counselling and self monitoring blood glucose increasing patients adherence tembagapura hospital...

7/21/2019 Counselling and Self Monitoring Blood Glucose Increasing Patients Adherence Tembagapura Hospital PresentationCouselling and Self Monitoring Blood Glucose Increasing Patients Adherence

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COUNSELLING AND SELF MONITORINGCOUNSELLING AND SELF MONITORINGBLOOD GLUCOSEBLOOD GLUCOSE

Increasing Patient's AdherenceIncreasing Patient's Adherence

By dr !ans Peter !ere"i#aBy dr !ans Peter !ere"i#a



OB$ECTI%ESOB$ECTI%ES

Understand "hat is 'g&&d' and '&&r' c&(()nicati&n "ith atientsUnderstand "hat is 'g&&d' and '&&r' c&(()nicati&n "ith atients

Rec&gni*e iss)es re#ated t& adherenceRec&gni*e iss)es re#ated t& adherence

Understand and +n&" h&" t& i(r&,e adherenceUnderstand and +n&" h&" t& i(r&,e adherence

Understand the i(&rtance &- Se#- M&nit&ring B#&&d G#)c&seUnderstand the i(&rtance &- Se#- M&nit&ring B#&&d G#)c&se

.SMBG/.SMBG/

0n&" h&" t& )se Ins)#in0n&" h&" t& )se Ins)#in



FIVE PILLARS OF DIABETESFIVE PILLARS OF DIABETESMANAGEMENTMANAGEMENT

MedicinesMedicines

M&nit&ringM&nit&ring

Ed)cati&nEd)cati&n

E1erciseE1ercise

Medica# N)triti&nMedica# N)triti&n

Theray Theray



CULTURAL CHARACTERISTICS OFCULTURAL CHARACTERISTICS OFINDONESIAN DIABETES PATIENTSINDONESIAN DIABETES PATIENTS

Find it hard t& )nderstand that dia2etes is a #&ng #i-e chr&nicFind it hard t& )nderstand that dia2etes is a #&ng #i-e chr&nic

diseasedisease

Thin+ that &nce c&ntr&##ed 2y a regi(en3 this regi(en can Thin+ that &nce c&ntr&##ed 2y a regi(en3 this regi(en can

c&ntr&# dia2etes -&re,erc&ntr&# dia2etes -&re,er

Thin+ that #&ng4ti(e dia2etes (edicati&n can ca)se rena# Thin+ that #&ng4ti(e dia2etes (edicati&n can ca)se rena#

dys-)ncti&ndys-)ncti&n

Psych&#&gica# ins)#in resistancePsych&#&gica# ins)#in resistance

Tendency t& try her2a# (edicine 5rst and ne,er -&##&" ) Tendency t& try her2a# (edicine 5rst and ne,er -&##&" )



OBJECTIVES OF PATIENT EDUCATIONOBJECTIVES OF PATIENT EDUCATION

Ens)re atients' accetanceEns)re atients' accetance

Ens)re atients t& articiate in (anagingEns)re atients t& articiate in (anaging

their diseasetheir disease

Ens)re atients '&2ey' the decisi&ns ta+ing inEns)re atients '&2ey' the decisi&ns ta+ing inc&&erati&n "ith their d&ct&rc&&erati&n "ith their d&ct&r

ACCEPTANCEACCEPTANCE

PARTICIPANCEPARTICIPANCE

AD!ERENCEAD!ERENCE



PATIENTS ACCEPTANCEPATIENTS ACCEPTANCE

Their i##ness is seri&)s Their i##ness is seri&)s

Their c&nditi&n is essentia##y se#-4(anage Their c&nditi&n is essentia##y se#-4(anage

They ha,e &ti&ns They ha,e &ti&ns

They They cancan change their 2eha,i&rchange their 2eha,i&r



GOOD COUNSELLING IN DIABETESGOOD COUNSELLING IN DIABETESMANAGEMENTMANAGEMENT

C&n,incing attit)de t&"ards the atientsC&n,incing attit)de t&"ards the atients

As+ing 6)esti&ns t& the atientAs+ing 6)esti&ns t& the atient

Acti,e #istenerActi,e #istener

In-&r(ati,eIn-&r(ati,e

Res&nsi,eRes&nsi,e

Enc&)rage atient t& sea+ &)tEnc&)rage atient t& sea+ &)t



CON%INCINGCON%INCING

Better PracticeBetter Practice

"Since you are newly diagnosed as"Since you are newly diagnosed as

Diabetes,Diabetes, the latest evidence of thethe latest evidence of the

management management is to begin theseis to begin these

therapy with regular follow up."therapy with regular follow up."

Be prepare for questions: even theBe prepare for questions: even thesilliest question. Dont answer if yousilliest question. Dont answer if you

dont know the latestdont know the latest

evidenceresearch.evidenceresearch.

!ld Practice!ld Practice

" will" will try to starttry to start you on you on

these #edication, and youthese #edication, and you

have to co#e back ne$thave to co#e back ne$t

#onth for follow up."#onth for follow up."



AS0ING 7UESTIONS TO PATIENTSAS0ING 7UESTIONS TO PATIENTS

O#d PracticeO#d Practice

8I- y&) d&n8I- y&) d&n9t start t&9t start t&

c&ntr&# y&)r 2#&&dc&ntr&# y&)r 2#&&d

g#)c&se3 I a( g&ing t&g#)c&se3 I a( g&ing t&

ha,e t& )t y&) &n ins)#inha,e t& )t y&) &n ins)#in

and y&) "i## ha,e t& ta+eand y&) "i## ha,e t& ta+e

sh&ts :&)r dia2etes issh&ts :&)r dia2etes is

n&t getting any 2etter8n&t getting any 2etter8

8:&) ha,e t& start "&r+ing8:&) ha,e t& start "&r+ing

&)t3 eat hea#thy3 and ta+e&)t3 eat hea#thy3 and ta+e

y&) (edicine r&)tine#yy&) (edicine r&)tine#y

Better PracticeBetter Practice

8:&) ha,e 2een "&r+ing t& c&ntr&# y&)r8:&) ha,e 2een "&r+ing t& c&ntr&# y&)r

2#&&d g#)c&se3 2)t &-ten a atient "i## need2#&&d g#)c&se3 2)t &-ten a atient "i## need

s&(e assistance -&r( ins)#in Researchs&(e assistance -&r( ins)#in Researchsh&"s that starting s&(e&ne &n ins)#insh&"s that starting s&(e&ne &n ins)#in

s&&ner than #ater3 assists the( in gettings&&ner than #ater3 assists the( in getting

2etter c&ntr&# ;hat a2&)t ins)#in c&ncerns2etter c&ntr&# ;hat a2&)t ins)#in c&ncerns

y&)<8y&)<8

8!a,e y&) 2een ta+ing y&)r (edicines &n a8!a,e y&) 2een ta+ing y&)r (edicines &n a

reg)#ar 2asis<8reg)#ar 2asis<8

8D& y&) +n&" h&" ()ch ca#&ries y&)r 2&dy8D& y&) +n&" h&" ()ch ca#&ries y&)r 2&dy

need in &ne day<8need in &ne day<8



ACTI%E LISTENERACTI%E LISTENER

Re=ecti&n &- the c&ntentRe=ecti&n &- the c&ntent

Re=ecti&n &- the -ee#ingsRe=ecti&n &- the -ee#ings

S)((ari*ingS)((ari*ing



INFORMATI%EINFORMATI%E

Ans"er a## y&)r atient's 6)esti&ns in aAns"er a## y&)r atient's 6)esti&ns in a

ti(e#y (anner3 d&n't r)sh Ma+e s)re y&)rti(e#y (anner3 d&n't r)sh Ma+e s)re y&)r

atient get a## the in-&r(ati&n they needatient get a## the in-&r(ati&n they need

;hen as+ed a2&)t s&(ething y&) d&nt;hen as+ed a2&)t s&(ething y&) d&nt

+n&"3 r&(ise the( y&) "i## #&&+ it ) and+n&"3 r&(ise the( y&) "i## #&&+ it ) andin-&r( the( &n the ne1t ,isitin-&r( the( &n the ne1t ,isit



ENCOURAGE PATIENTS TO SPEA0 OUTENCOURAGE PATIENTS TO SPEA0 OUT

Ens)re the atients 2ec&(e art &- the treat(entEns)re the atients 2ec&(e art &- the treat(ent

and "i## 'reeat'and "i## 'reeat' verbally verbally t& the (anage(ent &-t& the (anage(ent &-

their dia2etestheir dia2etes

Pe&#e retain>Pe&#e retain>

?@ O- "hat they read?@ O- "hat they read

@ O- "hat they hear@ O- "hat they hear

@ O- "hat they say@ O- "hat they say

@ O- "hat they say and d&@ O- "hat they say and d&



P%&'(&S)P%&'(&S)

%D*'+'(' %D*'+'('- Recognize issues related to Recognize issues related to

adherenceadherence

- Know how to improve Know how to improve

adherenceadherence



Global DAWN study highlighted the key barriersGlobal DAWN study highlighted the key barriers

to insulin initiationto insulin initiation

ore than /01 of patients are very worried about starting on insulin.ore than /01 of patients are very worried about starting on insulin.

ore than /01 of patients believe that starting on nsulin #ean thatore than /01 of patients believe that starting on nsulin #ean that

they have failed to #anage their disease.they have failed to #anage their disease.

!nly 201 believe that nsulin can help the# #anage their disease.!nly 201 believe that nsulin can help the# #anage their disease.

ore than 331 of *P postpone nsuline until it "absolutelyore than 331 of *P postpone nsuline until it "absolutely

essential".essential".

451 of doctors use nsulin as a threat for their patients.451 of doctors use nsulin as a threat for their patients.



!&" t& I(r&,e Patients' Adherence!&" t& I(r&,e Patients' Adherence

A#tering PatientsA#tering PatientsPerceti&nPerceti&n

4 I##ness3 4 Treat(ent3 4 Ins)#inI##ness3 4 Treat(ent3 4 Ins)#inAccetanceAccetance

Training4Ad,anced S+i## Training4Ad,anced S+i##

De,e#&(entDe,e#&(ent

4 Se#- (&nit&ring3 4 E(&"eringSe#- (&nit&ring3 4 E(&"ering

Patients3 4 Identi-ying and O,erc&(ingPatients3 4 Identi-ying and O,erc&(ingBarriersBarriers

Treat(ent F#e1i2i#ity Treat(ent F#e1i2i#ity

4 Prescri2ing Ins)#in Regi(es s)ita2#ePrescri2ing Ins)#in Regi(es s)ita2#e

-&r atients #i-esty#e-&r atients #i-esty#e

4 Particiat&ry decisi&n (a+ing 2yParticiat&ry decisi&n (a+ing 2yatientatient

Beha,i&r ChangeBeha,i&r Change

StrategyStrategyLi-esty#e M&di5cati&n Pr&gra(Li-esty#e M&di5cati&n Pr&gra(

Medicati&n Ed)cati&nMedicati&n Ed)cati&n Dr)gs3 Acti&ns3 Reacti&ns andDr)gs3 Acti&ns3 Reacti&ns andA#g&rith(sA#g&rith(s

Fre6)ent F&##&"4UFre6)ent F&##&"4UFre6)ent %isits and Te1t Re(indersFre6)ent %isits and Te1t Re(inders.SMS/.SMS/

S(&+ing Red)cti&nS(&+ing Red)cti&n

Pr&gra(Pr&gra(

Beha,i&ra# S)&rt and Nic&tineBeha,i&ra# S)&rt and Nic&tine

Re#ace(ent TherayRe#ace(ent Theray



S'67 !(&!+(8 B6!!D 869!S'S'67 !(&!+(8 B6!!D 869!S'



SB8SB8

&o include patient in a #ore pro;active approach&o include patient in a #ore pro;active approachtowards their condition.towards their condition.

Self;#onitoring #eans patient can check their ownSelf;#onitoring #eans patient can check their own

blood glucose with a blood glucose #eter. blood glucose with a blood glucose #eter.



P!&'(&%6 9S' !7 SB8P!&'(&%6 9S' !7 SB8

Diabetes education and understandingDiabetes education and understanding

Behavioural changesBehavioural changes

8lycae#ic assess#ent8lycae#ic assess#ent

!pti#i<ation for therapy !pti#i<ation for therapy



%D% +'!'(D%&!(S %D% +'!'(D%&!(S

&ype = Diabetes ellitus >&=D?&ype = Diabetes ellitus >&=D?

nsulin using &ype 2 D >&2D?nsulin using &ype 2 D >&2D?

(on;insulin using &ype 2 D(on;insulin using &ype 2 D



SMBG inSMBG in

T?DM T?DM

andand

Ins)#in Using TDMIns)#in Using TDM

&he 20=3 %D% advice:&he 20=3 %D% advice:patients on intensive insulinpatients on intensive insulin

therapy is for testing at leasttherapy is for testing at least

before #eals, occasionally after before #eals, occasionally after

eating, at bedti#e, beforeeating, at bedti#e, before

e$ercise or critical tasks such ase$ercise or critical tasks such as

driving, when low blood glucosedriving, when low blood glucoseis suspected, and after treatingis suspected, and after treating

low blood glucose to ensurelow blood glucose to ensure

nor#oglyce#ia has beennor#oglyce#ia has been

reached.reached.



SMBG in N&n4Ins)#in Tye DMSMBG in N&n4Ins)#in Tye DM

8eneral consensus with the ongoing researches:8eneral consensus with the ongoing researches:

not necessary as long as patient reached thenot necessary as long as patient reached the

targeted goals of 78, 2*PP8, *ba=c.targeted goals of 78, 2*PP8, *ba=c.

not cost effective, but will i#prove patient)snot cost effective, but will i#prove patient)sawareness if used as a part ofawareness if used as a part of ongoingongoing diabetesdiabetes

self;#anage#ent education.self;#anage#ent education.



- Dr. Richard Grant, chairman of the ADA Professional Practice- Dr. Richard Grant, chairman of the ADA Professional Practice

ommittee, !"#$ommittee, !"#$

@@'vidence;based guidelines apply to populations of'vidence;based guidelines apply to populations of

patients with diabetes, but we really need to tailor thesepatients with diabetes, but we really need to tailor these

population;level reco##endations to the individual inpopulation;level reco##endations to the individual in

front of us.Afront of us.A

Record theRecord the



Record theRecord the

results!results!



-%ohnny Appleseed -%ohnny Appleseed

@@&ype a quote here.A&ype a quote here.A



(S96((S96(

(&%&!((&%&!(ounsellingounselling



Who?Who?

G#yce(ic g&a#s are n&t (etG#yce(ic g&a#s are n&t (et



ChallengesChallenges

4 Psych&#&gica# ins)#in resistencePsych&#&gica# ins)#in resistence

4 Patient d& n&t )nderstand the need -&r &ti(a#Patient d& n&t )nderstand the need -&r &ti(a#

g#yce(ic c&ntr&#g#yce(ic c&ntr&#

4 Fear &- hy&g#yce(iaFear &- hy&g#yce(ia

4 Ta+es ti(e t& ed)cate3 d&se titrati&n3 c&ncern Ta+es ti(e t& ed)cate3 d&se titrati&n3 c&ncern

-&r atient9s sa-ety-&r atient9s sa-ety



Pa!en"s Bel!e# Pa!en"s Bel!e#

4 Ins)#in (eans I a( a -ai#)reIns)#in (eans I a( a -ai#)re

4 Ins)#in d&es n&t "&r+Ins)#in d&es n&t "&r+

4 Ins)#in ca)ses c&(#icati&ns &r deathIns)#in ca)ses c&(#icati&ns &r death

4 Ins)#in ca)ses "eight gainIns)#in ca)ses "eight gain

4 Ins)#in inecti&ns are ain-)#Ins)#in inecti&ns are ain-)#

4 Ins)#in ca)ses hy&g#yce(iaIns)#in ca)ses hy&g#yce(ia

4 Ins)#in is addicti,eIns)#in is addicti,e

4 Ins)#in is t&& e1ensi,eIns)#in is t&& e1ensi,e

4 Ins)#in (eans that (y #i-e "i## changeIns)#in (eans that (y #i-e "i## change



%ide&%ide&

hoosing nection Sitehoosing nection Site



-%ohnny Appleseed -%ohnny Appleseed

@@&ype a quote here.A&ype a quote here.A



$E%POINTS$E%POINTS

4 G&&d c&(()nicati&n ractice "ith atients "i##G&&d c&(()nicati&n ractice "ith atients "i##

i(r&,e atient9s adherencei(r&,e atient9s adherence

4 Manage(ent &- Dia2etes is c&(rehensi,e3 n&tManage(ent &- Dia2etes is c&(rehensi,e3 n&tdr)gs &n#ydr)gs &n#y

4 SMBG can i(r&,e atient g#yce(ic c&ntr&#SMBG can i(r&,e atient g#yce(ic c&ntr&#

4 Ins)#in initiati&n 2arriers sh&)#dn9Ins)#in initiati&n 2arriers sh&)#dn9t st& )s -r&(t st& )s -r&(

gi,ing a ,ery 2ene5cia# theray -&r atientsgi,ing a ,ery 2ene5cia# theray -&r atients



Than+ :&) Than+ :&)

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