Kaleidoscope model of diabetes care: time for a rethink?

Abstract

National Audit Data highlight persistent sub-optimum control among increasing numbers of people living with diabetes, with severe consequences for the individual and the NHS. The aim of the present review was to introduce a new cohesive, holistic model of care, tailored to individual needs to support optimum diabetes outcomes. This model of diabetes is necessary in order to understand the driving forces behind behaviour and their impact on diabetes management. Feelings (an emotional state or reaction) and beliefs (an acceptance that something is true or real) are fundamental behavioural drivers and influence diabetes self-management choices. Individually, these explain some of the complexities of behaviour and, collectively, they impact on personal motivation (rationale/desire to act) to achieve a specific outcome. Inevitably, they independently affect diabetes self-management and the environment in which individuals live. A model of care that proposes the encompassing of environment, intrinsic thought and therapy regimens to provide tailored, personalized healthcare should support enhanced diabetes self-management and outcomes from diagnosis. The Kaleidoscope model of care could be deliverable in routine care, incorporating each of the influences on diabetes self-management, and should benefit both individuals with diabetes and healthcare professionals.

Self‐reported diabetes self‐management competence and support from healthcare providers in achieving autonomy are negatively associated with diabetes distress in adults with Type 1 diabetes

“…In their recent review article, Barnard et al . 28 introduced a model of diabetes care that incorporates the various influences on diabetes self‐management, including feelings, beliefs and personal motivation. The findings of the present study encourage further discussion of this model of diabetes care, specifically the inclusion of each person's perceived level of autonomy support and self‐perceived competence in efforts to assess and alleviate diabetes distress.…”

Safe and Efficacious Use of Automated Bolus Advisors in Individuals Treated With Multiple Daily Insulin Injection (MDI) Therapy

“…Individuals with diabetes often become frustrated with their self-management efforts, which can lead nonadherence to treatment. 22 By focusing on their patients' progress and successes (even small ones), clinicians can help patients overcome their frustrations and sense of hopelessness and develop a sense of self-efficacy. 23 …”

Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy

“…From a cohesive and holistic perspective, diabetes care can be theoretically described by the underlying complexity of the relationship between diabetes and individual motivation, where external factors, personal factors, regimen factors and behaviour are central. Interactions between feelings, beliefs, motivation, environment and therapies can be driving forces behind behaviour and therefore affect diabetes management (Figure ; Barnard et al., , p. 528). To our knowledge, no studies have investigated whether emotional factors influence the development of LH.…”

“…People with T1D are largely expected to be able to self‐manage their insulin treatment to avoid complications (e.g. LH) (Barnard et al., ). This requires high levels of knowledge, skills and confidence, also known as patient activation (Hendriks & Rademakers, ).…”