What is the best approach for a patient with newly diagnosed diabetes who is not controlled and having difficulty understanding diabetes management and lifestyle changes?

Use Simple Visual Aids to Explain Diabetes Management

For a patient with newly diagnosed diabetes who is not controlled and struggling to understand lifestyle and medication management, explain diabetes using simple visual aids and diagrams—this is the most effective approach for patients with limited health literacy. 1

Why Visual Aids Are Superior

The American Diabetes Association specifically recommends that diabetes self-management education must be individualized and accessible, with special consideration for those with limited health literacy. 1 Visual diagrams and simple explanations are superior because they:

• Allow for immediate clarification of misconceptions 1
• Enable assessment of patient understanding in real-time 1
• Permit tailored messaging based on the patient's specific barriers 1
• Support patient-centered care that is respectful of individual needs and preferences 2

The ADA explicitly recommends "a simple and effective approach emphasizing portion control and healthy food choices for those with limited health literacy." 1

What to Include in Your Visual Education

Medication Management

• Start or optimize metformin immediately as first-line therapy while implementing education 1
• Use simple diagrams showing when to take medications and what to expect 1
• If HbA1c >9% or random glucose ≥250 mg/dL, initiate insulin therapy with visual dosing guides 1

Lifestyle Modifications Using Simple Terms

• Nutrition: Focus on reducing simple sugar intake rather than restrictive diets 1
• Show pictures of portion sizes and emphasize vegetables, whole grains, and lean proteins over processed foods 1
• Explain carbohydrate sources from vegetables, fruits, legumes, and whole grains are preferred over those with added sugars 1
• Physical Activity: Explain as "30 minutes, 5 days per week using simple terms like 'brisk walking that makes you breathe harder'" to reach 150 minutes weekly 1
• Add resistance training at least twice weekly using simple demonstrations 1

Critical Pitfalls to Avoid

Do not simply hand the patient a pamphlet (Option B)—this approach fails to:

• Identify specific barriers to lifestyle modification 1
• Assess health literacy and numeracy skills 1
• Verify patient understanding 1
• Provide immediate feedback and clarification 2

Do not focus only on medication adherence (Option C)—this ignores that:

• Lifestyle modifications must be implemented in concert with medication, not as separate interventions 1
• Nutrition therapy is an integral component that should be integrated with overall treatment 2
• DSMES addressing both lifestyle and medications improves outcomes more than medication focus alone 2

Screen for Diabetes Distress

• Ask "How much does diabetes interfere with your daily life?" to screen for diabetes distress, which affects 18-45% of patients 1
• High levels of diabetes distress significantly impact medication-taking behaviors and self-care 2
• If self-care remains impaired after tailored diabetes education, refer to a mental health provider 2

Follow-Up Strategy

• Schedule return visit in 2-4 weeks to reassess blood glucose control and review medication adherence 1
• Use teach-back method: "Can you show me how you would take your medication?" 1
• Refer to diabetes educator or registered dietitian for ongoing medical nutrition therapy, which reduces HbA1c by 0.3-2% 2
• DSMES over 10 hours total duration with ongoing support produces better outcomes 2

Evidence Supporting Visual Education

Video-based lifestyle education for newly diagnosed type 2 diabetes patients increased diabetes knowledge significantly (74.3% vs 56.4% correct answers) compared to standard care, and also improved A1C, cholesterol, and physical activity. 3 Knowledge is essential for making lifestyle changes, and visual methods facilitate better knowledge retention and implementation. 4