Type 1 diabetes mellitus: can coaching improve health outcomes?

Ten patients routinely attending a public health care service and with a glycated hemoglobin (HbA1c) level above 75% participated in eight coaching sessions. This study evaluated the patients' self-management of the disease and personal behavior. The participants were assessed at the beginning of the program and on two occasions after the intervention, with evaluation of biochemical and anthropometric data, and frequency of self-monitoring of blood glucose (SMBG). Questionnaires were applied during these evaluations to analyze emotional burden (B-PAID), medication adherence (Morisky Adherence Scale), and self-efficacy (IMDSES).

Results

HbA1c had a median level of 8.0% (range 76-10.3%) at the beginning of the study and reduced significantly 3 months after initiation of the intervention (7.78% [6.5-10%], p = 0.028), with no significant increase at 6 months (8.3% [713-9.27%], p = 0.386). SMBG improved significantly from the beginning to the end of the study, with the median number of glucose tests per week varying from 16.5 (range 0-42) at baseline to 29.0 (7-42) at 3 months and 27.5 (10-48) at 6 months (p = 0.047). No significant differences were observed in anthropometric parameters or in the scores of the instruments between the three measurements.

Conclusion:

A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs and could be an auxiliary method to help individuals with type 1 diabetes achieve their treatment goals.

Keywords
Type 1 diabetes mellitus; self-management; health coaching

Principles of coaching
*Focus on the future*
It focuses on the solution to problems rather than their source. A short, medium or long-term goal is defined.
*Action*
It is performed by weekly tasks, which are defined at the end of each session and must have deadlines to start and finish.
*Autonomy*
The goals to be achieved at the end of the process, as well as the weekly tasks and deadlines, are defined by the individuals in coaching, who have full autonomy in their choices.
*Active listening without judgment*
Building a relationship of trust in which the client can express himself freely.
*Effective questions*
These are open-ended questions that stimulate reflection and the elaboration of responses directed to new possibilities in the face of obstacles and difficulties. In addition, it generates the person's commitment to his own speech and decisions.
*Focus on the positive*
It seeks the optimistic look on adversity, seeking to resignify bad events and bringing to light more positive alternatives for confronting problems.
Coaching tools
S.M.A.R.T.
Once the goal is set, this tool is applied to format it, making the goal more realistic and achievable: S - specific; M - mensurable; A - attainable; R - relevant; T - time.
Behavioral profile
Questionnaire whose result indicates to the clients which behavior prevails in their day-to-day attitudes (analyst, communicative, executive, idealizer) and discusses how the predominant behavior helps or hinders the achievement of their goals.
Wheel of life
This tool was administered during the initial assessment to help guide the conversation, with participants reporting how successful or satisfied they were (0-10) in each life domain (career, family, financial, spiritual, health, intellectual, among others). This is a clinical tool to explore values, establish priorities, and set goals. Identifying areas in which the participants felt less successful or satisfied, they then chose areas on which to focus for coaching.
Action plan
It involves defining the first steps towards the goal, the goals to be achieved and contributing to the ultimate goal, predicting obstacles and how to circumvent them, and recruiting the skills and competencies needed to reach the desired state.

Sociedade Brasileira de Endocrinologia e Metabologia Rua Botucatu, 572 - Conjuntos 81/83, 04023-061 São Paulo SP Brasil, Tel: (55 11) 5575-0311 - São Paulo - SP - Brazil
E-mail: aem.editorial.office@endocrino.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence to: Janice Reis, Rua Domingos Vieira, 590 30150-240 - Belo Horizonte, MG, Brasil, janicesepulveda@gmail.com