Clinical Communication

Patient-Physician Communication and Diabetes Self-Care

From the Department of Family Medicine (Dr. Beverly) and the Department of Medicine (Mss. Worley, Court, Prokopakis, and Ivanov), Ohio University Heritage College of Osteopathic Medicine, Athens, OH.




  • Objective: To summarize the current literature, research findings, and interventions for self-care communication in the physician-patient relationship.
  • Methods: Literature review.
  • Results: Diabetes management requires patients to follow complex self-care recommendations for nutrition, physical activity, blood glucose monitoring, and medication. Adherence to these recommendations improves glycemic control and mitigates the risk of diabetes complications; however, many patients struggle to follow these behaviors in everyday life. In the physician-patient relationship, self-care communication is largely influenced by interpersonal trust. Physicians need to incorporate interpersonal and relational skills to establish a trusting relationship. Physician-level barriers to self-care communication include lack of time, lack of collaboration and teamwork among health care providers, lack of patients’ access to resources, and lack of psychosocial support for diabetes patients. Among patients, psychosocial barriers and health literacy may affect willingness to discuss self-care. Motivational interviewing techniques may be helpful for improving communication around patient self-management and promotion of healthy behaviors.
  • Conclusion: Physicians can assist patients with their diabetes self-care by discussing self-care challenges during medical visits.

Diabetes is one of the most significant and growing chronic health problems in the world, affecting approximately 415 million people [1]. Diabetes is marked by the body’s inability to make insulin as well as the body’s inability to effectively use the insulin it produces [2]. Diagnosis of diabetes has increased sharply in recent decades and is expected to increase even more, with the largest increases in middle- and low-income countries [3]. Diabetes is a leading cause of blindness, kidney failure, myocardial infarction, stroke, and amputation [3], and in 2015 it accounted for 5 million deaths worldwide [1]. Further, diabetes’s costs to society represent 12% ($673 billion) of global health expenditures [1]. By 2040, models predict that 642 million people will be diagnosed with diabetes and costs will continue to grow as the population ages [1]. Thus, prevention of diabetes is the ultimate goal; however, more effective management for individuals already diagnosed with diabetes is critical to reduce the risk of complications and the economic burden of the disease.

Diabetes management requires patients to perform complex self-care regimens, including weight reduction, frequent blood glucose monitoring, taking oral and/or insulin medications, engaging in physical activity, adhering to diabetes nutrition guidelines, and attending clinic appointments [4–9]. These self-care behaviors are critically linked to improved glycemic control, however, integrating them into one’s daily life can be challenging [10–12]. Recent National Health and Nutrition Examination Survey (NHANES) data show that approximately half of adults with diabetes are not meeting recommended goals for diabetes care [13]. Physicians can assist patients with their diabetes self-care by scheduling frequent follow-up visits and discussing self-care challenges with their patients [14].

In this review, we discuss the current literature on physician-patient communication and diabetes self-care. First, we discuss the qualities of an effective physician-patient relationship followed by the importance of self-care communication in diabetes care. Next, we discuss barriers and facilitators to self-care communication. Finally, we review interventions for improving physician-patient communication in diabetes self-care.


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