• increasing knowledge
  
• providing skills
  
• changing attitudes and behaviour

People with diabetes need a basic level of information in order to manage their diabetes. But in general, the most important skill that the diabetes educator can teach is how to apply this knowledge in their daily lives. Diabetes educators should empower people with diabetes to take charge of their own disease.

Glycemic control
All individuals with diabetes should be made aware of the importance of glucose control in delaying or preventing cardiovascular disease and other complications. People are told and often given schedules of when screening for complications should take place. They are encouraged to take the schedule to their doctor and ask for the tests to be done. Prevention of complications is a key part of the discussion the educator will have with the individual with diabetes.

Insulin use
Insulin use should be discussed in detail with all people with Type 1 diabetes. Individuals should be encouraged to learn to adjust their own insulin for changes in day to day activity. Although intensification of insulin regimen is a goal, this may or may not mean 'intensive therapy' in the sense of the term used in the Diabetes Control and Complications Trial.

Although the importance of improved therapy is recognised by most healthcare providers in most countries, actual implementation is difficult since rapid acting insulin, insulin pens and pumps for delivery are not available in all regions.

Insulin management for people with Type 2 diabetes is often not discussed as soon as it should be. When a person with Type 2 has done as well as he or she can on oral agents, and is not at target blood glucose levels, the switch to insulin should be made. Educators often recognise when the person has reached this point and are instrumental in advocating to the physician that the change should be made.

Lifestyle changes
Lifestyle issues and negotiating for change are part of the discussion between the educator and the person with diabetes. The educator will help individuals to recognise areas for change and then support them through these changes. Different concepts and theories are used to determine practice; currently the most widely accepted theories in North America are:

• Empowerment, which recognises the right of the individual with diabetes to be the primary decision maker in the management of their condition
  
• the Transtheoretical Model of Change that focuses on initiating an appropriate intervention for the readiness of the individual to make a change
  
• the Health Belief Model, which relates to the belief patterns of the individual.