Formulas must be found to include the patient in the different strategies that approach diabetes; indeed, a trained patient is an active, autonomous patient who takes better care of him/herself. This has been corroborated by the study 'Evaluation of training in patients with diabetes', prepared by the Andalusian School of Public Health (EASP) in collaboration with ESTEVE. Accordingly, experts emphasize the importance of education, awareness and empowerment of diabetic patients to promote shared-decision making and lifestyle changes.

According to Toñi López Cazorla, a nurse at the Infanta Elena Hospital of Huelva who has been participating in the Diabetes Classroom of this center for the past three years, "as a professional, I think that a patient learns more from another patient than from the professional him/herself, basically because they feel the same and they have gone through similar situations; expressing how they feel about their daily life with the disease helps them". According to Mauricio Dueñas, president of the 'Huelva Diabetes' Association and patient trainer, "the information about diabetes seems to be better transmitted among the patients themselves".

The study has evaluated projects such as the Patient School of the Department of Health, Social Services and Equality and the Active Patient Program of the Basque Public Health System, where workshops have been imparted by expert patients in Andalusia and the Basque Country with the participation of 300 people with diabetes.

In this sense, the workshops held in Seville have shown that attendants reduced their visits to Primary Care Centers by 33% and did not visit the Emergency Room in the past 6 months. In addition, they have a better knowledge of their disease, better quality of life indexes, and better physical activity levels.

Regarding Andalusian or Basque cities, both patients and professionals claim that this initiative has represented a turning point in the adoption of healthy lifestyles. Patients have also shown a better knowledge of the management of their disease, thereby increasing their self-control and confidence.

But there's more: patients also feel they have more resources and skills to meet their challenges, and become more involved and proactive in their relationships with professionals. "Another advantage to be considered is that interaction among patients contributes to demystify the possible consequences of diabetes and helps them define common needs and concerns".

These conclusions are all the more relevant if we consider that, according to the Spanish Society of Diabetes, 13.8% of the population has Type 2 diabetes, a condition at high risk of cardiovascular disease and increasing incidence that must be properly controlled.

According to Dr. Silvia Copetti, a Primary Care Physician in Catalonia who collaborates with the Expert Patient Program, "these workshops show how our messages frequently fail to reach and imbue the patient, whereas the expert patient -who is much closer on account of both his/her experience of the disease and the language he/she uses- is able to mobilize the patient and increase his/her awareness".

"We need to move forward and away from a paternalistic model in the doctor-patient relationship to reach a more deliberative model likely to benefit both parts. Group educational intervention is one step forward, where a trained, educated patient becomes an expert patient capable of conducting a group of patients with the same disease and where professionals assume observer roles", Dr. Copetti says. The question is whether "we are willing and able to develop our role in this new scenario and collaborate in the so-called empowerment of the patient".

For his part, Dr. Tomás Méndez, a Primary Care Physician in the Basque Country, says that participating in active patient programs "has changed my ways of issuing the information and the proposals for change to my patients. This has translated into a greater closeness, more focus on lifestyle changes, and greater involvement and co-responsabilization of the patient with his/her health".

From his experience as a patient training patient, Mauricio Dueñas says that "I wish I had had the opportunity to attend this type of workshops early in my diabetes; my life with the disease would certainly have been better. I therefore think that these workshops should be included in the protocols of the Andalusian Health System for all patients". Also importantly "these workshops are highly profitable for the health system in the medium and long term because patients gain autonomy to manage their disease and thus require fewer resources from the health system".

According to Juan Carlos Mendizábal, also a patient expert in diabetes, "along with other people with the same disease, I can now acquire new skills and tools to live with diabetes without letting it take control of my life".


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