'Stop Boring Patients': Tips for Engaging Diabetes Education

William H. Polonsky, PhD, CDE; Mark Harmel, MPH


July 24, 2020

This transcript has been edited for clarity.

The problem that we educators really need to address is the fact that most patients who probably need to get referred to diabetes education never even get referred. Of those who are referred, most of them never even make it.

The critical issue I want to make sure we talk about is that the majority of people who make it to a formal, group-based, multisession diabetes education program don't complete the program. Retention rates are terrible.

What's fascinating is that we actually don't have much data about that. It almost seems like most of us and most of our programs are a little too embarrassed to collect those data. The available evidence suggests that it's pretty bad, that maybe only about one quarter of patients complete 75% of a multisession group diabetes education program. That's the issue.

The Real Reason for Low Retention: Are We Boring?

What do we do about it? What's the problem and how do we face it? If we ask people who have dropped out or if we ask educators what they think the problem is, the answer is usually about convenience. Patients don't come back because they say they get busy, it's too far, parking's difficult, etc.

I would challenge that. I would ask those of you who are watching this right now to consider that maybe when your patients tell you that they didn't come back because it was inconvenient or they got busy, that's just the polite answer.

The real answer is something bigger than that. The answer is that people are voting with their feet because they're saying, "I'm not so sure that what's happening in this program is worth it for me. I don't find it engaging. I don't find that it touches my interests or efforts at all."

Broadly speaking, I would say the problem is that we, as diabetes educators, are unfortunately really boring. We have to address this problem of boredom.

Now, when I say "boredom," what I really mean is that we're not being engaging. We're not personalizing for each person in that room, so people lose interest. They don't feel that what they're hearing — what we're talking about — matters.

That's what I really want to make sure we draw attention to. I desperately want to see more data to understand whether this is as true as we think it is from the small amount of evidence available. If so, can we get creative and address it?

Make Room for Personalization

I don't think diabetes educators are boring people, but we're boring in these programs. The issue is often that we have this sense that the administrators or the credentialing bodies are requiring us to present enormous amounts of information, so we kind of squeeze the life out of our program and then there's no room to do what we need to do.

When we think about addressing this problem, there are two important points I want to bring up. The first is that we have to take a creative look at our programs and find a way to stop pushing so much information on people. We have to make room for being more interactive. We have to make room for personalizing things so that we can answer people's questions, deal with their confusion, and make it engaging and interesting.

We can't do that if we are feeling overwhelmed, if we're drowning in thoughts like, I have to tell everybody in this room about how hemoglobin gets glycosylated. I have to tell everybody about all the different kinds of oral medications, how they work, and all the injectable medications.

Do we really need to do that? What's more important is finding out what medications everybody in this room is on and how they're thinking about their medications. What do they know about the potential benefits? How are they thinking about the potential harms? What are they worried about regarding the medications they're on? What kind of suspicions do they have? How do they struggle with some of these things?

These are huge, valuable, and important areas that, if we don't have time to talk about them, are not going to be addressed. We can forget about explaining in enormous detail about medications, explaining in enormous detail about reading food labels and carbohydrate counting, and instead ask people very specifically, "Tell me about how you eat."

Let's look at all the different people in the room. Let's think about small, positive changes to make and why those might be useful. Let's make talking about carbohydrates and nutrition interesting for folks. One of the ways we can do that is by bringing flash glucose monitoring and CGM right into an education session. This can make all the difference in the world.

We need to find a way to creatively put aside all the extraneous information that's in our programs to make room for doing what the other intervention is, which is making things personal.

I can guarantee you that very few of our patients have any interest in learning about exactly what an A1c is, but they might be very interested in knowing what their A1c result is and what it means.

We need to make an effort to personalize the content, to talk to people in the room, to have a big whiteboard to keep a list of questions, and to have time in every session to make sure we address patients' issues and concerns.

When we do that, I think people are going to come back. I think people are going to want to come back and they're going to absorb more from what we do.

I encourage all of my fellow educators to brainstorm and get creative. Let's face the fact that we've got a problem with people not coming to our programs and disappearing from our programs too early. We can address this. We can do it by brainstorming and by thinking creatively.

Thanks for listening.

William H. Polonsky, PhD, CDE, is the president and founder of the Behavioral Diabetes Institute, an organization dedicated to studying and addressing the psychological needs of people with diabetes. He is an active researcher in the field of behavioral diabetes and the recipient of ADA'S Outstanding Educator in Diabetes Award.

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