Beyond the data: moving towards a new DAWN in diabetes

In this issue, the much-anticipated results of the second Diabetes Attitudes, Wishes and Needs (DAWN2) Study are published in three articles by the DAWN2 Study Group and made free for download on our website. The original DAWN1 study was groundbreaking at the time of its publication in 2001 because of its size, scope and international focus. The findings were also revolutionary because they described in great detail across countries the importance of addressing psychosocial issues, including diabetes-related distress, the value of team care in chronic illness and the need for a new approach to health care for people with diabetes [1]. DAWN1 sent a strong message that addressing the psychosocial and behavioural needs of patients is an essential component of diabetes care in order to achieve glycaemic goals and improve long-term outcomes. The findings of DAWN2 are no less important because they both confirm and deepen our understanding of these issues. Along with examining psychosocial issues among people with diabetes (Nicolucci et al., page 767), concerns of family members (Kovacs Burns et al., page 778) and health professional perceptions and system issues (Holt et al., page 789) are also explored in DAWN2. Because much of the worldwide growth in diabetes is in developing countries and attributed to major societal, economic and lifestyle changes [2], India, China, Turkey and Russian Federation countries are included in DAWN2. Improving our understanding about diabetes in countries such as these is essential if the global epidemic of diabetes and the increasing burden of this disease on both individuals and nations are to be effectively addressed. There was agreement among the patient and health professional participants in DAWN2 that greater opportunities for diabetes self-management education are needed. Multiple studies confirm the value of diabetes selfmanagement education, demonstrating improved clinical outcomes, quality of life and healthy coping, increased use of primary and preventive services and reductions in diabetes-related costs [3–6]. Despite the evidence for the effectiveness of diabetes self-management education, participation rates were low for both patient and family groups in DAWN2. Less than half of participants with diabetes (48.8%) and less than a quarter (23.1%) of family members reported attendance, although both groups valued diabetes self-management education and found it helpful. DAWN2 has demonstrated the need to increase accessibility to diabetes self-management education and the availability of diabetes educators. This is the essential first step in preparing patients and their families to actively engage in self-management, their care and the decision-making process. Diabetes self-management education therefore needs to go beyond didactic methodologies and information-based curricula and incorporate the psychosocial, behavioural and cultural aspects of diabetes [3,6,7] throughout the educational process. The inclusion of family members in diabetes self-management education will help them to be more effective in their support efforts and to ease the heavy burden they identified in DAWN2. In a recent consensus report [6], the authors point out the need for healthcare professionals to understand the individual characteristics of their patients and the context of their daily decisions and self-management efforts in order to create meaningful, realistic and relevant treatment and lifestyle goals. Based on the principles of patient empowerment, this viewpoint recognizes that the majority of diabetes care is provided by the patient and their family members, that goals need to be established collaboratively and that the role of healthcare professionals is to provide diabetes expertise, education and psychosocial support [6,7]. Healthcare professionals participating in DAWN2 indicated that they recognized the importance of greater engagement by patients and their families in order to improve self-management and outcomes. However, study participants Cover image: Chicago skyline at dawn from Navy Pier. The result of the DAWN2 study was announced at the 2013 Scientific Sessions of the American Diabetes Association in Chicago. Credit: Don Dexter Antonio Photography. The image is covered under the Creative Commons CC-BY-ND license.