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The key to managing DM is for the patient to slow their intake of calories, take more regular physical activity, maintain normal weight, and avoid further weight gain. Once a patient achieves a stable weight, then if the patient agrees, the CHW will help the patient increase their energy-producing exercise activity, called physical activity energy expenditure (PAEE) in metabolic units. To be able to obtain this PAEE, the patient will have to record their current activity level in the HAP. A PAEE goal is predetermined by the HAP, which is then translated into a step-by-step action plan consisting of sub-goals and specific dates to complete each task by. A detailed physical activity activity log booklet is provided to participants to write down their daily activity and assign a metric to how active they have been for a given day. To assist the CHW in keeping track of patient progress, a progress log is also provided to the CHW at each of the two patient follow-up visits. The progress log requires CHWs to fill in the date they met with the patient, the specific duration of that meeting and whether or not the patient achieved their PAEE goal.
Patients with DM who are not able to lose weight with diet and exercise alone are considered to have drug-resistant or pharmacotherapy-resistant DM, and they are at higher risk for developing complications (e.g. heart attack and stroke) and other co-morbidities. Pharmacotherapy resistance in patients with type 2 DM is often defined as glycosylated hemoglobin (HbA1C) values above normal (about 7.0 percent) after maximum medical therapy has been tried, including diet, exercise and metformin [ 31 ]. Note, the US Food and Drug Administration does not recommend HbA1C testing to guide clinical management. Despite the lack of evidence supporting HbA1C as a screening tool, some clinicians recommend it for first-line assessment in adults. There is insufficient evidence to establish HbA1C cutpoints and thresholds for treatment recommendations. Clinicians should consider the benefits and risks associated with pharmacotherapy before HbA1C testing. It is imperative that patients who have DM meet their HbA1C goal. The goal of the diabetes self-management education and support (DSMES) is to empower patients with diabetes to manage their own healthcare through education and self-care behaviours [ 32 ]. Most people who have a medical condition (condition) can take steps to manage their health, but it is difficult without the right tools and knowledge. Like other chronic illnesses, diabetes requires a commitment to long-term self-management to maintain good health [ 33 ]. Compartmentalizing learning and information into logical units of learning and behavior development is one of the key factors for improving the quality of self-management education and support. The purpose of life coaching and/or personal coaching is to help an individual build the skills and strategies needed to learn, manage and maintain good health [ 34 ]. SLAM is a popular method of enhancing patient self-management of diabetes and is often used in DSME programs. The Western Australian CHW program SLAM consists of ten weekly sessions of up to two hours in duration. All CHWs receive a manual with detailed scripted instructions and additional resources to support patients. The model curriculum in the manual provides a theoretical framework for the behaviour change strategies and techniques, and the strategies and techniques provide an integrated approach to effective behavior change. 3d9ccd7d82
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