In 2019, 30.3 million US adults were reported to have diabetes—an epidemic according to some public health experts.1,2 Even more sobering, an estimated 84.1 million (or more than 1 in 3) American adults have prediabetes.1 Diabetes is associated with multiple complications, including an increased risk for heart disease or stroke.3 In 2015, it was the seventh leading cause of death and a major cause of kidney failure, lower limb amputations, stroke, and blindness.2,4
As clinicians we often ask ourselves, “How can I help my patients become more effective managers of their diabetes, so that they can maximize their quality of life over both the short and long term?” Unfortunately, management of diabetes is fraught with difficulty, both for the provider and the patient. Medications for glycemic control can be expensive and inconvenient and can have adverse effects—all of which may lead to inconsistent adherence. Lifestyle changes—including diet, regular physical activity, exercise, and weight management—are important low-risk interventions that help patients maintain glycemic values and reduce the risk for diabetic complications. However, some patients may find it difficult to make or are ambivalent to behavioral change.
These patients may benefit from having structured verbal encouragement—such as motivational interviewing (MI)—incorporated into their visits. The following discussion will explain how MI can be an effective communication tool for encouraging patients with diabetes or prediabetes to make important behavioral changes and improve health outcomes.
Q What is MI?
First created by William R. Miller and Stephen Rollnick in the 1980s as a counseling method to help patients with substance use disorders, MI was eventually expanded to address other clinical challenges, including tobacco cessation, weight management, and diabetes care. MI helps patients identify their motivations and goals to improve long-term outcomes and work through any ambivalence to change. It utilizes an empathic approach with open-ended questions.5 This helps reduce the resistance frequently encountered during an average “lecture-style” interaction and facilitates a collaborative relationship that empowers the patient to make positive lifestyle changes.
MI affirms the patient’s experience while exploring any discrepancies between goals and actions. Two important components for conducting MI are (1) verbally reflecting the patient’s motivations and thoughts about change and (2) allowing the patient to “voice the arguments for change.”6 These components help the patient take ownership of the overarching goal for behavioral change and in the development of an action plan.
MI involves 4 primary processes: engaging, focusing, evoking, and planning (defined in the Table).7 MI begins with building rapport and a trusting relationship by engaging with empathic responses that reflect the patient’s concerns and focusing on what is important to him or her. The clinician should evoke the patient’s reasons and motivations for change. During the planning process, the clinician highlights the salient points of the conversation and works with the patient to identify an action he or she could take as a first step toward change.7
Motivational Interviewing Processes
Engaging: Demonstrating empathy
Focusing: Identifying what is important to the patient
Evoking: Eliciting patient’s internal motivations for change
Planning: Reinforcing the patient’s commitment to change
Source: Arkowitz H, et al. Motivational Interviewing in the Treatment of Psychological Problems. 2015. 7
Continue to: Q How can I use MI with my patients with diabetes?