Models of Diabetes Care in PHC Models of Diabetes Care in PHC Dr Nabil Sulaiman The University of Sharjah The University Melbourne Brought to you by This Presentation Trends in diabetes Lifestyle inte.
Models of Diabetes Care in PHC Dr Nabil Sulaiman The University of Sharjah The University Melbourne Brought to you by This Presentation Trends in diabetes Lifestyle interventions- evidence Models of interventions in PHC: Diabetes Nurse Educator (DNE) COACH model Chronic Disease Self Brought to you by management Diabetes in UAE High prevalence in the Gulf Countries In the UAE the prevalence is: 24% of adults 40% with diabetes and IGT Diabetes is occurring in younger age Brought to you by Environmental and behavioral changes New dietary habits (what and how we eat), Lack of physical activity, Overweight/ obesity, and Stresses of urbanization and working condition will lead to further rise of CVD and diabetes, and their risk factors Brought to you by Evidence RCT in Finland and the USA have demonstrated that the incidence of diabetes can be reduced by about 57% by modifying: • Physical activity and • Diet (Tuomilehto et al 2001, Knowler et al 2002) Brought to you by Lifestyle Changes However, uptake of such lifestyle changes has been poor Programs developed to enhance the uptake, such as: Diabetes Nurse Educator Coach program Chronic Disease Self- management Others Brought to you by In Primary Health Care In Australia, people with T2D have 80% of their care in General Practice Diabetes requires the GP to practise biomedical, anticipatory and psychosocial care using evidencebased and patient-centred medicine and Patient to engage actively in managing their illness Brought to you by Diabetes Nurse Educator Trained nurse Engage, educate and empower patient to manage diabetes and impact of disease on patient and family Based on trust and partnership between PHC centre- Diabetes nurse educator and patient Patient determines agreed targets Continuity and access Brought to you by Diabetes Coach Program Tested in Melbourne using RCTs for CVD Trained nurse or dietitian to COACH Following diagnosis or after discharge from hospital Education and empowerment Patient determines agreed targets Follow up consultation or phone calls Showed benefit in several outcomes Brought to you by Chronic disease self management Is an effective way in which patients are empowered to become more active and effective in managing their disease Patient engages in “activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes” Brought to you by Lifestyle modification • • • • Diet Exercise Weight loss Smoking cessation If a 1% reduction in HbA1c is achieved, you could expect a reduction in risk of: • • • 21% for any diabetesrelated endpoint 37% for microvascular complications 14% for myocardial infarction However, compliance is poor and most patients will require oral pharmacotherapy within a few years of diagnosis Brought to you by Stratton IM et al BMJ 2000; 321: 405–412 Type diabetes in different populations Lowest rates Highest rates (Rural India) Asian Indian (Fijian Indian) (Rural Kiribati) Micronesian (Urban Kiribati) (Rural Tunisia) Arab (Oman & UAE) (Central Mexico) Hispanic (US Mexican) (Rural China) Chinese (Mauritian Chinese) (Rural W Samoa) (Urban W Samoa) Polynesian (Rural Tanzania) African (US Afr Amer.) (Poland) European (Laurino, Italy) (Rural Fiji) Melanesian (Urban Fiji) 10 15 20 Prevalence of Type diabetes (%) Amos et al 1997 25 Brought to you by Diabetes Australia Facts 2008 T2DM in CALD populations: Prevalence of diabetes Prevalence of risk factors Complications Hospitalisations due to nontreatable diabetes Death rates due to diabetes Brought to you by Diabetes Australia Facts 2008 Prevalence of diabetes is increasing over time Reduces quality of life Preventable via lifestyle modifications Some population groups are at higher risk including CALD Brought to you by Meta-analysis of 11 trials in CALD Improved HbA1c after culturally at 3M Weight Mean Difference -0.3% at 3M and 0.6% at 6M Knowledge scores improved at 3M Healthy life style improvement at No difference in secondary outcomes: lipid levels, qoL, self-efficacy, BP, Hawthorne K, Robles Y, Cannings-John R, Edwards S Culturally appropriate health education for type diabetes in ethnic minority groups Cochrane Database of Systematic Revies 2008 (3) Brought to you by What are the main reasons for not taking any actions to lower your risks? PRE Practices No time to cook own meal Like to eat fast food Too busy to follow a routine POST n % n 35 37.2 18 % p-value 20 0.004* 23 24.5 10 11.1 0.029* 23 24.5 34 37.8 0.053** Brought to you by Time in minutes you spent walking for recreation/exercise in the last week (mean) Exercise PRE n POST n 180 258 pvalue 0.007* Brought to you by Qualitative Study Qualitative focus groups to investigate feasibility and cultural appropriateness, barriers and facilitators of known interventions in Sharjah Brought to you by Aims The target setting is primary health care centers People visiting all primary health care centers/ Hospitals in Sharjah will be targeted Risk factors are: Diabetes Physical activity High cholesterol Unhealthy eating (poor diet) Smoking Brought to you by Interventions Brought to you by Interventions Case-finding/ screening for prediabetes and diabetes in PHC Consultation with doctors, nurses and patients to identify appropriate diabetes intervention Engaging people with diabetes/ pre-diabetes in CDSM programs and the COACH Family study to look at the genetic profile CME for doctors and nurses in EB diabetes management Training nurses to be diabetes nurse educators (DNE) to provide the interventions in PHC centres Brought to you by Brought to you by This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause Brought to you by Our views have increased the mark of the 25,000 Thank you viewers Looking forward for franchise, collaboration, partners Brought to you by Brought to you by Contact ,011-41425180 :-Us ,011-25464531 011-66217387 91-+,91-9818308353 + 9818569476 othermotherindia@gmai l.com www.other-mother.in Saxbee Consultants Details :-www.parveenchadha.com https://cparveen.wix.com/other-mother https://twitter.com/othermotherindi http://www.linkedin.com/profile/view?id=326103341&trk=nav_responsive_tab_profile https://www.facebook.com/pages/Other-Mother-Nursing-Crusade/224235031114989?ref=hl A WORLDWIDE MISSITION JOIN US ... Trends in diabetes Lifestyle interventions- evidence Models of interventions in PHC: ? ?Diabetes Nurse Educator (DNE) COACH model Chronic Disease Self Brought to you by management Diabetes in. .. by Interventions Brought to you by Interventions Case-finding/ screening for prediabetes and diabetes in PHC Consultation with doctors, nurses and patients to identify appropriate diabetes intervention... Engaging people with diabetes/ pre -diabetes in CDSM programs and the COACH Family study to look at the genetic profile CME for doctors and nurses in EB diabetes management Training nurses to be diabetes