Patients with diabetes are responsible for the vast
majority of management requirements of their condition.
However, their ability and motivation to engage
in required self-management behaviors may be mitigated
by multiple intrinsic and extrinsic factors. Intrinsic
barriers include attitudes and health beliefs, limited
diabetes knowledge and technical skill, reduced
functional health literacy, and inadequate self-efficacy
to promote positive behavior change. Extrinsic
barriers include financial considerations, inadequate
family and community support systems, ineffective
clinical relationships, and limited access to effective
diabetes health care delivery. Diabetes providers
have opportunities for enhancing patient engagement
with clinical recommendations and diabetes
self-management through effective communication,
including efforts to contextually assess patients’ perceptions
of diabetes and how the condition fits
within the context of their changing lives. This article
provides a conceptual framework for establishing
and building an effective clinical alliance with patients
with the goal of empowering them to take
more control of their diabetes and reduce their risks
for poor diabetes outcomes