Response from Shobhana Ramachandran, Ph.D., diabetes educator and nurse, Chennai, India With a chronic disorder like diabetes, positive outcomes are achieved only when patients and families, community support and healthcare teams are informed, motivated, prepared and working together. Asking people to take more responsibility for their diabetes does not mean we are not doing our jobs; it means we are doing our jobs better. With diabetes, self-care is so important. Successful outcomes very much depend on whether the patients can make the necessary changes to their lifestyle, such as a better diet and more exercise. Numerous studies have shown that patients with chronic conditions who are involved with their care decisions and management have better outcomes than those who are not. The healthcare professional still plays a very important role in helping people with diabetes accomplish the very difficult task of modifying their behaviour. I think it is part of our responsibility as healthcare professionals to encourage our patients to take better care of themselves. There is still a great deal of support necessary from diabetes educators, nurses and doctors. We can support them with the right information, teach practical skills and suggest diet modification and exercise. Most importantly, we can give them a sense of self-confidence that they can do the job of taking care of their diabetes better than any doctor or nurse can. This emphasis on patient-centred care means that we have to stay in constant touch with the patients, in the form of frequent visits as well as follow-up mails and telephone calls. On every occasion, we take the opportunity to focus on motivation, education and promoting self-care. One thing we can do better is to listen more. In my daily work, I face poverty, language barriers and lack of physician time, but I still feel that emotional issues such as depression are an important part of the picture. Very often I come across patients refusing to take insulin, for instance, due to misinformation or fear of what it means. When they meet with diabetes educators like ourselves, they need to feel comfortable telling us about their problems. And that’s where listening comes in. In India we have a unique opportunity as well as an obligation to create a new kind of healthcare system for chronic conditions that places patients at the centre but with the supporting healthcare team right by their side. Shobhana Ramachandran, Ph.D. is a nurse and has been a diabetes educator at the Diabetes Research Centre & M.V. Hospital for Diabetes, the WHO Collaborating Centre for Research, Education & Training in Diabetes in Chennai, India, for the past 20 years. | 
