Type 2 diabetes puts patients at risk for serious health consequences that they can prevent or delay by achieving glycemic control. However, glycemic control depends largely on self-management. Consequently, determining what physicians might do in medical appointments to improve patients' self-management is of utmost concern. Patients were asked to discuss, in focus groups, their illness experience and their goals for regularly scheduled appointments. Six interrelated themes emerged from the analysis of transcripts: complications and comorbidities, time, control, information, family influences, and the physician-patient encounter. These themes and their implications for diabetes appointments were explored, specifically considering how physicians might use information about patients' perspectives to improve patients' self-management and thereby their glycemic control.

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PURPOSEW e examined the effectiveness of a multicomponent lifestyle activity intervention for overweight or obese patients with impaired fasting glucose (prediabetes). The physician-directed counseling intervention included collaborative goal setting with patients to achieve specifi c changes in physical activity and nutrition behaviors. Nurse surveillance was used to provide reinforcement and to monitor progress. METHODSWe randomized 88 adult patients with prediabetes and a body mass index of 25 kg/m 2 or greater to either an immediate-or a delayed-intervention group. Individualare "carved out" to an external staff person substantially improves implementation and allows more effective use of clinicians in a supporting role, such as reinforcing the intervention with patients. One potential limitation of the health educator model is that clinic staff won't accept an outsider. Contrary to this admonition, the current project demonstrated that the health educator becomes incorporated as part of the staff in a very short period of time, and other research indicates that the model works well in a variety of health care settings. 2 Another potential limitation is the sustainability of the model. One solution for sustaining this model in FQHCs is to use students in health-related professional programs (eg, public health, social work, nursing, medicine). These students could be a consistent source of low-cost health educator staff at FQHCs during their practicum or independent study experience, and the program could be replicated in most large cities. This approach, however, will require the development of standardized practicum curricula within different professional schools to train students in the techniques and practice of SBI.To read or post commentaries in response to this article, see it online at http://www.annfammed.org/cgi/content/full/3/Suppl_2/S58.

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