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Moving from denial to compliance

Several months ago, I heard the term “non-compliant diabetic” for the first time. It was used by a nurse-educator for the Canadian Diabetes Association in a conversation we were having. Enter the term into Bing and you get about 534,000 results. Checking out a link in Bing, I found another term: HONDA Hypertensive Obese Non-compliant Diabetic Adult.

Hmmm … four characteristics all rolled into one. Also makes me think of my first bike, the great little Honda 50. But I digress.

There’s a great article by David Mendosa (one of my favourite writers on diabetes) in Diabetes Monitor entitled “Incorrect Diabetes Terms” in which he addresses politically incorrect terminology when it comes to discussing diabetes and People With Diabetes. Here’s an excerpt from David’s article regarding non-compliant diabetics:

“For most of us, to be labelled noncompliant is a worse slander than being called a diabetic. This is particularly true when health care people criticize us for not doing things that they haven’t clearly explained or where we think they are wrong.

“An endocrinologist friend wisely says, ‘The ‘noncompliant’ label always grated on me — it’s assuming a model of health care delivery that assumes the doc to be the captain of the ship and the patients to be chained to the oars’.”

Physician Fred Kleinsinger suggests that instead we call it non-compliant behavior and identifies what he describes as four criteria: “1) the patient's medical problem is potentially serious and poses a clinically significant risk to length or quality of life; 2) at least one treatment exists that if followed correctly, will markedly reduce this risk; 3) the patient has easy access to the treatment or treatments; and 4) the patient deviates significantly from most patients (with similar medical problems) in degree of compliance with medical advice, treatment, or follow-up in a way that directly or potentially jeopardizes the patient's health or quality of life.”

I happen to work in an area where I have regular contact with a large number of physicians and when I ask them about people not following their directions when it comes to diabetes, the most common explanation I hear is “denial”. Kleinsinger would agree with that.

“In my experience, denial is especially common in long-term diabetic patients whose diabetes was either of juvenile or of midlife onset. Good blood glucose control demands enormous effort compared with control of signs or symptoms of other common chronic illnesses, such as hypertension. The diabetic patient must pay close attention to diet and exercise; monitor blood glucose levels at home, a process requiring finger sticks; schedule frequent blood tests; and take pills, insulin injections, or both. Contemplating these complex requirements along with the long-term risk of blindness, kidney failure, and cardiovascular complications may stimulate denial in many patients.”

I guess it’s another reason why the Drew Carey story resonated so much with me. In many ways, my own denial has prevented me from taking the necessary action to deal with diabetes. I realize that over the last little while, I have been moving further and further away from denial and starting to take responsibility for the first time in a long time. Wish me luck.

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