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