Ueda 2016 4-non pharmacological diabetes management - emad hamed
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Transcript of Ueda 2016 4-non pharmacological diabetes management - emad hamed
Non Pharmacological Diabetes Management
UEDA Diabetes Mini-Course
Aswan Feb. 2016
Foundations of Care
Agenda
1. Diabetes Self-management Education
2. Medical Nutrition Therapy
3. Physical Activity
4. Smoking Cessation
5. Immunization
6. Psychological Issues
Diabetic Patient Care
Non-Pharmacological
Exercise
Stress Management
Foot Care Education
SMBG
Smoking Cessation
Diet
Pharmacological
Oral Hypoglycemic Drugs
Insulins
Insulin Analogs
Interventional Foot Care
Interventional Cardiology
Etc….
Education
LS11 Encourage increased duration and frequency of physical activity (where needed), up to 30-45 minutes on 3-5 days per week, or an accumulation of 150 minutes per week of moderateintensity aerobic activity
Adults with diabetes should be advised to perform at least 150 min/ week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than 2 consecutive days without exercise. A
Both aerobic and resistance exercise are beneficial for patients with diabetes, and it is optimal to do both types of exercise. At least 150 minutes per week of aerobic exercise, plus at least two sessions per week of resistance exercise, is recommended.
Adults and older people: 150 minutes (two and half hours) each week of moderate- to vigorous-intensity physical activity. Muscle-strengthening activity should also be included twice a week.
Exercise
Stress in Diabetics
Stress within the Family
Stress in the work
Other stresses
Stress due to Diabetes
Explore the social situation, attitudes, beliefs and worriesrelated to diabetes and self-care issues. Assess well-being(including mood and diabetes distress), periodically, by questioning or validated measures
Psychosocial screening and follow up may include, but arenot limited to, attitudes about the illness, expectations formedical management and outcomes, affect/ mood, general and diabetes related quality of life, . E
In both type 1 and 2 diabetes, interventions that target families’ ability to cope with stress or diabetes-related conflict should be included in educational interventions when indicated (Grade B, Level 2)
Stress, whether physical stress or mental stress, has been proven to instigate changes in blood sugar levels, which for people with diabetes can be problematic.*
Stress Management
Reference1. Surwit RS, van Tilburg MAL, Zucker N, McCaskill CM, Parekh P, Feinglos MN, Edwards CL, Williams P, and Lane JD. Stress management improves long-term glycemic control in Type 2
diabetes. Diabetes Care, 2002; 25: 30-34.
Stress Management improves long-term glycemic control in Type 2 diabetes
Effectiveness of foot care education among people with type 2 diabetes in rural areas in India
We found that even 5-6 min of time devoted to individual patient education improved their foot care practice. When consistently reinforced, this education is likely to result in healthy habit formation, which may prevent disability and reduce medical expenditure in the long run.
ReferenceSuman Saurabh, Sonali Sarkar, Kalaiselvi Selvaraj, Sitanshu Sekhar Kar, S. Ganesh Kumar, andGautamRoy. Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India. Indian J Endocrinol Metab. 2014 Jan-Feb; 18(1): 106–110.
Foot care education in patients with diabetes at low risk of complications: a consensus statement
The key educational elements for diabetes patients at low risk of
complications are captured with the mnemonic CARE:
Control: control blood glucose levels (in accordance with recommendations
from your healthcare professional).
Annual: attend your annual foot screening examination with your healthcare
professional.
Report: report any changes in your feet immediately to your healthcare
professional.
Engage: engage in a simple daily foot care routine by washing and drying
between your toes, moisturizing and checking for abnormalities.
Effectiveness of smoking cessation counseling
Smoking cessation is one of the few interventions that
can safely and cost-effectively be recommended for all patients, and it has been identified as a gold standard against which other preventive behaviors should be evaluated. A number of large randomized clinical trials have demonstrated the efficacy and cost-effectiveness of certain forms of provider and behavioral counseling in changing smoking behavior of primary care and
hospitalized patients.
Strategies for improving glycemic control: effective use of glucose monitoring “SMBG”
Self-monitoring of blood glucose (SMBG) is one strategy for improving glycemic control; however, patient adherence is suboptimal and proper education and follow-up are crucial.
Patients need to understand:- why they are being asked to self-test
what their glycemic targets are
what they should do based on the results of self-monitoring
Patients also must be taught proper technique and must be given specific recommendations regarding frequency and timing for self-monitoring.
ED1 Make patient-centered, structured self-managementeducation an integral part of the care of all people with type 2 diabetes.
ED4 Ensure that education is accessible to all people with diabetes, taking account of culture, ethnicity, psychosocial, and disability issues.
People with diabetes should receive diabetes self-management education (DSME) and diabetes self-management support (DSMS)
when their diabetes is diagnosed and as needed thereafter. B
People with diabetes should be offered timely diabetes education that is tailored to enhance self-care practices and behaviors(Grade A, Level 1A).
Managing diabetes can be exceedingly demanding, often requiring you to make lifestyle changes – stopping smoking, changing your diet and physical activity levels, taking medication and monitoring your blood glucose levels.
Education
Development of a Therapy“Drug Mesh”
Effectiveness
Safety
Affordability
Exercise
Stress Management
Foot Care Education
SMBG
Smoking Cessation
Diet
Education
IDF Recommendations
UEDA Diabetes Mini-Course
Aswan Feb. 2016
Education
ED1 Make patient-centered, structured self-management education an integral part of the careof all people with type 2 diabetes:
From around the time of diagnosis.
On an ongoing basis, based on routineassessment of need.
On request.
ED2 Use an appropriately trained multidisciplinary teamto provide education to groups of people withdiabetes, or individually if group work is consideredunsuitable. Where desired, include a familymember or friend.
ED3 Include in education teams a health-careprofessional with specialist training in diabetesand delivery of education for people with diabetes.
ED4 Ensure that education is accessible to all peoplewith diabetes, taking account of culture, ethnicity,psychosocial, and disability issues. Considerdelivering education in the community or at a localdiabetes center, through technology and indifferent languages. Include education about thepotential risk of alternative medicine.
Education
ED5 Use techniques of active learning (engagement in
the process of learning and with content related
to personal experience), adapted to personal
choices and learning styles.
ED6 Use modern communications technologies to
advance the methods of delivery of diabetes
education.
ED7 Provide ongoing self-management support.
Education
Psychological Care
PS1 In communicating with a person with diabetes,
adopt a whole-person approach and respect that
person’s central role in their care. Communicate
non-judgmentally and independently of attitudes
and beliefs.
PS2 Explore the social situation, attitudes, beliefs and
worries related to diabetes and self-care issues.
Assess well-being (including mood and diabetes
distress), periodically.
PS3 Counsel the person with diabetes in the context
of ongoing diabetes education and care.
PS4 Refer to a mental health-care professional with a
knowledge of diabetes when indicated.
Indications may include: severe coping
problems, signs of major depression, anxiety
disorder, personality disorder, addiction and
cognitive decline.
Psychological Care
Lifestyle Management
LS1 Offer lifestyle advice to all people with type 2 diabetes
around the time of diagnosis.
LS2 Review and reinforce lifestyle modification yearly and
at the time of any treatment change or more frequently
as indicated.
LS3 Review and provide ongoing counselling and
assessment yearly as a routine, or more often as
required or requested, and when changes in medication
are made.
LS4 Advise people with type 2 diabetes that lifestyle
modification, by changing patterns of eating and
physical activity, can be effective in controlling many
of the adverse risk factors found in the condition.
LS5 Provide access to a dietitian (nutritionist) or other
health-care professional trained in the principles of
nutrition, at or around the time of diagnosis, offering
an initial consultation with follow-up sessions as
required, individually or in groups.
LS6 Individualize advice on food/meals to match needs,
preferences, and culture.
Lifestyle Management
LS7 Advise on reducing energy intake and control offoods with high amounts of added sugars, fats oralcohol.
LS8 Match the timing of medication (includinginsulin) and meals.
LS9 Provide advice on the use of foods in theprevention and management of hypoglycemiawhere appropriate.
LS10 Introduce physical activity gradually, based onthe individual’s willingness and ability, andsetting individualized and specific goals
Lifestyle Management
LS11 Encourage increased duration and frequency of
physical activity (where needed), up to 30-45 minutes
on 3-5 days per week, or an accumulation of 150
minutes per week of moderate-intensity aerobic activity
(50-70% of maximum heart rate).
LS12 In the absence of contraindications, encourage
resistance training three times per week.
LS13 Provide guidance for adjusting medications (insulin)
and/or adding carbohydrate for physical activity.
Lifestyle Management
In Conclusion
All mentioned
“Non-Pharmacological/Non-Interventional”
modalities of Diabetes Care are
Effective, Safe And Can Be Affordable.
In Conclusion
If we can offer People with Diabetes such care
This is excellent
If we don’t have the time or the “Know How”
We have to develop a system to deliver such care
This is their RIGHT
& Our Mission
Lastly we hope that course will achieve
its goals and help you all in getting the
best of the forthcoming conference
UEDA Board
UEDA Diabetes Mini-Course
Aswan Feb. 2016