Realizing the benefits of keeping blood sugar levels in balance through medication and diet does not necessarily make it easy for people with diabetes to rise to the many challenges of self-monitoring and diet management. Maintaining lifestyle changes, especially in eating habits, is a long-term process that can be hindered by such factors as poor motivation due to lack of social support and the complications and sacrifices posed by a new diet.
Asymptomatic Nature of Diabetes
The Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services found in a 1999 study of diabetic patients that 69 percent were less likely to adhere to their diets than follow their medication regimes because of the difficulty of changing behavior on a daily basis. One reason is that diabetes often is asymptomatic which removes important incentives for self-monitoring and self-care.
Public awareness of controversies regarding treatment and diet management, the belief that doctors can be wrong and the uncertainty of prognosis also can diminish the motivation of a diabetic patient to adhere to a plan of complex meal interventions.
Depression and Low Self-Efficacy
Russell E. Glascow and colleagues reported in the "Diabetes Spectrum" in 2001 research indicating that the greatest psychological barrier to self-management in diabetics is a low level of self-efficacy. Depression often accompanies diabetes, and the resulting low energy levels make it difficult for diabetic patients to adhere to a diet that will improve the quality of their lives, especially if they get discouraged by trying to make too many changes at once rather than building up a new diet regime gradually.
Giving into temptation at mealtime can discourage people from getting back on track or even believing they are sufficiently strong to meet new dietary challenges, especially if they expect to be perfect in their diet management. Those who have tried dieting before to lose weight and been unsuccessful can feel they will not succeed in a new diet now. Others may feel a stricter diet than they are accustomed to will take all the pleasure out of eating.
Lack of Social and Environmental Support
Many diabetic patients either have not the proper support from friends and family, or they hesitate to ask for help in planning meal changes because they feel it will create negative feelings and stress in the household. Others feel they must give up going to restaurants with their families or eating at the homes of their friends. Proper education can help overcome these barriers, such as tips on choosing healthy foods in a restaurant, sharing restaurant meals to avoid large portion sizes, eating a snack before dining with friends and keeping a diabetes cookbook in the kitchen to make meal planning easier.
The prevalence of fast food is an environmental factor that can compete with a person's intention to maintain the proper diet.
Missing Favorite Foods
The idea that diabetics must give up foods they grew up with or foods that are their favorites can cause a diabetic patient to ignore the necessity to begin diet management. The truth is no food needs to be sacrificed, although perhaps low-fat ingredients need to be substituted in their preparation or minor changes made, or portion sizes reduced.
References
- U.S. Department of Health and Human Services: Improving Care for Diabetes Patients Through Intensive Therapy and a Team Approach
- Diabetes Spectrum: Psychosocial Barriers to Diabetes Self-Management and Quality of Life
- The American Journal of Managed Care: Barriers to Successful Management of Type 2 Diabetes and Implications for Managed Care
- Changing Life with Diabetes: Overcoming Barriers to Healthy Eating
- MayoClinic.com: Diabetes
