I think the point you are making would be radical to some. I don't agree with those people, I do agree with YOU. IMHO, essentially what you're proposing is offering the patients the psycho-social support we all learned about back in school but in today's nursing practice, many of us find we have little time for.
Patients are bombarded by news media about the "obesity epidemic" as well as the "type 2 diabetes epidemic" but with that bombardment comes little in the way of true education. People who develop type 2 diabetes are then criticized, for example in this thread- "you could have prevented this if only......." but we don't think about what cost emotionally this diagnosis means for them. We throw a bunch of medication at them, tell them they now have to perform painful procedures "x" times a day (for those who may poo-poo this, try poking your fingers with a needle 4 times a day and see how you like it! it ain't fun!), rush them through a diet teaching program to make their heads swim, tell them if they don't do what we say all these nasty things will happen! How can patients possibly process all this information, deal with all the education they must undergo, and then face the stigma of being called "one of THOSE people". No wonder complicance is such a huge issue.
I was diagnosed with Type 2 diabetes over a year ago. I'm a nurse, a good one but didn't realize this was happening. NO ONE in my family has ever had diabetes. Yes, I am obese...my sister who was much larger than me never developed diabetes, neither did my mom or paternal grandmother, all women who struggled with weight issues. How did I GET SO LUCKY as to get a gene that decided I needed to get this illness? I struggled for a long time with denial, this couldn't be happening to me. Tried different meds, let my PCP manage things but when my A1C remained high, I finally accepted this diagnosis and sought out an endocronologist. My diabetes is now undercontrol with an average A1C of 6.8. Do I use diligence in monitoring my daily glucose levels? Not as well as I should. Do I follow the diet and take my meds? Religiously. For some reason, poking my finger puts me in a place of anxiety. I accept I'm a diabetic, I accept I need to manage this disease and I am doing my best.
But let me be honest: I already have issues regarding my weight, now this pushes me further into a mental arena that makes life even more difficult. Self-esteem is a problem as is PTSD from an issue from a few years ago. You know what hurts most? The looks I get from others about my now being "one of those people". Because I'm fat, it is now considered acceptable to judge me because I now have this illness. How I"m a drain on the healthcare system, how I could have prevented all of this, how I"m a bad person. Yes, there are consequences for not managing my disease properly but instead of judging me, why not offer a hand to help?
Your blog reminds us all that if we wonder why our patients are non-compliant, we need to look to make sure we are TRULY supporting them. Have we truly given them our best or just shoved a bunch of papers at them and said "good luck"...when they stumbled did we offer them a hand up or just give them the emotional equivalent of a "smack-down"? I have dealt with my share of non-compliant patients (my primary patient population is heart failure patients) and yes, some of them drive me crazy when they don't do as they should...but I will never give up on them. I will try to support them the best I can as much as they will allow me to. It may require some deep breathing on my part but I still try. Just some thoughts.