Department of Health Education and Promotion, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran


Type 2 diabetes is one of the most life-threatening public health challenges in the world. It
causes a high disease burden including increased disability, reduced life expectancy and everincreasing costs of care in almost every country. The growing burden of diabetes along with
rapid cultural changes, aging population, increasing urbanization, changes in nutritional habits,
reduced physical activity, and improper lifestyle and behavior patterns would inexorably drive
increased health care costs and demands. Several models of education have been proposed
to reduce the complications of chronic diseases including diabetes. However, it is widely known
and acknowledged that adopting self-care and self-management behaviors play a fundamental
role in diabetes control and treatment.A non-systematic (narrative) search strategy was used to
collect necessary data. Several models of diabetes care such as compliance-based or curative
models exist. Neither the curative model nor the compliance/adherence model is rigorously
effective in diabetes care. The model of self-empowerment – based on the three fundamental
aspects of chronic illness care: choices, control, and consequences – is much more applicable
in the management of diabetes. This point to an approach which recognizes that patients are
responsible for their diabetes care. Self-empowerment model has the potential to place diabetes
care into context – a context which is based on active involvement of patients and informed,
proactive healthcare professionals in the process of care.


1. Spinaci S, Currat L, Shetty P, Crowell V, Kehler J. Tough Choices:
Investing in health for development: Experiences from national
follow-up to commission on macroeconomics and health. WHO
Report 2006.
2. Zimmet P, Alberti KG, Shaw J. Global and societal implications of
the diabetes epidemic. Nature 2001;414:782-7.
3. Wild S, Roglic G, Grren A, Sicree R, King H. Global prevalence of
Diabetes: Estimates for the year 2000 and projections for 2003.
Diabetes Care 2004;27:1047-53.4. International Diabetes Federation. Diabetes Atlas. 3rd ed. Brussels,
Belgium: International Diabetes Federation; 2006.P.50-78
5. O’Kane MJ, McMenamin M, Innes J, Moore A, Bunting B, Coates V.
The relationship between socioeconomic deprivation, educational
attainment and clinical outcomes in type 2 diabetes: A cohort study.
Diabetologia 2008;51(Suppl 1):1091.
6. Tol A, Pourreza A, Shojaeezade D, Mahmodi M, Mohebbi B.
The assessment of relations between socioeconomic status and
number of complications among type 2 diabetic patients in teaching
hospitals affiliated with Tehran University of medical sciences. Iran
J Public Health 2012; 41:66-72
7. Bagust A, Hopkinson PK, Maslove L, Currie CJ. The projected health
care burden of type 2 diabetes in the UK from 2000 to 2060. Diabet
Med 2002;19(Suppl 4):1-5.
8. Harrison M, Fullwood C, Bower P, Kennedy A, Rogers A, Reeves D.
Exploring the mechanisms of change in the chronic disease
self-management program: Secondary analysis of data from a
randomized controlled trial. Patient Educ Couns 2011;85:e39-47.
9. Butt J. Media Backgrounder, Diabetes in the developing world, 2010.
World Diabetes Foundation. Available from: http://www. on 7th Dec
10. Hogan P, Dall T, Nikolov P; American Diabetes Association.
Economic costs of diabetes in the U.S in 2002. Diabetes Care
11. Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S,
Alaedini F, et al. Prevalence of diabetes mellitus and impaired
fasting glucose in the adult population of Iran: National Survey of
Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care
12. Delavari A, Forouzanfar MH, Alikhani S, Sharifian A, Kelishadi R.
First nationwide study of the prevalence of the metabolic syndrome
and optimal cutoff points of waist circumference in the middle east:
The national survey of risk factors for non-communicable diseases
of Iran. Diabetes Care 2009;32:1092-7.
13. International Diabetes Federation. Diabetes Atlas. 4rd ed. 2011.5th
November. Available from: at http://www.worlddiabetesfoundation.
org International Diabetes Federation ,Brussels, Belgium
14. Esteghamati A, Khalilzadeh O, Anvari M, Meysamie A, Abbasi M,
Forouzanfar M, et al. The economic costs of diabetes: A populationbased study in Tehran, Iran. Diabetologia 2009;52:1520-7.
15. Dall TM, Zhang Y, Chen YJ, Quick WW, Yang WG, Fogli J.
The economic burden of diabetes. Health Aff (Millwood)
2010;29:297- 303.
16. Abolhasani F, Mohagerie Tehrani MR, Tabatabaei O, Larijani B.
Burden of diabetes and its complication in year 2000. Iranian Journal
of Diabetes and Lipid Disorders 2005;5:130.
17. Tol A, Sharifirad GR, Shojaeezadeh D, Alhani F, Eslami AA, Mohajeri
Tehrani MR, et al. Evaluation of self-care practices and relative
components among Type 2 diabetic patients. Journal of Education
and Health Promotion 2012. In press.
18. Tol A, Baghbanian A, Sharifirad GR, Shojaeizadeh D, Eslami AA,
Alhani F, et al. Assessment of diabetic distress and disease related
factors in patients with type 2 diabetes in Isfahan: A way to tailor an
effective intervention planning in Isfahan-Iran. Journal of Diabetes
and Metabolic Disorders 2012. In press.
19. Tol A, Baghbanian A, Shojaeezadeh D, Azam K, Esmaeeli
Shahmirzadi S, Asfia A. Empowerment assessment and influential
factors in patients with type 2 diabetes. Journal of Diabetes and
Metabolic Disorders 2012. In press.
20. Tol A, Baghbanian A, Rahimi A, Shojaeizadeh D, Mohebbi B,
Majlessi F. The Relationship between perceived social support from
family and diabetes control among patients with diabetes type 1 and
type 2. Journal of Diabetes and Metabolic Disorders 2011;10:1-8.
21. Hill-Briggs F. Problem solving in diabetes self-management:
A model of chronic illness self-management behavior. Ann Behav
Med 2003;25:182-93.
22. Fox E. Predominance of the curative model of medical care:
A residual problem. JAMA 1997;278:761-4.
23. Funnell MM, Anderson RM. Empowerment and self-management
of diabetes. Clin Diabetes 2004;22:123-7.
24. Gonder-Frederick LA, Cox DJ, Ritterband LM. Diabetes and
behavioral medicine: The second decade. J Consult Clin Psychol
25. Funnell MM, Tang TS, Anderson RM. From DSME to DSMS:
Developing empowerment-based diabetes self-management
support. Diabetes Spectr 2007;20:221-6.
26. Coons SJ, McGhan WF, Bootman JL, Larson LN. The effect of selfcare information on health-related attitudes and beliefs of college
students. J Am Coll Health 1989;38:121-4.
27. Anderson RM, Funnell MM. Using the empowerment approach to
help patients change behaivior. Practical psychology for diabetes
clinicians. 2th ed. American Diabetes Association; 2002. p. 1-10.
28. Delavari AR, Mahdavihazaveh M. Prevention and controlling
diabetes. Health Deputy, Disease Management Center, Ministry of
Health of Iran; 2005. p. 45.IRAN
29. Tang TS, Gillard ML, Funnell MM, Nwankwo R, Parker E, Spurlock D.
Developing a new generation of ongoing diabetes self-management
support interventions. Diabetes Educ 2005;31:91-7.
30. Hunt LM, Pugh J, Valenzuela M. How patients adapt diabetes selfcare recommendations in everyday life. J Fam Pract 1998;3:207-15.
31. Humphry J, Jameson LM, Beckham S. Overcoming social and
cultural barriers to care for patients when the diagnosis is diabetes.
West J Med 1997;167:138-44.
32. Cooper H, Booth K, Gill G. A trial of empowerment - based education
in Type 2 diabetes- Global rather than glycaemic benefits. Diabetes
Res Clin Pract 2008;8:165-71.
33. Tol A, Alhani F, Shojaeazadeh D. Sharifirad GR. Empowerment
approach to promote quality of life and self- management among
type 2 diabetic patients. Health System Research 2011;7:1-10.[In
34. Anderson R, Rubin R. Using the empowerment approach to help
patients change behavior. Practical Psychology for diabetes
clinicians. 2th ed. 2002. p. 3-12.
35. Anderson RM, Funnell MM, Fitzgerald JT, Marrero DG. The Diabetes
Empowerment Scale. A measure of psychosocial self-efficacy.
Diabetes Care 2000;23:739-43.
36. American Diabetes Association. Standards of medical care diabetes.
Diabetes Care 2009b;32(Supplement 1):S13-S61.
37. Tol A, Shojaeezadeh D, Sharifirad G, Alhani F, Tehrani MM.
Determination of empowerment score in type 2 diabetes patients
and its related factors, J Pak Med Assoc 2012;62:16-20.
38. Sigurdardottir A. Jonsdottir H. Empowerment in diabetes
care: Towards measuring empowerment Scand J Caring Sci
2008;22:284- 91.
39. Geoffrey CW, Zeldman A. Patient-centered diabetes self-management
education. Curr Diab Rep 2002;2:145-52.
40. McGowan P. Self-Management: A Background Paper. Proceedings
of the first International Conference on Patient Self-Management.
Victoria. British Columbia, Canada; 2005. p. 12-14
41. Malathy R, Narmadha MP, Ramesh S, Alvin Jose M, Dinesh Babu N.
Effect of a diabetes counseling programm on knowledge, attitude
and practice among diabetic patients in Erode district of South India.
Pharmacy Practice 2011;3:65-72.
42. Funnell MM, Anderson RM, Arnold MS, Barr PA, Donnelly M,
Johnson PD, et al. Empowerment: An Idea whose time has come
in diabetes education. Diabetes Educ 1991;1:37-41.
43. Rappaport J. Terms of empowerment/exemplars of prevention
toward a theory for community psychology. Am J Community
Psychol 1987;15:121-48.
44. Toljamo M, Henttinen M. Adherence to self- care and social support.
J Clin Nurs 2001;10:618-27.