December 6, 2018
How group diabetes education in Argentina is changing lives
Every year, nearly 800 people of all ages and their families gather to live together and receive diabetes education.
By Gabriel Lijteroff
Every year, over four consecutive days, nearly 800 people of all ages and their families gather to live together and receive diabetes education at events organised by the Federación Argentina de Diabetes (FAD) (Diabetes Federation of Argentina).
Why do people with diabetes who have received treatment information and know what they have to do for adequate management of their disease, fail to achieve their therapeutic goals? What leads them to seek education if they fail to use insulin as required, to adhere to their meal plans, to engage in physical activity and to self-monitor their blood glucose? Why, if there are a wide range of choices in the pharmacologic arsenal, self-monitoring methods that become more and more comfortable, and so many ongoing educational programs in diabetes, is the achievement of therapeutic targets so low?
In the belief that self-management groups are an important therapeutic tool, FAD facilitates collaboration with various public and private entities on any activity related to education, quality of life and equality of conditions for all people living with diabetes.
Among these activities, their annual meeting stands out. Nearly 800 participants from all over the country and of all ages, gather together for four days in a tourist facility located at the center of the vast territory of Argentina, to facilitate access for everyone. Groups from both crowded cities and small rural towns, enrich this event with their diverse customs and regional accents. Everyone participates with the goal of learning within a friendly and relaxed atmosphere.
Workshops on different topics of interest are organised, arranged by type of diabetes and age, as well as groups for family members. A medical specialist is available to each group. Topics are adapted to participants and there are two coordinators in charge of recording the blood glucose readings of each attendee and keeping them informed of the daily activities, in addition to providing significant support. The team of coordinators of the 19 groups is largely composed of people who have once been children or teenagers with diabetes and have attended previous events, and by leaders of the associations that make up FAD.
Sharing leads to discovery
The physician can show one direction, but it is always easier for a person with diabetes to walk along this path when someone has done it before and done it well. They can see themselves reflected in the other and eventually correct mistakes by exchanging knowledge, with the support of a healthcare professional. The feeling of being supported, understood and listened to by a peer who also has diabetes has an added value in the process of learning to live with the condition.
Each group shares a table during meals, and this is of particular benefit to children and teenagers who, sometimes for the first time, can self-monitor their blood glucose and inject themselves with insulin openly, thus sharing this experience with those who must do the same daily. A private experience, sometimes done stealthily for fear of social rejection, becomes something that is lived more naturally. Children, who are generally the only ones in their school with diabetes, find new friends who also take insulin as they do. A teenage girl will be able to have a conversation with an older woman who was able to get pregnant and have children successfully. Someone who has recently been diagnosed with diabetes can meet people who have learnt to live with it many years ago.
Little children surprise their parents when they show them they can give themselves their insulin shot and self-monitor their blood sugar as the other kids in the group do. Meeting other people who have lived through older age with diabetes encourages them. These adults, in turn, when they eventually need to inject insulin by themselves but postpone this for fear, or leave these injections in the hands of others, are involuntarily inspired and encouraged when they see how easily these children do so.
When it comes to initiating a new therapy, listening to the experience of another person who has already made the decision and understood its benefit has a strong impact contributing to acceptance and adherence. Beyond the patients’ trust in their physicians, since “biting a chili pepper tells you more about it than planting a field of it”, the concept that personal experience is the best teacher, prevails instinctively.
The experience of living with diabetes is difficult to convey. Only people with diabetes truly understand and feel in their own flesh what it means to daily inject themselves with insulin, to have to closely monitor their blood glucose and take the corresponding measures. This is why the team of coordinators is largely composed of members of the young sub-committee of FAD who live with diabetes. They have once been children and teenagers, have attended previous events and have decided to undertake the commitment of giving back what they have received, with the special sensitivity that having this unique knowledge brings.
The healthcare professionals who take part as educators and who are responsible for the groups, are selected following strict evaluation, with consideration of their suitability, teaching vocation and community work in the place where they live. Both they, the organising team of the event and the group coordinators, volunteer their time and efforts and receive nothing else in return, other than the satisfaction of a job well done, the grateful hugs of participants and the promise to meet again next year.
This type of event emphasizes the value of group education as a resource that supports patients and families, and fosters empowerment and success with diabetes. It is a strategy that, year after year, FAD urges not to ignore.
Gabriel Lijteroff is a Specialist in Internal Medicine and M.Sc. Diabetes Chief of Diabetology at Hospital S.T. de Santamarina, Monte Grande, Buenos Aires, Argentina. He is Director of the Scientific Committee and Ex-President of the Argentinian Diabetes Federation (FAD) and a member of the Executive Committee of IDF SACA management 2018- 2020.