Life gets in the way of diabetes self-care: Polonsky

A lack of self motivation is often not the reason why people fail to manage their diabetes, rather it’s the obstacles of every day life that get in the way, behavioural diabetes expert Dr William Polonsky, told delegates during his lecture given as part of the ADEA Thought Leadership Series.

It’s the job of diabetes health professionals to help patients figure out what their obstacles are and help remove them, he told the delegates attending what was the first lecture of the series in Brisbane on Friday.

A balancing act

People with diabetes are being asked to undertake a difficult task when it comes to managing their diabetes, Dr Polonsky, a licensed clinical psychologist and certified diabetes educator, told the audience.

“People are being given a job – they didn’t volunteer for it, there is no pay, no vacations, you don’t get to say no.

People with diabetes are trying to do a few things at once – optimising blood glucose levels, blood fats and blood pressure, avoiding too many hypos, as well as have a life.

“They are asked to just tack this on to everything else they are doing… it’s a juggling act that can be a little trying and difficult” he told the audience.

People are busy and have a lot of competing responsibilities and priorities that demand their attention.

It’s therefore not surprising that many people are not managing their diabetes well, said Dr Polonsky.

It’s not always a lack of motivation

US data from 2013 showed that only around half of patients were meeting the ADA targets for HbA1c, BP and cholesterol, and only a quarter were meeting all three.

While there were a number of contributors to these statistics, one was patient disengagement, Dr Polonsky said.

However he emphasised that this doesn’t mean the person is not compliant or in denial.

“This just means that diabetes isn’t as high on their own priority list as we would wish… And our job is to find out what to do about that,” he said.

While many health care professionals complain that their patients are unmotivated to look after their diabetes, Dr Polonsky says he doesn’t believe this is the case.

“Almost no one is unmotivated to live a long and healthy life,” he said.

For many people the obstacles to managing their diabetes often outweigh the positive benefits, he explained.

“So our job is not to motivate people but to figure out what these obstacles are and remove them”.

Obstacles have themes

According to Dr Polonsky common obstacles people with diabetes face included depression, a lack of perceived benefits, high-perceived costs and unrealistic or vague expectations.

Diabetes health professionals could help patients address these by treating depression, asking about diabetes-related distress, challenging unrealistic beliefs, helping people to understand the benefits (rather than perceived harm) of taking their medication, and setting realistic expectations.

Dr Polonsky also stressed the importance of helping individuals with diabetes to develop a focused, implementable plan for action.

Those who were unable to attend can still register to watch the recordings of all three lectures in the series – visit for more details.

Associate Clinical Professor at the University of California, San Diego, Dr Polonsky is well known for his work in the field of behavioural diabetes. He is also President and Founder of the Behavioral Diabetes Institute in the US.


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