Diabetes is one of the most common chronic diseases in the US and around the world.
According to the UN World Health Organization, 422 million people worldwide have diabetes. In the US, 34.2 million people, or 10.5% of the population, have been diagnosed with the debilitating disease.
Diabetes is a complex and multifaceted condition that may or may not be present with other health conditions. It develops as a result of a wide range of factors, including genetic, personal, social, and environmental factors. While there are standard medical protocols for diagnosing and treating diabetes, the role of a health coach in helping people manage their diabetes is not as well known.
This article describes six research-backed ways health coaches can support clients with type 2 diabetes and, ultimately, help improve their clients’ diabetes management as well as their health and wellness.
An Overview of Diabetes Management Strategies
Diabetes is a complex, multifaceted condition that requires continuous monitoring, medical care, and management strategies. It is a condition that affects how the body turns food into energy. More specifically, it doesn’t allow the effective utilization of glucose, the building block of carbohydrates, and the preferred energy source of our cells. This may be due to a resistance to insulin, the hormone that tells cells to allow glucose into the cell for use (insulin resistance), or due to a breakdown of the cells in the pancreas that produce insulin.
Depending on the stage of diabetes development, people may be able to manage their blood glucose with diet and exercise, or they may need medication and exogenous insulin (insulin that is put into the bloodstream through injections or other means).
Diabetes is a chronic disease, meaning that there is no cure, but medical and nutritional developments have identified tools that can support people with diabetes in living a life of wellness.
The primary guidelines physicians and other primary healthcare providers use for patient diabetes management include:
- Classifying and diagnosing diabetes, including the use of screening and diagnostic tests. This allows for the classification of type 1, type 2, pre-diabetes, or gestational diabetes.
- Lifestyle behavior change for diabetes prevention focused on weight loss and increasing physical activity, identifying sustainable and realistic eating patterns.
- Evaluating the need for pharmacologic interventions, including metformin.
- Providing and educating on tools for self-monitoring, including glucose monitoring.
- Identifying the need for insulin provision and, if needed, providing and educating on the tools for insulin provision.
The diabetes cycle of care for US physicians does include many support and coaching elements, but most primary healthcare providers do not have the time or knowledge on behavior change strategies to support patients in this way. This is where health coaches can be a vital support for people living with diabetes.
6 Ways Health Coaches Can Support Clients with Diabetes
Connecting with Clients in a Way That Makes Sense
One of the primary roles of a health coach is to identify and utilize effective communication pathways to be of support to clients in-between their doctor’s appointments.
Even before the COVID-19 pandemic, when the use of digital health tools skyrocketed, health promotion programs for people with diabetes recognized the value of digital tools in supporting clients.
An intervention and study published in 2019, for example, found that people with diabetes who used health promotion apps with a virtual health coach integration (a health coach who connected with clients through the app to ask about how they are doing, offer information, identify goals, and be of support) had enhanced benefits to diabetes control than those people who just used the app. In other words, what made the difference in glycemic control was the personalized digital communication.
While you may not connect with your clients through an app, the study reveals how health coaching principles can adapt to a wide variety of communication platforms.
Empower Patients Toward Self-Efficacy
The adoption of health coaching in primary healthcare settings has increased significantly over the last decade due to the role health coaches have in supporting clients in building the confidence to take control of their health management through understanding their condition and their treatment, and seeing how to make realistic changes that can help them manage their blood glucose and other diabetes symptoms.
The combination of knowledge, confidence and a sense of agency all lead to self-efficacy. Self-efficacy is the “individual’s belief in her or her capacity to execute behaviors necessary to produce specific performance attainments.”
Studies have demonstrated the effectiveness of health coaching as a strategy to encourage and provide the tools to clients so that they can implement and maintain behaviors that support their health. In people living with diabetes, a chronic condition that can be managed, but not cured, self-efficacy is a tool and a pathway to wellness.
In fact, health coaching is highly effective in helping people living with diabetes develop a greater sense of self-efficacy through developing skills such as goal-setting, problem-solving, and managing cognitive (thought-based) and emotional barriers.
Showing Empathy and Offering Support
Important elements of health and wellness coaching approaches are the ability to listen actively and understand your clients’ health history, socio-cultural environment, and the barriers that may affect their ability to adopt certain strategies for diabetes management.
Making assumptions about your clients, not believing their experience, dismissing client desires and needs, or making clients feel like they are solely responsible for the condition they are in is a form of gaslighting; gaslighting can play a significant role in weakening your clients’ sense of self-efficacy, not to mention the effect on their emotional and mental wellbeing.
In fact, being supportive and understanding helps build trust, and trust allows clients to feel you truly have their best interest at heart and have the tools and knowledge to improve their diabetes management. Your client may not have a supportive social network, in which case your role may be even more important. Helping clients make sense of their health condition and how it is intertwined with elements out of their control not only shows empathy and offers emotional support, it incorporates important principles of trauma-informed care and motivational interviewing.
Grounding Recommendations to Fit the Individual
In the less than 15 minutes physicians have with patients, it is not likely that your client will have been able to ask questions, and it is even less likely that your client’s physician will have been able to describe how to apply recommendations to their lifestyle.
That is where the health coach comes in.
Then, they can work with clients to help them understand how and why these protocols are important for managing their diabetes, and, equally importantly, support them in finding ways to make the protocols work within their lifestyle.
For example, if your client’s primary physician recommended that your client carry out aerobic exercise three to five times a week, you can:
- Offer an explanation as to how aerobic exercise differs from anaerobic exercise.
- Describe how exercise can help them manage their blood glucose and feel better.
- Identify exercise and physical activity your client enjoys.
- Guide your client toward identifying strategies that will help them carry out an exercise in a way that makes sense for them. This should include considering their budget, home and community environment, time availability, and individual likes and dislikes.
Identifying Strategies to Monitor Glucose and Take Medication
The medical community worldwide has developed standards of care, including treatment and management, for many types of chronic disease. For people living with diabetes, this may include:
- Glucose monitoring
- Supporting technology
- Insulin pumps
The responsibility of the health coach is not to prescribe or question pharmaceutical protocols, but they can have a vital role in supporting clients to integrate these practices into their day-to-day life. In fact, practices like regular glucose monitoring and insulin provision, in the case of insulin-dependent diabetes, not only help to improve health and wellness, they can also save lives.
Making Lifestyle Changes Make Sense
The medical and pharmaceutical interventions mentioned in the previous section often go hand-in-hand with factors like eating habits, rest, hydration, and regular physical activity.
The term lifestyle changes, however, is often overused and can oversimplify the complexity of making changes to a person’s current lifestyle. After all, health behaviors that influence diabetes risk and management, such as eating patterns, stress, physical activity, and rest, are influenced by factors that may not be within a person’s control, including social, environmental, and psychological factors.
As health coaches, you have the knowledge and ability to do specifically that—coach clients to utilize disease management tools and resources and identify and utilize internal strengths in a way that makes sense to them. With regards to clients with diabetes and other chronic diseases, this may mean:
- Supporting your client in healing their relationship with food.
- Suggesting ideas to your client to finding ways to move that feel good.
- Providing tools, like apps, reminders, classes, and support groups, that are tailored to your client’s abilities and affinities.
- Providing information, with permission, on how behaviors that are realistic for your client can improve their diabetes management.
- Providing culturally relevant food and physical activity choices.
- Building upon existing supportive relationships and empowering them as well by allowing your client to invite them to sessions and sending them information.
The tools and techniques you choose to make lifestyle recommendations relevant to your client will depend on your personal coaching style and your area of expertise, but the core principle of coaching your client through the diabetes cycle of care remains.
This article was written for health coaches with clients living with different types of diabetes and facing challenges managing symptoms and blood glucose levels. We discussed six strategies you can use to help support clients at all different stages of the health behavior change continuum, including connecting and providing follow-up to clients, helping them find ways to stay on top of their medication and monitoring protocol, and guiding them toward feeling empowered and self-efficacious.