Vignette: How it could be

Ten years ago, Thomas was 52 years old, approximately 70 pounds overweight, had type 2 diabetes, hypertension, and osteoarthritis in his knees and hips. For most of his life he had been very active in competitive sports like football and basketball. Up to the age of 40 years he had normal weight for men his height and build, but gradually gained additional weight. He started to have problems with his knees and experienced several injuries requiring arthroscopic surgery. He continued to play these sports because they were important to him but in a modified manner that didn’t require running and quick starts and stops. However, he paid the price for continuing and experienced increased pain and mobility problems.

Five years ago he participated in a community self-management program and learned helpful skills and strategies. His priority concerns were how to lose weight and to eat in a way that didn’t leave him hungry all the time. He was impressed by this program and became a leader and subsequently led the program four times. He told his doctor about the self-management program and was surprised that the doctor was already familiar with the key concepts such as action planning and problemsolving. His doctor also encouraged him to join an online program where he could take the selfmanagement program again, access his medical record, add certain types of information such as his latest HbA1c levels, communicate with peers, receive online newsletters, and find community resources.

Today Thomas continues to manage and cope with diabetes, but feels he has more control. He used the problem-solving process and found ways to get 30 minutes of daily exercise by parking three blocks away from the office and using the stairs instead of the elevator, and eating foods that are healthy and leave him satiated. For his home he bought a popular video fitness program and enjoys playing it with his wife and grandchildren, and he also joined an online chat room for older men with diabetes. He has lost nearly 40 pounds, has much more energy and has a really great relationship with his doctor who also happy with the way Thomas is controlling his disease.