Diabetes Mellitus Management and Patient Rapport: Sarah's Case Study

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Introduction:
Diabetes is considered as the epidemic of the 21st century as in Australia, itself, almost 280
people develop diabetes on a daily basis, making it the biggest challenge faced by the
healthcare system (Diabetes Australia, 2018). Diabetes majorly is of three types; diabetes
type 1, diabetes type 2 and gestational diabetes. Out of these, type 2 diabetes accounts for
nearly 85% of all diabetes cases and is continuously rising (Diabetes Australia, 2018). As per
the case study, 50 yrs Sarah, a single mother of four children has recently developed diabetes
and is found to face major difficulties in maintaining the recommended lifestyle. She is not
following the diet regime and exercise schedule that has led to high blood sugar levels and
can cause major complications. Thus, it becomes essentially important for the healthcare
professional to give her time, communicate the need for keeping her blood sugar under
control and support her in this difficult time.
Diabetes Mellitus and its types
Diabetes Mellitus (DM) is a serious condition characterised by high blood sugar level in the
body leading to various severe complications if not managed well (Australian Institute of
Health and Welfare (AIHW), 2015). Basically, glucose from food is used to produce energy
for cells to function. This process requires an action of insulin hormone and in the absence of
insulin or its disturbed action, glucose remains unutilised and its level increases in the blood
causing diabetes. Diabetes is majorly of two types; type 1 and type 2 (Brooks-Worrell &
Palmer, 2011).
In Type 1 diabetes, insulin is not produced in the body causing high blood sugar level. It is an
autoimmune condition, in which, pancreas insulin-producing cells are attacked by the body's
own antibodies. This condition usually develops in early childhood and is also caused by
genetic predisposition. Since there is no production of insulin in the body, this condition is
only treated through external insulin (Brooks-Worrell & Palmer, 2011). On the other hand, in
type 2 DM, pancreas produces insulin but either the amount produced is insufficient or body
cells fail to respond to insulin, causing high blood sugar level. Type 2 DM has been found
associated with the poor lifestyle of being overweight, sedentary routine or consuming a poor

diet. This condition is more common in adults and can be managed through proper diet,
regular exercise and with some medications (Nolan, Damm, & Prentki, 2011).
Pathophysiology and complications of Type 2 DM
Type 2 diabetes is a progressive condition characterised by insulin resistance and gradual loss
of insulin-producing a capacity of the pancreas (Nolan et al., 2011). The actual cause is
unknown but it is found to run in family and overweight people with poor lifestyle habit are
at higher risk of developing type 2 DM. As seen in the case of Sarah, due to her busy
schedule, she was unable to engage in regular exercise and even consumed take away
unhealthy food predisposing her to develop this condition.
Insulin is the main hormone that regulates blood glucose level by converting it to energy. In
type 2 DM, the receptors gradually fail to respond to insulin (Department of Health, 2018).
To respond to this insulin resistance and increased insulin demand, beta cells of pancreas start
producing large amounts of insulin. However, over time, these cells wear out and lose their
ability to produce insulin. By the time a person is diagnosed with type 2 diabetes, almost 50
to 60% of insulin-producing cells is already lost. Thus, it is a combination of insulin
deficiency and insulin resistance. Nolan et al. (2011) suggest that it can be managed through
healthy eating and regular diet. However, if blood glucose levels are continuously high, it can
lead to severe long term complications including diabetic retinopathy, diabetic nephropathy,
diabetic neuropathy and other cardiac problems (Brooks-Worrell & Palmer, 2011). Sarah's
high blood sugar levels may damage her small blood vessels along with damaging functions
of eyes, kidneys and heart. So, it is extremely essential to encourage her to adopt the
recommended lifestyle.
Significance of building rapport for Healthcare professionals
Building rapport is one of the most essential communication skills for healthcare
professionals and ensures the health and safety of their patients. Godsell et al. (2013) and
Workman (2013) have suggested that Building rapport is the ability of healthcare
professionals to build and maintain a working relationship with their patient and to gain their
trust. Price (n.d.) also agreed that positive rapport with patients not only helps in delivering

better care but also assists in developing trust, which in turn is essential for the development
of the effective therapeutic relationship (Price, n.d.). Manchester (2018) further found
building rapport as the key to effective care as it makes the patients comfortable and to trust
their care providers. The author has shared her experience with diabetes patients whereby
adopting effective approaches to establish rapport with patients resulted in better adhesion to
the treatment plan. This eventually led to better health results (Manchester,2018). On the
contrary, Gilpatrick (2004) has suggested that if efforts are not made to develop a rapport
with the patient and there is poor communication, it can greatly affect the patient-HCP
relationship and thus, affect the quality of treatment perceived.
HCPs must communicate it to their patients that they are working in their best interests. By
adopting effective communication skills, showing empathy, acknowledgement and assisting
empowerment, HCPs can connect to the patients (Leach, 2005). It leads to high treatment
compliance, patient satisfaction and better patient outcomes. Bakić-Mirić & Bakić (2008)
further added that the usual patient complaints are not regarding the HCP’s expertise or
clinical competency rather these are regarding the communication issues. Thus, through
better verbal and non-verbal communication skills adopted by professionals, trust and rapport
can be built with patients and their willingness to agree with their care providers can be
enhanced manifold. Patients would feel valued, wanted and would have the feeling that their
individual needs are understood and well considered.
Strategies to build rapport with Sarah
To improve the health outcomes of Sarah and to encourage her to adopt the recommended
lifestyle, HCP would adopt the strategy of active listening and empathy. Leach (2005) has
found these strategies to be very effective in developing a rapport with patients. So first of all
by active listening, which is the highest and effective level of listening to understand and feel
the patient's concerns, a therapeutic relationship would be built with her. The HCP would
actively listen to Sarah’s issues in maintaining a healthy diet and exercise regime and would
paraphrase her sentences to make her feel listened and valued. Like, the care provider can
listen and respond ‘I can understand how difficult it must be for you to manage your health
along with all these responsibilities’. This would comfort Sarah and would help in gaining
her trust. Secondly, through empathy, which is the ability to understand the situation, feeling
and motives of another person, HCP can successfully built a rapport with her (Cunico et al.,
2012). Sarah seems quite angry and frustrated with her lack of time and continuous pressure

of maintaining a healthy lifestyle. Thus to comfort her, empathy would be the best approach
where HCP would calm the situation through the passive body language of low voice tone
and eye contact, listening to her and saying that ‘I understand you are upset’. Hull (2007)
found it to assist in gaining her trust, help her open up, clear her doubts and finally enhance
treatment compliance.
Conclusion
In conclusion, this work has depicted the significance of diabetes mellitus and the difference
between type 1 and type 2 diabetes. For managing diabetes mellitus and keeping healthy
blood sugar level, patients have to modify their lifestyle, which can be challenging in various
situations. Thus, it becomes important to build rapport with patients and keep them
motivated for treatment adhesion. The role of building rapport with patients has been
discussed by using the two major strategies of active listening and showing empathy.

References
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