Non Pharmacological Diabetes Management

By

Dr. Emad HamedEIDC – Naga-Hammady

Qena –Upper Egypt

Diabetes 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

Foundations of Care

Here we will try to compare with very simple statistics between two settings for Diabetes management..

The first was an ordinary clinic with limited facilities.

The second is UEDA Integrated Diabetes Center with much more facilities and a totally different approach as shown in the following comparison

Comparing Diabetes Care in a Standard Clinic with UEDA Diabetes Integrated Center

Comparing Diabetes Care in a Standard Clinic with UEDA Diabetes Integrated Center

Foundations of Care

Agenda

1. Self-management Education

2. Physical Activity

3. Medical Nutrition Therapy

4. Psychological Issues

5. Smoking Cessation

6. Foot Care Education

7. Immunization

Self-management Education

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.

Self-management Education

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.

Physical Activity

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.

Physical Activity

Medical Nutrition Therapy

Psychological Issues

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

Stress in Diabetics

Stress within the Family

Stress in the work

Other stresses

Stress due to Diabetes

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

Smoking Cessation

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.

Foot Care Education

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.

Immunization

Endorphins

Endorphins

These are often classified to be the happy hormones.

Any form of physical activity leads to the release of these

feel good neurotransmitters. The increase in endorphins

secretion leads to a feeling of euphoria, modulation of

appetite, the release of different sex hormones and an

enhancement of immune response. This helps combat the

negative effects of stress.

Endorphins and exercise

Elevated serum beta-endorphin concentrations induced by exercise have been linked to several psychological and physiological changes, including mood state changes and 'exercise-induced euphoria', altered pain perception, menstrual disturbances in female athletes, and the stress responses of numerous hormones (growth hormone, ACTH, prolactin, catecholamines and cortisol)

Metformin increases insulin sensitivity and plasma beta-endorphin in human subjects.

In conclusion, metformin causes a significant parallel increase in insulin sensitivity and plasma beta-endorphin level in human subjects.

ReferenceOu HY1, Cheng JT, Yu EH, Wu TJ. Metformin increases insulin sensitivity and plasma beta-endorphin in human subjects. Horm Metab Res. 2006 Feb; 38(2):106-11

Exercise

Increase B-Endorphins

MetforminStress

Management

Improve ……..Mood

Insulin ResistanceGlycemic Control

Many Modalities of Diabetes Care are Interconnected (Beta-Endorphins May be one of these Links)

Development of a Therapy“Drug Mesh”

Effectiveness

Safety

Affordability

Exercise

Stress Management

Foot Care Education

SMBG

Smoking Cessation

Diet

Education

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

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