This guide provides a step-by-step approach to explaining a diagnosis of type 2 diabetes. You should also read our overview of how to effectively communicate information to patients.
Structuring your explanation
Explaining a diagnosis requires structure and adequate background knowledge of the disease. Whether the information being shared is about a procedure, a new drug or a disease, the BUCES structure (shown below) can be used.
Opening the consultation
Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
BUCES can be used to remember how to structure a consultation in which providing information is the primary focus. Before explaining the various aspects of a disease, it is fundamental to have a common starting point with your patient. This helps to establish rapport and creates an open environment in which the patient can raise concerns, ask questions and gain a better understanding of their problem. After introducing yourself, it is important to take a brief history (this is the first part of the BUCES structure):
- What has brought the patient in to see you today?
- What are their symptoms?
- Are there any risk factors that can be identified? (e.g. lifestyle/family history)
Tip: Practice taking concise histories to get the timing right. In OSCE stations, timing is crucial and you do not want to spend all your time taking a history when you are meant to be explaining a diagnosis! A rough guide would be to keep the introduction and brief history between 1-2 minutes maximum.
What does the patient understand?
Following a brief history, it is important to gauge the patient’s knowledge of their condition. Patients may know someone with the condition, or this may be their first encounter with the disease. Be open with the patient and work to identify any misconceptions they may have. The patient sitting before you may not even know at this point that they have diabetes – you may be the first person to inform them of the diagnosis.
Due to these reasons, it is important to start with open questioning. Good examples include:
- “What do you think is causing your symptoms?”
- “What do you know about type 2 diabetes?”
- “What has been explained to you about type 2 diabetes so far?”
Open questioning should help you to determine what the patient currently understands, allowing you to tailor your explanation at an appropriate level.
At this stage, primarily focus on listening to the patient. It may also be helpful to give positive feedback as the patient talks (i.e. should a patient demonstrate some understanding, reinforce this knowledge with encouraging words and non-verbal communication such as nodding).
Checking the patient’s understanding should not be solely confined to this point of the consultation but should be done throughout by repeatedly ‘chunking and checking’.
Tip: Try using phrases such as: “Just to check that I am explaining what type 2 diabetes is clearly, can you repeat back to me what you understand so far?”. This is far better than only saying “What do you understand so far?” as the onus is placed upon the quality of your explanation rather than there being an issue with the patient’s ability to understand.
What are the patient’s concerns?
The patient’s concerns should never be overlooked. A diagnosis of type 2 diabetes can be a significant life event and provoke a variety of worries. Asking the patient if they have any concerns before beginning your explanation allows you to specifically tailor what is most relevant to the patient, placing them at the centre of the explanation. The ICE (ideas, concerns and expectations) format can provide a useful structure for exploring this area further.
ICE
Ideas
- What does the patient think is causing their symptoms?
- What is their understanding of type 2 diabetes?
Concerns
- What are the patient’s concerns regarding their diagnosis?
Expectations
- What is the patient hoping to get out of the consultation today?
Explanation
After determining the patient’s current level of understanding and concerns, you should be able to explain their condition clearly.
You should begin by signposting what you are going to explain to give the patient an idea of what to expect.
“I’m going to begin by talking about how your body controls blood sugar, then move on to discuss what type 2 diabetes is, why it is important to address and how we can manage it together.”
In preparation for your OSCE, practice your explanation in patient-friendly terms. Consider using visual aids such as diagrams or drawings to help understanding.
Tip: Use the mnemonic “Normally We Can Probably Manage” to help you remember the structure of explaining a disease.
Normal anatomy/physiology
The control of blood sugar can be explained by using an analogy of insulin as a key to the cell.
“Carbohydrates that we eat are broken down into sugar and released into our blood. This sugar is the fuel for all the cells that make up our body, and it needs to get from the blood into the cells for them to function properly.”
“A chemical called insulin acts like a key to unlock the cell and let the sugar in. This chemical is produced in an organ called the pancreas.”
What is type 2 diabetes?
“In type 2 diabetes, cells don’t respond to insulin as well. This could be thought of as the key being rusty and so it doesn’t open the lock as easily. As a result, the sugar cannot enter the cell and builds up in the blood. This build-up of excess sugar over time can cause damage to many different parts of the body.”
“At first, the body tries to fix this by producing more insulin, more keys to open the lock; but over time, the pancreas cannot keep up with how much is needed and eventually starts to produce less and less.”
For further information, see the Geeky Medics guide to type 2 diabetes.
What are the causes of type 2 diabetes?
Type 2 diabetes is caused by a combination of genetic and environmental factors that lead to increased insulin resistance and subsequently decreased insulin production.
- Genetic: having a family history of diabetes means a person is 2-6 times more likely to develop type 2 diabetes. Someone is 2-4 times more likely if they are of Asian, African or Afro-Caribbean ethnicity.
- Environmental: obesity, physical inactivity, low fibre and high glycaemic index diets and certain medications (such as corticosteroids)1
“There are certain genetic factors that increase the risk of developing type 2 diabetes such as your family history and ethnicity. However, many factors in your lifestyle can have a significant impact. These include not getting enough exercise, being overweight, and a diet high in certain carbohydrates.”
Problems/complications of type 2 diabetes
It is critical to explain the significance of type 2 diabetes, as it may be a disease without symptoms. This understanding will encourage patients to attend structured screening and monitoring, enabling them to identify problems early and seek medical advice.
It is important not to scare the patient but to explain that you are outlining the potential complications so that they are aware of them. A clear explanation is essential so that the patient is informed on how to reduce the likelihood of complications and improve adherence to lifestyle and pharmacological interventions.
“The build-up of sugar within the blood, when sustained over time, can lead to damage to many parts of the body by affecting the blood vessels and nerves.”
The complications of type 2 diabetes can be divided into microvascular and macrovascular. There can also be acute complications such as diabetic ketoacidosis and hyperosmolar hyperglycaemic state.
- Macrovascular: atherosclerotic cardiovascular disease, peripheral arterial disease
- Microvascular: nephropathy, retinopathy, neuropathy
Cardiovascular and peripheral vascular disease
“High blood sugar levels cause thickening and narrowing of large blood vessels that can eventually lead to heart attacks or strokes. This also reduces blood supply to the legs, which can lead to the development of ulcers, infection, and possibly require amputation.”
Nephropathy
“The damage to blood vessels can also affect the kidneys, impacting their ability to filter waste. If this progresses significantly, end-stage kidney disease requiring dialysis can develop.”
Retinopathy
“Circulation to the eye can be damaged in a similar way, leading to irreversible effects that may progress to blindness.”
Neuropathy
“Nerves anywhere in the body can be affected. Symptoms such as reduced sensation, pain, poor blood pressure control and delayed stomach emptying, amongst many others, can result from this.”
Infection and healing
“High blood sugar levels can help feed bugs that cause infection, combined with a reduction in immune system function and poor wound healing. This can lead to more regular and severe infections, including a higher risk of sepsis.”
Management
Normal blood sugar levels can be achieved with the right lifestyle changes and medical treatment. However, because of the many potential complications, regular monitoring is essential.
“Our target in managing your type 2 diabetes is to reduce your blood sugar levels to a target range and prevent complications of the disease. There may not be any symptoms of the early stages of these, so it is important to attend regular monitoring.”
Explain to the patient that there are steps they can take in their own lives and things you will do as their doctor.
“We recommend a combination of healthy lifestyle changes and long-term medications. I can explain and discuss these options with you in more detail so you understand how they will help.”
Non-pharmacological
All patients with type 2 diabetes should be encouraged to adopt several lifestyle changes.
“In addition to the medication, you can make some lifestyle changes that reduce your blood sugar levels and help reduce the risk of complications.”
Start by explaining what the patient can do to manage their condition, including:
- Following dietary advice (high fibre, low-glycaemic index carbohydrates, low-fat dairy products)
- Weight loss if the patient is overweight or obese
- Undertaking at least 150 minutes of moderate physical activity a week
- Limiting alcohol intake and smoking cessation 1
A referral to a structured education programme, such as DESMOND, can help facilitate further understanding of these changes.
It can also be useful to signpost patients to resources such as NHS Better Health or Diabetes UK, which provide information and support for lifestyle interventions.
Pharmacological
Pharmacological treatments are used in managing type 2 diabetes; however, they should support lifestyle changes and not be a replacement. Some people may be able to lower their blood sugars to a normal range with lifestyle changes alone, so the ongoing use of medications should be regularly reviewed.
“If you are unable to lower your blood sugar with lifestyle changes alone, medications can be used long-term to support. It is important to routinely have your blood sugar control monitored to ensure it stays within a target range.”
Pharmacological therapies work to either increase the body’s sensitivity to insulin or increase insulin production. As diabetes progresses, the body’s insulin production decreases and may necessitate insulin to be given by injection.
“Oral medication is used first to try and increase your body’s response to the insulin you produce. If needed, further medication can be added, and if this is ineffective, extra insulin can be given via injections.”
For further information, see the Geeky Medics guides to metformin counselling, SGLT2 inhibitor prescribing and insulin prescribing.
Monitoring
Routine reviews are a crucial part of diabetes care, involving blood monitoring and screening for complications. This includes:
- HbA1c monitoring: measured every 3-6 months until stable on unchanging treatment, then every 6 months
- Cardiovascular monitoring: annual blood pressure, BMI, renal function, lipid profile and urine albumin
- Vaccination: influenza and pneumococcal
- Foot checks: annually
- Retinopathy screening: at diagnosis, then yearly unless low risk 1
“It is very important that we work together to manage your diabetes, and part of this involves attending regular reviews. To check blood sugar control and reduce complications from diabetes, we will arrange regular monitoring blood tests in addition to screening for any complications with your feet, eyes and kidneys.”
Closing the consultation
Summarise the key points back to the patient.
“We have discussed quite a lot today about what type 2 diabetes is, how the condition is managed and the possible complications. I realise this is a lot of information to take in, so I have a leaflet summarising everything we’ve discussed. I will also refer you to a structured education programme to learn even more about managing your diabetes.”
Ask the patient if they have any questions or concerns that have not been addressed.
“Is there anything I have explained that you’d like me to go over again?”
“Do you have any other questions before we finish?”
Offer the patient some leaflets on type 2 diabetes and its management and direct them to reliable websites to gather more information (examples include Diabetes UK and NHS conditions).
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Editor
Dr Jamie Scriven
References
- NICE CKS. Diabetes – type 2. 2025. Available from: [LINK].
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