Dramatic change in a young woman's perception of her diabetes and remarkable reduction in HbA1c after an individual course of Guided Self-Determination

Abstract

A 24-year-old woman with type 1 diabetes participated in a randomised controlled trial proving effectiveness of a flexible Guided Self-Determination (GSD) intervention. She had for 10 years been living with a complex situation of eating disorder, poor glycaemic control, non-attendance and psychosocial distress. She managed to change her perception of diabetes dramatically and improved her glycaemic control. Considering the complexity of her case, we explored how she achieved these changes. A GSD-trained nurse delivered the intervention, which involves reflection sheets and advanced professional communication. Glycated hemoglobin was reported in the patient's record and an interview conducted by external interviewers was analysed thematically, indicating that a four-stage process of empowerment had taken place: 'focusing on life prior to numbers', 'unpacking a heavy burden', 'breaking out of isolation through communication' and 'finding strength within oneself'. The article emphasises that GSD works by breaking isolation through communication as an appropriate way to achieve good diabetes control.

The effect of guided self-determination on self-management in persons with type 1 diabetes mellitus and HbA1c≥64 mmol/mol: a group-based randomised controlled trial

“…This interpretation is consistent with a recently published qualitative paper evaluating how a GSD approach could bring about a dramatic change in a young woman’ s perception of her diabetes. 21 …”

“… 19 20 In addition, a case report on a young woman showed considerable reduction in HbA 1c after a GSD intervention. 21 In conclusion, GSD seems worthy of further research for several reasons. First, patient involvement and person-centred care are highly appreciated and recommended, but difficult to implement as part of clinical care.…”

The Patient–Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting

“…At the same time, studies have suggested a possible risk of not identifying patients’ needs because of the limited time allotted 13,14. Research has clarified that the relationship between patients with diabetes and HCPs was central for patients’ ability to cope with their disease 15,16. In particular, patients with cancer need supportive and caring relationships with the HCP17,18 because cancer treatment often affects patients’ quality of life, even years after the diagnosis 19.…”

Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study

“… 31 Moreover, in previous research showing that the GSD intervention can develop life skills and reduce psychosocial distress in individuals with type 1 diabetes, participants completed the reflection sheets on paper at home as preparation for an in-person consultation with health care personnel, which may facilitate dialogue around assistance with, explanation for, and tailoring of the intervention. 13 – 19 The fact that the written reflection and communication with health care personnel occurred primarily electronically may have undermined perceptions of support for some participants.…”