From Acorns to Oak Trees: The Development and Theoretical Underpinnings of Diabetes Conversation Map Education Tools

Diabetes is one of the Western world's most common chronic conditions, with global prevalence increasing rapidly.1 Type 2 diabetes constitutes ~ 85–95% of all diabetes cases in developed countries and accounts for an even higher percentage in developing countries.1 The primary goals of diabetes treatment are to achieve near-normal blood glucose levels over the long term and to reduce the risk of both micro- and macrovascular complications,2–7 without significant impairment of patients' quality of life.8 Since the turn of the 20th century, health care professionals (HCPs) specializing in chronic conditions such as diabetes have increasingly understood and used therapeutic patient education to empower their patients to make behavioral changes. In his 1918 book A Diabetic Manual: for the Doctor and Patient ,9 Elliott P. Joslin described diabetes as a condition characterized by self-management. Consequently, patient education should be considered a vital component in the holistic management of the disease. In the United Kingdom, the National Service Framework recently published recommendations for standards in diabetes care10 focusing on provision of information, structured education, and psychological support. However, there is little consensus on the “how,” “when,” and “what” of educational curriculums. There are now multiple published structured education programs designed for people with type 2 diabetes. These vary in scope, length, content, and approach but share the same goal: to improve knowledge and understanding of the condition and through this to empower people with type 2 diabetes to improve the management of their own condition and migrate along the continuum of care to achieve long-term improved clinical and health status.11,12 As the well-known 14th century proverb states, “Mighty oaks from little acorns grow.” However, teaching methods and educational programs often are not tailored to, and at times conflict with, patients' needs …