclusionsOur results demonstrated that physicians have concerns about insulin use, and suggested that their concerns can lead to delay of insulin initiation.

Psychological status of Chinese patients with Type 2 diabetes: data review of Diabcare‐China studies

To describe the status of glycaemic control, self-reported adherence to treatments, psychological well-being and quality of life in Chinese patients with Type 2 diabetes in 2006. Subjects having registered for care for > 12 months at a diabetes clinic were enrolled in this study. Glycaemic control was determined by HbA(1c) and plasma glucose levels; information about self-reported adherence to treatments was obtained by questionnaire; psychological well-being was assessed by use of a modified World Health Organization-5 Well-being Index; and quality of life was measured by use of a modified Diabetes Attitudes, Wishes and Needs (DAWN) survey. All data were tabulated and statistical analyses were performed. A total of 2702 patients were enrolled during 2006. Only 23% of patients achieved an HbA(1c) level of < 48 mmol/mol (6.5%) as per the 2007 China guideline for Type 2 diabetes and only 16.2% followed all treatment recommendations from healthcare providers. Of the patients, 46.0-68.6% of the patients showed positive psychological well-being. A quality-of-life survey showed that 28.5-50.6% of the patients experienced various diabetes-related emotional problems. Large percentages (approximately 50%) of patients were experiencing psychological insulin resistance. Although in China therapies for Type 2 diabetes are more effective and available than ever before, the patient outcomes remain disappointing. Problems with glycaemic control, self-reported adherence to treatments, psychological well-being and quality of life, all of which are key to diabetes control, are common among Chinese patients with Type 2 diabetes.

Quality of Life, Wishes, and Needs in Women with Gestational Diabetes: Italian DAWN Pregnancy Study

The DAWN (Diabetes Attitudes, Wishes and Needs) study is a survey promoted by the International Diabetes Federation to recognize the perceptions and attitudes of people suffering from diabetes mellitus. In this context, we evaluated the quality of life of Italian and immigrant women with gestational diabetes mellitus (GDM). Information was gathered using a structured questionnaire for patients' self-compilation. In a 3-month period, a 51-item questionnaire was submitted to 198 Italians and 88 immigrants (from 27 different foreign nationalities). Italian women were older and had higher education than the immigrants. 60% of the Italians and 38% of the immigrants had a family history of diabetes mellitus. In both groups, the diagnosis of GDM caused anxiety; one-third of women feared their child could contract diabetes at delivery and/or have congenital malformations. Some women had trouble in following treatment regimens: the major concern being dietary advice and blood glucose testing. Most women were satisfied (34%) or highly satisfied (60%) with the quality of care, although the degree of cooperation between diabetes specialists and gynaecologists was considered sometimes unsatisfactory. In order to optimize maternal and foetal outcomes, educational projects and improved communication between patients and the healthcare provider team are recommended.

General practice and social service partnership for better clinical outcomes, patient self efficacy and lifestyle behaviours of diabetic care: randomised control trial of a chronic care model

BackgroundThe International Diabetes Attitudes, Wishes, and Needs (DAWN) programmes have shown the existence of a critical gap in self management support and access to the support system. This study aims...

Monitoring of Individual Needs in Diabetes (MIND): Baseline Data From the Cross-National Diabetes Attitudes, Wishes, and Needs (DAWN) MIND Study

OBJECTIVETo test the feasibility and impact of implementing the computer-assisted Monitoring of Individual Needs in Diabetes (MIND) procedure, which is aimed at improving recognition and management of the psychological needs of diabetic patients in routine care.RESEARCH DESIGN AND METHODSThe MIND study was implemented in diabetes clinics across eight countries as part of the annual review. The computerized assessment covered emotional well-being (World Health Organization 5 Well-Being Index), diabetes-related distress (Problem Areas in Diabetes), life events, and the patient’s agenda. Medical data were retrieved from the charts, and agreed-upon actions were recorded.RESULTSOf 1,567 patients monitored using the MIND, 24.9% had either likely depression or high diabetes-related distress; 5.4% had both. Over 80% of these patients were newly identified cases, and 41% of patients with depression were referred to a mental health professional.CONCLUSIONSMonitoring of well-being and diabetes-related distress as part of routine diabetes care is feasible and helps to identify and discuss unmet psychosocial needs.

Insulin Initiation During a 20-Minute Office Visit: Part 1: Setting the Scene

In a 2006 survey, only 42% of patients with diabetes had A1C levels below national targets,1 suggesting the need for a more inclusive approach encompassing lifestyle change, frequent glucose monitoring, and rigorous treatment. Several individually controlled factors, including diet, physical activity, stress, and medications, affect blood glucose control; therefore, it makes sense to empower patients with diabetes to take an active role in their diabetes care. Too often, patients with diabetes have been treated as if they have a character flaw rather than encouraged to become actively engaged in the management of this “inherited metabolic disarray.”2 Support for empowering patients' engagement in their own diabetes management can be found in the results of the worldwide Diabetes Attitudes, Wishes, and Needs (DAWN) study involving 3,170 patients with type 2 diabetes.3 In this study, the quality of patients' collaboration with their health care professional (HCP) was the strongest predictor of patient-reported outcomes. Access to and relationship with the HCP were strongly associated with patients' well-being and perceived diabetes control.4 Patients who had a higher level of interaction with their HCP were also more likely to adhere to their treatment regimen, presumably as a result of being more fully informed and involved in treatment decisions.4 Similarly, access to a nurse during treatment also improved adherence, suggesting that the involvement of HCPs who can take on a supportive educational role has a positive influence on treatment outcomes. Effective management of type 2 diabetes demands a high level of commitment on the part of patients because it involves the performance of numerous self-care behaviors. This is particularly true for patients who require insulin therapy, even though today's advanced insulin formulations and delivery systems have helped to simplify insulin management. Unfortunately, HCPs (patients' key health care providers) are typically only able …

In the Beginning: Setting the Stage for Effective Diabetes Care

O ne of the most difficult aspects of a clinician's job is delivering bad news to patients. Although there is worse news than a diagnosis of diabetes, the Diabetes Attitudes, Wishes, and Needs (DAWN) study showed that 85.2% of patients experienced negative emotions at the time of diagnosis.1 Even symptomatic patients, who may be initially relieved that the news is not as bad as they feared, are likely to experience distress as the daily realities of caring for diabetes hit home. Patients often ask, “What does this mean?” Trying to understand this question from the patient's perspective will ultimately make your task easier. Although it is tempting to provide a complete explanation of diabetes, the underlying questions patients are really asking are, “Why is this happening to me?” and “How will diabetes affect my life?” At the time of diagnosis, most patients do not really want a comprehensive review of the “pancreatic mechanics” or the pathogenesis and other clinical aspects of diabetes. Offer a simple explanation of diabetes and relate it to the patient's particular situation, both clinically and environmentally. Describing diabetes as an insulin deficiency or defect (and not as a “sugar problem”) will help to set the stage for future treatment. Admittedly, there is no one best way to provide this news. However, there are seven key messages that patients need around the time of diagnosis that may make it easier for them to incorporate diabetes into their lives and help you to create a working (and more successful) partnership with them. 1. Diabetes is self-managed. Although most health professionals expect that patients will actively manage their diabetes, we rarely discuss the fundamental importance of their self-management role with them. Patients who are mostly accustomed to dealing with acute illnesses may be expecting that the illness will go …

Lessons from DAWN: Implementing Effective Insulin Therapy

Negative attitudes to insulin therapy are common. Results from the Diabetes Attitudes, Wishes and Needs (DAWN) study show that barriers to achieving adequate glycemic control include misconceptions and concerns of patients and providers regarding the use of insulin. Data from DAWN highlight the importance of addressing psychosocial factors as an integral component of care for patients with diabetes. Strategies to deal with the initiation of insulin therapy can provide ways to overcome barriers to effective therapy and bridge the gap between diabetes targets and clinical practice. By identifying and addressing patient and provider concerns regarding initiation of insulin therapy, providers can facilitate effective self-management of diabetes and help patients achieve current targets for glycemic control.

Where Is the Patient in Diabetes Performance Measures?

Health policies are important determinants of clinician and patient behavior, and an important policy issue is what items are included in healthcare quality and performance measures. There is consensus that patient-centered care and self-management support are essential evidence-based components of good diabetes care. However, most major diabetes performance measures such as the National Committee for Quality Assurance (NCQA)/American Diabetes Association (ADA) Provider Recognition Program indexes have not included self-management or psychosocial items. We review the case for and propose a set of patient-centered, self-management indicators to be included as a standard part of diabetes quality indicators. The proposed indicators include: patient self-management goal(s), measures of health behaviors (e.g., healthy eating, medication taking, physical activity, and smoking status), quality of life, and patient-centered collaborative care. We discuss the evidence and the concerns about patient-report measures and summarize successful incorporation of such patient-centered measures in other countries and by the American Association of Diabetes Educators (AADE). The adage that "what gets measured, gets done" applies to diabetes management and many other areas of healthcare. Inclusion of the proposed indicators in national diabetes performance measures would be consistent with Institute of Medicine (IOM), ADA, Centers for Disease Control (CDC), Diabetes Attitudes, Wishes, and Needs (DAWN), AADE, and Society of Behavioral Medicine (SBM) recommendations. Such action would enhance both the priority and delivery of quality, patient-centered care, and diabetes self-management support.