Table 3 Harm reduction principles applied to diabetes patient-clinician interactions

Humanism

Respect for the dignity of the patient; recognition that patients engage in behaviors for some benefit to themselves

Pragmatism

The expectation that patients will behave perfectly at all times is unrealistic; upstream factors outside of patient control also drives behavior

Individualism

Patients have their own unique needs and capabilities; patients need different treatment plans from one another

Autonomy

Clinicians can guide choices but the decision is ultimately made by the patient

Incrementalism

Positive change happens in changes and often takes years; return to previous behavior is normal

Accountability without termination

Clinicians explain consequences of choices to patients without judgement, patients decide accordingly; clinicians are never punitive