By Author
  By Title
  By Keywords

June 2020, Volume 70, Issue 6

Primary Care Diabetes

Creating happiness in the diabetes care clinic

Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Hitesh Punyani  ( Department of Endocrinology, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, india )
Munish Dhawan  ( Department of Paediatrics, Miri Piri Hospital, Shahabad, India )


Happiness is an essential part of human health. The purpose of health care, including diabetes care, is to achieve happiness, or euthymia. Happiness, can also be viewed as a means to achieving good health, as well as a technique to overcome challenges, encourage team work and ensure better adherence to therapy. This opinion piece shares simple ways of achieving happiness in the diabetes care clinic. It lists best practices related to environment communication style, communication content, and inter-consultation contact. If integrated into daily practice, these will help create a happy health care ecosystem, which in turn will enhance patient satisfaction

Keywords: Communition, Euthymia, Euthymic euglycemia, Language, Person centred care.


The Challenge: Suboptimal Care


In spite of great advances in healthcare, especially diabetes care, satisfaction levels with our management are far from optimal. Many persons living with diabetes, and their family members, tend to be unhappy with the services they receive from their diabetes care providers.1,2 Diabetes care professionals, on the other hand, express frustration at lack of self-care by persons with the syndrome.3


The Reason: Understanding Health


One reason for this may be a discrepancy in the understanding of the concept of health. Diabetes professionals tend to view their work in terms of physical or biomedical targets of health. The average person, however, ascribes to the World Health Organization (WHO) definition. WHO reminds us to consider not only physical, but also mental and emotional aspects of health.4


The Solution: Euthymic Euglycaemia


The concept of euthymic euglycaemia calls for the pursuit of euthymia in persons with diabetes.5 Optimization of mood, i.e., euthymia is understood to be a target in itself, a tool to achieve the target of glycaemic control, and a technique employed to facilitate optimal health.6 The sister construct of glycaemic happiness suggests focusing on four pillars or stakeholders: the person living with diabetes, the family member, the physician, and the style of patient-physician communication. Happiness should be viewed, by all those involved, not only as an endpoint of health but as a means to achieve good health.

To ensure euthymia, all these stakeholders and process should be euthymic. In simpler words, this suggests that a health care system which promotes happiness will facilitate the achievement of euthymic euglycaemia. This means that the health care system's structure(environment), operating procedure and process (communication) should promote happiness. This brief communication describes a few ways to create a happy environment within the diabetes care clinic (Table). These practices can easily be extrapolated to other health care settings.


The Environment


A comfortable environment is conducive to a relaxed encounter with the health care system. Physical comfort, or ease, helps facilitate good health as well. This can be ensured by ensuring ambient lighting, temperature and air quality. Personal comfort creates a sense of euthymia in the diabetes care provider, which facilitates euthymic communication. Thus, the environment is an important determinant of ensuring happiness.


Communication Style


Eulexithymia has been proposed as a desirable aspect of language of diabetes care.7 The diabetes care provider's communication style, both verbal and non-verbal, contributes significantly to happiness.8,9 Examples of positive communication styles are listed in Table-1.

A happy diabetes care provider should be able to instill a sense of optimism and dynamism, in the patient. This can be done through a proactive and friendly communication style.


Communication Content


Integrating happiness into routine communication makes it an integral part of practice. Asking the patient about the current level of happiness, and agreeing upon its improvement as a target, creates a framework for further  shared decision making. This discussion creates a feeling of team work between patient and physician, and serves as a tool as well as technique for better clinical care. Happiness can be introduced as a trouble shooting technique (Table). The table describes examples of the ways in which happiness can be used in the diabetes care clinic. In short, a discussion on happiness has a theranostic (both therapeutic and diagnostic) effect on the person seeking care.


The Take Home Message


Attention to happiness in communication, through simple measures, helps kickstart a virtuous cycle which reinforce happiness in the person living with diabetes and the health care provider.




1.      Nicolucci A, Kovacs Burns K, Holt RI, Comaschi M, Hermanns N, Ishii H, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking of diabetes?related psychosocial outcomes for people with diabetes. Diabetic Med. 2013; 30:767-77.

2.      Kovacs Burns K, Nicolucci A, Holt RI, Willaing I, Hermanns N, Kalra S, et al, DAWN2 Study Group. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking indicators for family members living with people with diabetes. Diabetic Med. 2013; 30:778-88.

3.      Holt RI, Nicolucci A, Kovacs Burns K, Escalante M, Forbes A, Hermanns N, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national comparisons on barriers and resources for optimal care-healthcare professional perspective. Diabetic Med. 2013; 30:789-98.

4.      Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948.

5.      Kalra S, Balhara YP, Bathla M. Euthymia in diabetes. European Endocrinology. 2018; 14:18.

6.      Kalra S, Das AK, Baruah MP, Unnikrishnan AG, Dasgupta A, Shah P, et al. Euthymia in Diabetes: Clinical Evidence and Practice-Based Opinion from an International Expert Group. Diabetes Therapy. 2019; 10:791-804.

7.      Kalra S, Balhara YP, Bathla M. Eulexithymia" and diabetes care professionals. US Endocrinology. 2017; 13:55-6.

8.      Kalra S, Punyani H, Dhawan M. The diabetes clinic: Creating an illusion of time. J Pak Med Assoc. 2019; 69: 1395-98.

9.      Kalra S, Kalra B. Communication in diabetes care. J Pak Med Assoc 2018; 67: 1946-48.


Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: