Occupational Therapy Interventions For Adults With Type 2 Diabetes Mellitus

Editor's note: This text-based course is a transcript of the webinar, Occupational Therapy Interventions For Adults With Type 2 Diabetes Mellitus, presented by Ryan Osal, OTD, MS, NZROT (non-practicing status), OTR/L, CHC, CEAS.

*Please also use the handout with this text course to supplement the material.

Learning Outcomes

• After this course, participants will be able to distinguish the primary differences between Type 1 and Type 2 diabetes mellitus, including their underlying mechanisms and trends in prevalence.
• After this course, participants will be able to identify complications related to Type 2 diabetes mellitus and how these complications affect daily life and work performance.
• After this course, participants will be able to evaluate evidence-based assessment tools, lifestyle management approaches, and community resources available for diabetes care in both the USA and global settings.

Introduction

Welcome, everyone. Today, I’ll be presenting on occupational therapy for managing type 2 diabetes in the adult population. I’m excited to share insights from research and clinical practice, along with real-life examples that highlight the importance of our role as occupational therapy practitioners (OTPs) in this area.

While we have a growing body of evidence, there are still gaps in research regarding long-term occupational therapy interventions specifically for type 2 diabetes. Additionally, various socio-environmental factors can influence health behaviors and outcomes, which may not be fully addressed in every case we discuss today.

The agenda for today will include the following key topics:

• First, we’ll clarify the differences between type 1 and 2 diabetes.

• Next, we’ll review the epidemiology and some key statistics that help us understand the scope and impact of diabetes globally and in the U.S.

• We’ll examine the complications commonly associated with type 2 diabetes, often affecting functional performance and quality of life.

• Then, we’ll shift to occupational therapy's critical role in managing type 2 diabetes. This includes addressing lifestyle changes, daily routines, habits, and goal setting.

• From there, we’ll explore assessment and evaluation tools that help us tailor our interventions.

• We’ll also dive into lifestyle management approaches, including self-care behaviors and health behavior models that support sustainable change.

• I’ll highlight resources available in the U.S. and internationally that can support clinicians and clients.

• And finally, I’ll walk you through a case example that ties together many of the themes we’ll discuss.

We’ll wrap up with a summary and open the floor for questions and answers. By the end of this session, I hope you feel more confident as an occupational therapist working with adults managing type 2 diabetes—and more inspired to support their long-term health and well-being through meaningful, occupation-based interventions.

Difference Between Type 1 and 2 Diabetes

Let’s examine the difference between type 1 and type 2 diabetes.

Type 1 diabetes occurs when the body stops producing insulin altogether. This happens because the immune system mistakenly attacks and destroys the beta cells in the pancreas—the cells responsible for producing insulin. As those beta cells are destroyed, insulin production drops significantly. Without enough insulin, glucose can't enter the cells where it's needed for energy. Instead, it builds up in the bloodstream, leading to high blood sugar levels.

In contrast, type 2 diabetes is a bit different. The body still produces insulin, but the cells don’t respond properly. This is known as insulin resistance—a term I’m sure many of you are already familiar with. Under normal circumstances, the pancreas would ramp up insulin production to compensate. However, in type 2 diabetes, that compensatory mechanism doesn’t function effectively over time.

So while insulin is still being released, the cells are not responding as they should. I often explain it like this: imagine each cell has a lock, and insulin is the key. In type 2 diabetes, those locks are damaged, so even though the key (insulin) is present, it can’t open the door properly. As a result, glucose remains in the bloodstream instead of being used for energy by the cells. This leads to elevated blood sugar levels, which can cause a wide range of complications if not managed appropriately.

Epidemiology of Diabetes

Now, let’s examine the statistics surrounding diabetes, both globally and within the United States.

Globally, the numbers are staggering. Currently, there are approximately 537 million adults diagnosed with diabetes, and over 90% of these individuals are living with type 2 diabetes. That alone is a massive public health issue, but the projected increase is even more concerning. By 2030, that number is expected to rise to 643 million, and by 2045, to 783 million. These are truly staggering figures.

Diabetes is also a leading cause of death worldwide, contributing to 6.7 million deaths each year—that’s roughly one person every five seconds. The financial toll is equally alarming. The global healthcare cost of diabetes has reached at least $966 billion USD, reflecting a 316% increase over the past 15 years.

Bringing the focus to the United States—as of 2024, the Centers for Disease Control and Prevention (CDC) reports that more than 38 million people are living with diabetes, which translates to about 1 in every 10 Americans. Of these, approximately 90% to 95% are diagnosed with type 2 diabetes.

In 2022, the total cost of diabetes and its related complications in the U.S. reached a staggering $413 billion. This includes direct medical expenses and indirect costs such as lost productivity, missed workdays, and reduced earning potential.

Even more concerning is the projection that the number of Americans diagnosed with type 2 diabetes is expected to double by the year 2030. As occupational therapists, these numbers are a call to action—highlighting the urgency of our role in prevention, education, and chronic disease management.

Complications of Type 2 Diabetes Mellitus

Type 2 diabetes, as many of you know, can lead to a wide range of serious complications if not managed effectively. These complications affect multiple body systems and can significantly diminish a person’s quality of life and independence—areas that lie squarely within our scope as occupational therapists.

Among the more common complications is heart disease, which remains one of the leading causes of death for individuals with diabetes. Nerve damage, or diabetic neuropathy, is another critical concern—it can cause pain, tingling, or numbness, particularly in the hands and feet, and may interfere with balance, mobility, and fine motor coordination.

Kidney disease, or diabetic nephropathy, often progresses silently and can ultimately require dialysis or a transplant. Vision issues are also prevalent—diabetic retinopathy can cause vision impairment or blindness if not identified and treated early.

Additional complications include skin conditions such as bacterial or fungal infections, slow wound healing, especially in the lower extremities, and hearing loss, which is frequently under-recognized in this population.

Sleep apnea is a common co-occurring condition, often worsened by obesity and poor glycemic control. And finally, there is mounting evidence linking type 2 diabetes to cognitive decline, with an increased risk for dementia.

These complications underscore the need for early intervention, sustained patient education, and comprehensive lifestyle management. They also reinforce our critical role as occupational therapy practitioners in supporting self-care routines, health literacy, and meaningful daily function.

Type 2 Diabetes Mellitus and Occupational Therapy

As OTPs, we are uniquely equipped to support individuals with diabetes by helping them build habits and routines that promote a healthy lifestyle and improve overall quality of life. We play a key role in sustaining behavioral changes and enhancing diabetes self-management, particularly by making health-related activities more meaningful and integrating them into our clients’ daily lives in realistic, motivating, and sustainable ways.

As you can see in the current slide, the Occupational Therapy Practice Framework—specifically the most recent edition—aligns closely with our role in diabetes care, particularly within the domain of health management. This includes supporting clients and their families in promoting and maintaining social and emotional well-being, effectively managing symptoms and chronic conditions, communicating with healthcare providers, handling medications, engaging in regular physical activity, maintaining proper nutrition, and managing personal care devices such as glucometers or insulin pumps.

We must also recognize the powerful influence of social determinants of health on our clients’ ability to manage their condition. Individuals from socially disadvantaged backgrounds are not only at greater risk of developing type 2 diabetes, but they also face increased challenges in managing it due to life circumstances that are often outside their control. These inequities in diabetes care are deeply tied to poor social determinants of health, including low income, limited education, lack of reliable transportation, restricted healthcare access, and substandard living conditions—all of which contribute to ongoing disparities in health outcomes.

I’ve witnessed this firsthand in my practice in Philadelphia and Aotearoa, New Zealand, where I worked in a primary care clinic. In both settings, our OT team worked closely with social workers, psychologists, health coaches, and community workers to ensure continuity of care beyond the clinic walls. Our shared goal was to bridge the gap between medical recommendations and what was feasible for our clients to implement in their everyday environments—something that is especially crucial when addressing the layered challenges presented by social determinants of health.

Evaluation Tools

Now I’d like to share some of the evaluation tools I’ve personally used in practice. Just to note—there are many other validated documents, forms, and assessments out there, but I’ll highlight several that I’ve found particularly helpful when working with individuals managing type 2 diabetes.

Rapid Estimate of Adult Literacy in Medicine – Short Form

Let’s begin with health literacy. The first tool I often use is the Rapid Estimate of Adult Literacy in Medicine – Short Form. This is a quick, seven-item word recognition test designed to assess a patient’s health literacy. It was validated in diverse research settings and correlates well with the original 66-item full version. The scores range from 0 to 7, with 0 indicating a third-grade reading level or below—suggesting a need for primarily visual or audio-based education materials—while a score of 7 reflects high school-level literacy and the ability to understand most standard patient education materials. Intermediate scores reflect varying challenges in comprehending health-related information.

As with all tools, it’s important to use clinical reasoning. While these instruments are validated, it’s worth acknowledging that many were not designed with marginalized or minority populations in mind. We must always interpret results with an awareness of cultural, social, and linguistic context.

Literacy Assessment for Diabetes (LAD)

The next tool is the Literacy Assessment for Diabetes (LAD), sometimes humorously referred to as the “LADIES” tool. This tool assesses an adult patient’s ability to read common medical and nutritional terms—many of which are specific to diabetes care. The LAD provides valuable insight into whether a client can fully understand the terminology used in education and instructions. The raw score ranges from 0 to 60. Scores from 0 to 20 suggest a reading level of 4th grade or below; 21 to 40 corresponds to a 5th to 9th grade level; and 41 to 60 indicates a reading level of 9th grade or higher.

Newest Vital Sign (NVS)

Another widely used tool is the Newest Vital Sign (NVS), a quick, reliable screening available in both English and Spanish. It typically takes about three minutes to administer. The test is based on interpreting a nutrition label from an ice cream container, which, interestingly, the authors never explained why they chose that example. It consists of six questions, and patients respond based on the information provided on the label. A score of 0 to 1 suggests a high likelihood of limited literacy, 2 to 3 suggests possible limited literacy, and 4 to 6 suggests adequate literacy. I’ve used this tool alongside our standard OT evaluations and frequently collaborated with our dietitians and medical team to ensure a coordinated approach, particularly when addressing nutritional education.

Mini Nutritional Assessment (MNA)

Now, specifically for nutrition, I often use the Mini Nutritional Assessment (MNA), a validated tool that is trademarked and designed for geriatric clients aged 65 and older. It helps identify those who are malnourished or at risk. Originally 18 questions, the revised short form now contains six questions while maintaining its accuracy. Scores of 12–14 suggest normal nutritional status, 8–11 indicate a risk of malnutrition and 0–7 signal malnutrition. This tool is quick to administer and works well in clinical settings.

Four Leaf Survey

A newer tool I’ve used is the Four Leaf Survey. It’s a 12-question instrument that helps individuals assess their current diet based on where it falls on the spectrum from the Standard American Diet (SAD) to a Whole Food Plant-Based Diet (WFPBD). Each question is scored with positive or negative values, ranging from -44 (very poor diet) to +44 (highly plant-based diet). A score in the 30 to 44 range represents a high percentage of whole plant-based calories. I’ve used this tool to support clients who are tracking dietary changes over time. Again, I collaborate closely with dietitians to ensure consistency and clarity in messaging.

Medication Management: MediCOG

Moving into medication management, there are two tools I’d like to mention. First is the MediCOG, which combines the well-known Mini-Cog cognitive screening with a Medication Transfer Screen (MTS). Each section contributes 5 points for a total score out of 10. A score of 8 or higher may suggest adequate capacity to manage medications, depending on the complexity of the regimen.

Medication Management: Medication Management Instrument for Deficiencies in the Elderly

The second tool is the Medication Management Instrument for Deficiencies in the Elderly. This one assesses an individual’s knowledge of their medications, ability to take them correctly, and understanding of how to obtain refills. It includes a section to document the full medication list. In using this tool, I often collaborate with our in-house pharmacist, physician associates, nurse practitioners, and primary care physicians to ensure that medication management is accurate, safe, and sustainable for the client.

Quality of Life and Emotional Distress: Short Form Health Survey (SF-36)

Next is the quality of life and emotional distress section. The Short Form Health Survey (SF-36) is a widely used self-report tool that assesses quality of life across eight domains, including physical limitations, pain, vitality, social roles, and mental health.

Quality of Life and Emotional Distress: Problem Areas in Diabetes (PAID) scale

Another useful tool is the Problem Areas in Diabetes (PAID) scale, a 20-item questionnaire measuring emotional distress associated with diabetes—such as fear, anger, or frustration. Scores range from 0 to 100 (after multiplying by 1.25), with higher scores indicating greater emotional burnout. A score above 40 may signal the need for psychological support, while very low scores, especially in individuals with poor glycemic control, may suggest denial. I’ve shared these results with our broader team, including psychologists and social workers, to coordinate emotional support for clients.

Health Behavior Domain: McGill Empowerment Assessment for Diabetes

One tool I use in the health behavior domain is the McGill Empowerment Assessment for Diabetes, developed at McGill University. It’s a 28-item validated questionnaire designed to assess empowerment related to diabetes, covering areas like attitudes, knowledge, skills, and sense of support. It’s helpful for identifying readiness for change and evaluating intervention effectiveness.

Health Behavior Domain: Readiness Ruler

Another widely recognized tool is the Readiness Ruler, often used in motivational interviewing. This tool helps clients reflect on their readiness to change and builds their confidence in making meaningful life adjustments. It’s especially useful for exploring ambivalence and promoting self-directed goal-setting, which aligns well with the OT approach.

Overview

All of these tools complement the standard OT evaluation process. According to the American College of Lifestyle Medicine, the clinical objective for managing type 2 diabetes should be remission, with appropriately dosed, intensive lifestyle interventions serving as a core element of care. These assessments and strategies are best applied within a collaborative, interdisciplinary model—and I’ve seen firsthand how powerful that collaboration can be. Whether in our rehab center or in our primary care clinic, we worked side by side with dietitians, pharmacists, physicians, and behavioral health providers to support our clients in a truly holistic and meaningful way.

Lifestyle Management and Self-care Behaviors

Now let’s talk about the self-care behaviors that are critical in managing type 2 diabetes. These include:

1. Healthy coping

2. Healthy eating

3. Physical activity

4. Monitoring

5. Medication adherence

6. Problem-solving

7. Risk reduction

Let’s begin with healthy coping. People with diabetes are two to three times more likely to experience depression compared to those without diabetes. They also have a 20% higher chance of developing anxiety. When a client expresses concerns about their mental well-being, it’s essential that we encourage and empower them to reach out to their medical providers. No one needs to navigate this journey alone; support is always available.

In any aspect of diabetes care—and truly, in all healthcare—we must take a team-based approach. Collaboration is vital. I often share examples of both unhealthy and healthy coping strategies. These can be examined on three levels:

• The micro level focuses on individual behaviors

• The meso level involves support from family, peers, and community

• The macro level addresses broader organizational or policy-related support

This framework helps clients recognize that their coping strategies are influenced by more than willpower—they’re shaped by their environment, their social network, and their access to resources.

Regarding healthy eating, research consistently shows that individuals who follow a plant-based or whole-food, plant-based diet are at reduced risk of developing type 2 diabetes. These diets have been shown to independently and collectively enhance insulin sensitivity, lower blood pressure, prevent weight gain, and reduce systemic inflammation. Additionally, plant-based nutrition has been linked to lower mortality rates among individuals with type 2 diabetes.

Here are a few excellent, evidence-based nutrition resources I’ve shared with clients and families:

• Doctors for Nutrition (Australia): Their materials are universally accessible.

• Plant-Based Health Professionals UK: While the organization is UK-based, many of its members practice internationally.

• Physicians Committee for Responsible Medicine (PCRM), based in Washington, D.C.: Their site includes extensive free materials, including recipes, physical activity tips, and more.

• George Washington Medical Faculty Associates also has excellent public resources, including nutrition, movement, and community support guidance.

As a reminder, the evaluation tools I shared are also free and accessible online for clinical use.

Moving on to physical activity—these tips are aligned with recommendations from the American College of Sports Medicine.

• We encourage clients to engage in regular aerobic exercise, which helps regulate glucose.

• High-intensity resistance training is often more beneficial than low to moderate-intensity exercises when done safely.

Let me clarify the intensity levels with a few examples:

• Low intensity: casual walking, stretching, light housework

• Moderate intensity: brisk walking (3–4.5 mph), hiking, yoga

• High intensity: jogging, running, cycling (~10 mph), martial arts

Another helpful strategy is encouraging clients to stay active after meals. Even a 5–10 minute walk—safe and feasible—can help reduce post-meal blood sugar spikes. Sitting immediately after eating can lead to higher glucose levels, so we want to support gentle movement when appropriate.

We must also prevent blood sugar crashes during or after exercise, particularly in insulin clients. Clients may need to lower their insulin dose or consume carbohydrates—ideally from whole-food plant-based sources—before or during exercise.

For clients on beta blockers, common in those with heart conditions, we advise against relying solely on heart rate to monitor exercise intensity. Instead, they should use the Rating of Perceived Exertion (RPE) Scale and ideally consult with an exercise physiologist or physical therapist.

We also discuss optimal workout timing. Exercising 30 minutes to 1 hour after meals can help stabilize blood glucose levels instead of working out on an empty stomach.

The next self-care behavior is monitoring. Clients may monitor blood glucose levels, food intake, and activity through devices like traditional or continuous glucose monitors (CGMs). Based on my experience, most clients still use fingerstick glucose meters, although CGMs are becoming more common due to convenience.

To briefly touch on A1C levels:

• A level of 5.7% to 6.4% is considered prediabetes

• A level of 6.5% or higher indicates diabetes

When clients are taking medications, there are three key points we must communicate to the medical team:

1. If the client reports or we observe any side effects

2. If the client has stopped taking the medication

3. If the medication negatively impacts their quality of life

Medication adherence is critical, and open communication with providers like physicians, PAs, and nurse practitioners helps ensure safety and effectiveness.

Now, let’s talk about problem-solving, which often arises in everyday scenarios. We use a three-step guidance approach:

1. Identify the problem: What needs to change? Is it related to meals, physical activity, travel, illness, or new life stressors?

2. Find a solution: Have life circumstances changed? Are there tools or updated resources available? Is the treatment plan misunderstood?

3. Take action: What solution does the client want to try? Do they need support to implement it?

This collaborative process is most effective when it includes the client’s family or support system.

Finally, let’s talk about risk reduction—an area where occupational therapy can play a huge role. Here are some practices we reinforce with clients:

• Schedule routine medical checkups

• Get screened for sleep apnea and hearing loss

• Follow a nutritious eating plan, ideally developed with a dietitian

• Stay active and reduce sedentary behavior

• Take medications as prescribed

• Track blood glucose regularly

• Avoid smoking and vaping

• Maintain oral hygiene

• Inspect feet daily for signs of damage or infection

• Receive recommended vaccinations (e.g., flu, pneumonia, hepatitis B)

• Talk to a provider about any feelings of sadness or emotional distress

As many of my clients have shared over the years—both in Philadelphia and Aotearoa, New Zealand—managing type 2 diabetes is a journey with ups and downs. It affects not only the individual but also their family and support network. By building trust, collaborating with interdisciplinary teams, and empowering clients through education and meaningful routines, occupational therapy has a powerful role in improving quality of life and long-term outcomes.

Health Behavior Change Model

Overview

Now, I’d like to shift gears and talk about the Health Behavior Change Model—specifically, the one I used frequently in practice: the Transtheoretical Model of Change (TTM). Some of you may also know it as the Stages of Change Model. This model outlines an individual’s readiness to change by describing behavior change as a progression through distinct, dynamic stages. It’s important to remember that these stages are not linear—the process is multidirectional. This slide shows that clients can enter, exit, and re-enter the model at any point based on their circumstances.

Here are the six stages of the model:

1. Precontemplation: The client has no intention of changing their behavior shortly—often because they are unaware that change is needed.

2. Contemplation: The client knows the need for change and is considering action, typically within the next six months.

3. Preparation: The client intends to take action soon—usually within the next one to three months—and may already be taking small steps toward change.

4. Action: The client is actively implementing new behaviors, but the change is still recent and not yet habitual.

5. Maintenance: The client has sustained the behavior change over time—typically six months or longer—and is working to prevent relapse.

6. Termination: In theory, the client has no desire to return to prior negative behaviors. However, in reality, termination is rare. As we know, life challenges—internal and external—can cause clients to cycle through earlier stages again. This is natural and expected in the change process.

Alongside the model, I also used several health behavior approaches to guide and support clients through change.

Other Health Behavior Approaches

First is Motivational Interviewing (MI). This client-centered counseling approach recognizes ambivalence as a natural barrier to behavior change. Rather than confronting resistance, MI works to resolve it by exploring a client’s intrinsic motivations and personal values. The therapist-client relationship is built on collaboration, empathy, and mutual respect. By creating a safe and supportive space, MI helps clients move toward meaningful change at their own pace. I’ve included a resource in the slide deck for those who want to learn more or deepen their MI skills.

Another model I’ve used is Acceptance and Commitment Therapy (ACT). ACT focuses on increasing psychological flexibility, or staying present and acting in ways that align with one’s values—even when faced with difficult thoughts or emotions. ACT is built around six core processes:

• Cognitive defusion: Learning to see thoughts as just thoughts—not facts.

• Acceptance: Allowing room for difficult emotions instead of avoiding them.

• Contact with the present moment: Mindfully engaging with what’s happening now.

• Self-as-context: Viewing oneself from a stable perspective, beyond current thoughts or feelings.

• Values identification: Clarifying what truly matters to the client.

• Committed action: Taking steps in alignment with those values.

As you might have noticed, values are a recurring theme in ACT. We often integrate this into our OT work when we ask, “What’s meaningful to you?”—a question central to both ACT and occupational therapy.

When I worked in a primary care clinic, I often used Focused Acceptance and Commitment Therapy (FACT)—a brief adaptation of ACT. FACT is designed to fit fast-paced clinical environments. It’s transdiagnostic, meaning it can be used across a wide range of conditions. It focuses less on diagnosis and more on helping clients identify what matters most. FACT uses mindfulness, experiential exercises, and values clarification to support meaningful behavior change in a shorter timeframe. It resonated deeply with my OT practice because it centers on what truly matters to clients—their values, goals, and daily life.

I also used Cognitive Behavioral Therapy (CBT) strategies. CBT is a widely used, evidence-based talk therapy that helps individuals manage challenges by identifying and changing unhelpful thought and behavior patterns. It’s based on the principle that thoughts, emotions, physical sensations, and behaviors are interconnected and that negative thinking can create a cycle of distress. CBT helps clients break this cycle by teaching practical strategies to reframe thoughts and take constructive action. Unlike some therapeutic models, CBT is typically focused on present-day challenges rather than past experiences.

Each approach—TTM, MI, ACT, FACT, and CBT—has provided me with useful tools to support clients with type 2 diabetes. They have helped me frame conversations, navigate ambivalence, and build care plans rooted in what truly matters to each person.

I’ve included links and resources in this slide deck for anyone interested in exploring these approaches further or pursuing training and certification.

Community and Educational Resources in the US and Global Contexts

I also want to take a moment to share a few resources—both U.S.-based and international—that you may find helpful in supporting your clients or deepening your knowledge. These organizations offer free handouts, professional development opportunities, certification pathways, and practical guidance for healthcare providers across disciplines. While not specific to occupational therapy, the content is highly applicable to our work in chronic disease management, especially with individuals living with type 2 diabetes.

First is the American Diabetes Association (ADA)—perhaps the most recognized and influential organization in diabetes care worldwide. Their website includes evidence-based guidelines, handouts for patients and families, and clinical updates for practitioners.

Next is the Academy of Nutrition and Dietetics, the primary professional organization for dietitians in the United States. They offer a range of resources on nutrition therapy, meal planning, and chronic condition management that we can easily integrate into our interdisciplinary care plans.

I also want to highlight the Lifestyle Redesign® program developed by the University of Southern California (USC). Originally a module-based framework, USC has since enhanced it into a certification program. It’s rooted in occupational therapy and supports long-term lifestyle change through meaningful activity engagement—something that aligns beautifully with our professional philosophy.

Then we have the American College of Lifestyle Medicine (ACLM), which I’ve referenced throughout this webinar. ACLM promotes intensive lifestyle interventions as a core component of chronic disease care and offers a wealth of continuing education and evidence-based materials.

Finally, I encourage you to explore the World Lifestyle Medicine Organization, the global counterpart to ACLM. They connect providers internationally and offer cross-cultural resources that can be incredibly valuable, especially when working with diverse or underserved populations.

These organizations provide practical tools, downloadable materials, and sometimes free training to help you and your clients navigate diabetes management with more clarity, confidence, and support.

Case Example

Now, I’d like to share a fictional case example with you. While this example is set in a rehab center for today's presentation, it is strongly influenced by my experiences across various clinical settings.

The client was a 35-year-old adult recently diagnosed with type 2 diabetes. I conducted a standard occupational therapy evaluation using our rehab center’s assessment form during our initial OT session. I also incorporated the Readiness Ruler to gain insight into the client’s current mindset regarding behavior change.

When we discussed the client’s readiness to change, they rated themselves as 5 out of 10 regarding the importance of making changes to improve their health and 4 out of 10 in their confidence to do so. During our interview, the client expressed a strong desire to learn about goal setting, improve their health, and increase motivation for self-improvement. They specifically mentioned needing support with healthy eating routines and physical activity.

Following that initial session, we began building a collaborative plan. In terms of nutrition, the client shared a favorite recipe—something that was culturally meaningful and enjoyable to them. I coordinated with the dietitian in our rehab center to modify the recipe to make it more nutritionally balanced while maintaining its taste and cultural significance. We then incorporated the modified recipe into a cooking and eating activity during our OT session. This made the experience both functional and personally meaningful, reinforcing healthy choices through occupation-based practice.

For physical activity, we explored the client’s past exercise history. They shared that they used to follow online aerobic exercise videos but stopped because the sessions—typically around 30 minutes—felt too long and overwhelming. We discussed how to break this down into smaller, more manageable steps.

We started by identifying and practicing a 10-minute video that the client felt comfortable with. I monitored their vital signs during the session to ensure safety. As their comfort and endurance improved, we progressed to 20- and eventually, 30-minute sessions to build a realistic, sustainable routine that the client could carry into their home environment following discharge.

In terms of outcomes, the client reported increased motivation for making health-related changes and greater confidence in managing both their nutrition and physical activity. They were able to develop a structured yet flexible approach to lifestyle modification—one that focused on small, achievable steps rather than trying to overhaul everything at once.

Some of the key strategies that contributed to the success of this intervention included:

• Client-centered goal setting

• Use of the Readiness Ruler to support health behavior change

• Interprofessional collaboration with dietitians and other team members

• Breaking down tasks into manageable steps which helped the client avoid feeling overwhelmed

This case reinforced the power of meaningful, occupation-based interventions and the value of a collaborative, client-driven approach in supporting behavior change and self-management in diabetes care.

Summary

In summary, type 2 diabetes is an escalating global health concern, with its prevalence continuing to rise due to a variety of contributing factors. In the United States, millions face daily challenges that impact their health, routines, and overall quality of life.

As occupational therapy practitioners, we play a vital role in diabetes care. By addressing the everyday routines that shape health behaviors, promoting self-management strategies, and supporting meaningful lifestyle changes, we help our clients build sustainable habits that improve outcomes over time.

Through interprofessional collaboration, we contribute to a more holistic, client-centered approach—one that fosters adherence, encourages healthy behaviors, and helps minimize long-term complications. This comprehensive strategy is evidence-based and deeply rooted in our profession’s core values.

Ultimately, this kind of care enhances the quality of life for individuals with and managing type 2 diabetes.

Before we wrap up, I want to emphasize once again the importance of acknowledging and addressing the social determinants of health. These broader factors—such as income, education, access to healthcare, and living conditions—profoundly influence our clients’ ability to manage their conditions. As practitioners, being mindful of these realities strengthens our advocacy and ensures that our interventions are equitable and meaningful.

Exam Poll

1)What is the primary difference between Type 1 and Type 2 diabetes mellitus?

A. Type 1 diabetes results from insulin resistance, while Type 2 diabetes is caused by autoimmune destruction of beta cells.

B. Type 1 diabetes is an autoimmune condition causing beta cell destruction, while Type 2 diabetes involves insulin resistance and impaired insulin production.   Correct Answer

C. Type 1 diabetes primarily affects older adults, while Type 2 diabetes is exclusive to children.

D. Type 1 diabetes can be prevented through lifestyle changes, whereas Type 2 diabetes cannot be managed with medication.

2)According to the International Diabetes Federation (2022), how many adults worldwide are living with diabetes, with over 90% having Type 2 diabetes?

A. 100 million

B. 250 million

C. 537 million   Correct Answer

D. 1 billion

3)Which of the following is NOT a common complication of Type 2 diabetes mellitus?

A. Dementia

B. Skin conditions

C. Liver cirrhosis   Correct Answer

D. Kidney disease

4)What is the key role of occupational therapy practitioners in diabetes management?

A. Diagnosing diabetes and prescribing medications

B. Helping clients develop health-related habits and routines to support self-management   Correct Answer

C. Replacing the role of dietitians and physical therapists in diabetes care

D. Providing emergency medical treatment for diabetes-related complications

5)Which of the following self-care behaviors is essential for diabetes management and is supported by occupational therapy interventions?

A. Avoiding all carbohydrates completely

B. Relying only on medication without lifestyle changes

C. Skipping meals to lower blood sugar

D. Engaging in regular physical activity   Correct Answer

Questions and Answers

Are there any health literacy screening tools for non-English speaking clients, specifically Spanish-speaking clients?
Yes. One of the tools I shared is the Newest Vital Sign, which has a Spanish version available. I recommend checking that out. Many of the tools I presented were primarily validated for English-speaking populations, but I’m hopeful we’ll see more validated tools for Spanish-speaking clients and their families. A few of the other tools I shared may also have Spanish versions, so it's worth reviewing the links again.

Would you recommend using physical activity guidelines for the younger population with type 2 diabetes?
The American College of Sports Medicine guidelines I shared today are focused on adults and older adults. However, they also offer specific strategies and clinical guidelines for younger populations, including those 18 and older. So yes, appropriate resources are available for youth with type 2 diabetes.

Is vision loss screening helpful for individuals with diabetes and in diabetes management?
Absolutely. Screening for vision loss is very helpful for high-risk individuals with diabetes. While I didn’t share specific tools for vision screening—since I’m not a certified vision therapist—we have an optometrist who visits our clinic monthly. I refer clients to the optometrist, who performs the screening alongside optometry students. It’s a great collaborative approach.

Is home health care still billable when teaching diabetes management from an OT perspective?
Yes, it is. When I worked in a rehab center, I incorporated diabetes management into therapeutic activities, therapeutic exercise, and self-care interventions. As long as I documented the rationale for each intervention and linked it to improving occupational performance or participation, Medicare and Medicaid reimbursed these services. It's essential to frame everything within the OT scope.

How many visits do you typically get with clients for type 2 diabetes? Are more sessions allowed in rehab settings?
I haven’t worked in an acute rehab setting, but I did work in a transitional rehab facility where clients typically stayed for about one to two weeks after hospital discharge before moving to a nursing home or long-term rehab. Based on what my colleagues have shared, clients in rehab settings tend to have more sessions allowed compared to home health or outpatient care.

Are there other health management items we should educate clients about—like foot health or regular eye exams?
Definitely. The American Diabetes Association (ADA) provides excellent resources on managing various aspects of health, including foot care and regular ophthalmology appointments. The American College of Lifestyle Medicine also offers helpful, free resources, though they’re more general and not always specific to type 2 diabetes. I often use these resources with my clients and their families—they’re very practical and accessible.

References

See additional handout.