Motivational Interviewing in Diabetes Care by Marc P Steinberg and William R. Miller

Motivational Interviewing (MI) is a collaborative counseling strategy designed to elicit and strengthen motivation for behavior change. It has been applied to diabetes patients, to encourage them to discuss behaviors associated with self-management, as well as to help them with motivation and confidence when it comes to making changes that will improve health and wellbeing in relation to their illness.

MI involves health care professionals engaging with their patients in a specific way, for example, asking open-ended questions, affirming when they share information, and reflecting on what they say. It also recommends assessing a patient’s confidence, ability, and commitment to achieving goals.

The book, Motivational Interviewing in Diabetes Care, is jointly authored by physician Marc P. Steinberg, and clinical psychologist William R. Miller. Marc P. Steinberg has devoted much of his career to diabetes care, while William R. Miller is the codeveloper of MI-present counseling techniques.  It provides a stimulating perspective for diabetes care and illustrates how the use of MI in conversations about change can offer a more pleasant experience for both the provider and the patient. It provides a concise overview of evidence-based MI and a brief introduction of the evidence across fields that supports its efficacy. It demonstrates a shift between more traditional provider-patient interactions (“I don’t have time, so I just have to tell them what to do”) to a more person-centered approach, in which the provider trusts that the person has most of what they need to make a change and that together they will find it. The authors consistently offer amplified examples of scenarios to address the importance of building an alliance with patients by facilitating self-care options that can improve diabetes outcomes.

It also delivers a clear message about the value of providing diabetes care while adopting a team approach. It says: “Unlike acute-care medicine, the long-term management of diabetes is an ongoing process that involves a team of specialists and, most importantly, the patient themselves.”, which exemplifies the importance of evoking from the patient why they may consider managing their diabetes, and what tools and types of support they might need to manage the condition. The author explains the importance of using EPE (elicit-provide-elicit), “when what is needed is lifestyle behavior change, though, a one-way transmission of information and advice is usually insufficient.”

The first chapters provide an overview of both the relational foundation of MI, emphasizing the importance of the spirit of MI, and later introduces the technical part of MI, core skills. Almost every chapter presents a concept or processes of MI in conjunction with ample samples of conversations between patients and health providers.

The book provides a nice illustration of how to approach diabetes care with patients throughout the phases of care; from the engagement process, when the patient first learns about the diabetes diagnosis, to a step-by-step process of highlighting important topics, such as nutrition, physical activities, insulin treatment, substance abuse, psychological issues, and other important life style adjustments.

This book is a great guide for any provider, particularly those providing diabetes care. Regardless of your exposure to MI, this book is well-structured and simplifies the foundations of MI, while also conveying how it “fits” in consultations with diabetic patients. Although the book emphasizes the use of MI in managing diabetes, the examples provided are so well explained that any provider can benefit from understanding how different this type of communication is and how powerful our words and approach can be in either cultivating change talk and/or “cuddling” sustain talk. The author also brings up a great point about being able to enjoy the work that we do and spend much of our life time doing. So then why not make it more enjoyable, efficacious, and, motivating?

Ray Nanda, MD
Family Medicine
Kaiser Permanente Orange County Medical Offices
Regional Physician Lead, Center for Healthy Living
Southern California Permanente Medical Group