The setting and attaining of individual goals in patients with diabetes appears to be possible at a community level, and across various ethnic groups. Success with this also is associated with improved glycaemic control. Although most Diabetes Self-Management Education standards emphasize the collaborative setting of patient defined goals, health care professionals often battle to remain objective in the process. We continually need to actively reflect on and be aware of whose goals are being set and whose agenda is being served.

When looking at the title of this discussion, one may be tempted to ascribe greatest importance to “goal setting”, but I would argue that “Individual” is the preeminent independent and determining variable on which all goal setting in diabetes management should be based.

For example, we all understand the role of overweight and obesity in the aetiology and pathophysiology of type 2 diabetes and its attendant risks and complications. Weight loss, particularly central or visceral, is thus an important healthcare professional agenda item. However, in my country, South Africa, 9 out of 10 South Africans see their ‘ideal’ body image as ‘fat’. Many people, particularly black women, associate being fat with wealth, health and success. Being thin is associated with being HIV and TB infection.

In your community, when ‘trying to help’ to set some health related goals, what usual healthcare ‘advice’ may be viewed variously by your patient as taboo, insane or inappropriate because of local customs, culture, socialisation or situation ?

Information about the discussion leader

The discussion will be moderated by Mr Michael Brown, clinical consultant and head of the Centre for Diabetes and Endocrinology Media and Publishing (Pty) Ltd, Johannesburg, South Africa

References

1. Diabetes Self Management. Look at a post entitled "Setting Goals for Healthy Living” by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, Bradley Eilerman, MD, and Leonard Bennett, PharmD.
2. Anderson DR, Christison-Lagay J, Procter-Gray E. 2010. Self-Management Goal Setting in a Community Health Center: The Impact of Goal Attainment on Diabetes Outcomes; Diabetes Spectrum, March 20, 2010 23:2 97-105;
   
   
3. Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M et al. 2009. National standards for diabetes self-management education. Diabetes Care 32 (Suppl. 1): S87-S94.
   
   
4. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, Reddy P, Parker W, Hoosain E, Naidoo P, Hongoro C, Mchiza Z, Steyn NP, Dwane N, Makoae M, Maluleke T, Ramlagan S, Zungu N, Evans MG, Jacobs L, Faber M, & SANHANES-1 Team (2013) South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press