Time requirements for diabetes self-management: too much for many?

Overview

BACKGROUND: In Crossing the Quality Chasm, the Institute of Medicine laid out principles to improve quality of care and identified chronic diseases as a starting point. One of those principles was the wise use of patient time, but current recommendations for chronic conditions do not consider time spent on self-care or its impact on patients' lives. OBJECTIVE: To estimate the time required for recommended diabetes self-care. METHODS: A convenience sample of 8 certified diabetes educators derived consensus-based estimates of the time required for all self-care tasks recommended by the American Diabetes Association. RESULTS: For experienced patients with type 2 diabetes controlled by oral agents, recommended self-care would require more than 2 extra hours daily. Elderly patients and those with newly diagnosed disease, or those with physical limitations, would need more time. Exercise and diet, required for self-care of many chronic conditions, are the most time-consuming tasks. CONCLUSION: The time required by recommended self-care is substantial. Crossing the Quality Chasm suggests how clinicians and guideline developers can help patients make the best use of their self-care time: elicit the patient's perspective; develop evidence on the health consequences of self-care tasks; and respect patients' time.