role of diabetes education

Dr. Riyad Banayot, MDDr. Riyad Banayot, MD

The need for diabetes education

Aims of diabetes education are: Change behavior and promote Self-management

A person with diabetes will understand the impact of factors such as food intake, exercise, stress and medication on blood glucose

Make appropriate adjustments to maintain glucose within a target level.

Diabetes education provides tools and support to patients so as to manage their disease.

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Role of the diabetes educator has changed from Expert gives out information to Facilitator helps people to learn what

they need to know and supports them through the changes required to manage their diabetes.

The diabetes educator has a complex role that combines the clinical, educational and psychological components of diabetes care.

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Diabetes educators provide support and counseling through life changes after diagnosis (such as changes in routine with a new school or a new job, in an ongoing education process) .

Diabetes educators can help the individual to develop the positive psychosocial adaptation needed to achieve effective self-management of diabetes.

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Diabetes educators – Who ?

Healthcare professionals, most often nurses, dietitians, pharmacists and social workers.

Physicians, psychologists and physical therapists may also refer to themselves as diabetes educators, if they have a specific interest in diabetes.

Lay people, who have had training in teaching and in diabetes management, can also be diabetes educators.

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Diabetes education – Where ? Can be provided in a number of different

institutions, depending on the needs and resources available in the region. Hospitals Inpatient setting Outpatient services Local diabetes associations Local pharmacies Home care nurses Individual's home Community centers

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Challenges facing educators Vary from country to country, and even

within countries. Rural and urban communities have different

issues Vary among different cultural groups. However; Common core issues are:

Availability of education Perceptions of the disease Cost of diabetes education

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Challenges facing educatorsAvailability of education

Availability of diabetes education The need for more diabetes educators to serve the

numbers of people with the disease is a common challenge. In urban areas up to 30-40% of people can be reached through a diabetes education facility. However, in rural this number may drop to zero. People in rural areas may have to travel for days to access specialist services.

The sheer number of people with diabetes may overwhelm the resources available for treatment and education. Similarly, the demand for normo-glycemia may place impossible expectations on healthcare professionals and patients alike.

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Challenges facing educatorsPerceptions of the disease

Diabetes is not seen as a serious disease Poor appreciation of the seriousness of diabetes

is found amongst healthcare professionals and patients.

Physicians and healthcare providers who tell their patients that "your sugar is a little high, just watch what you eat" or use terms such as “borderline” or “mild diabetes” are demonstrating a lack of awareness of the disease that is passed on to the patients.

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“TIME” called the disease an “epidemic that keeps on raging” “What alarms public health experts the most is the speed at which diabetes has spread”

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Diabetes is not seen as a serious disease This attitude is also apparent in the care provided

where patients are not aggressively managed in order to achieve target blood glucose levels. Delays in starting people with Type 2 diabetes on insulin once oral glucose-lowering agents have failed can have far-reaching implications.

Patient empowerment can also be neglected. People are often not referred to diabetes education until they have a problem, where an earlier referral might have avoided it altogether.

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Diabetes is not seen as a serious disease Psychosocial issues and patient attitudes to the

disease are largely overlooked, but these are important in putting the education received into practice.

Patients and their families may consider Type 2 diabetes to be less serious than other diseases if they receive this impression from their physician.This can add to the inertia of making difficult lifestyle changes, particularly where symptoms of diabetes and its complications are not yet present or significant.

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Challenges facing educatorsCost of education Cost is a major issue in diabetes management.

For the patient, expenditure on pharmaceuticals, insulin, glucose meters and test strips can be substantial, which can hamper optimal self-management. The cost of diabetes education can also be an issue.

For the healthcare provider, a key issue is the lack of trained educators. This can be linked to the lack of resources, ability and/or facilities for training diabetes educators. Funds for hiring a diabetes educator and for setting up an education program have to be sourced.

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Strategies for challenges

Availability Must encourage governments to recognize

diabetes as a serious disease and to develop national strategies for the management of diabetes.

This can be done through partnership with organizations, such as the World Health Organization and the International Diabetes Federation.

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Strategies challengesPerceptions of the disease

Promoting diabetes as a serious disease The need to educate physicians and pharmacists

and other healthcare professionals about diabetes, but more needs to be done by diabetes associations to increase awareness of diabetes and increase membership.

As awareness of “diabetes as a serious disease” increases in the general public, consumers will insist their physicians know more about the disease.

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Strategies for challengesFunding/Cost Another key role for diabetes associations is to

continue to lobby governments on funding issues. Efforts from members of national organizations may prompt education to be part of the national health insurance

The government may have to provide essential supplies, such as test strips, syringes and needles, to people with diabetes at reduced cost.

However, the government and insurance agencies need to be lobbied further to increase funding for diabetes supplies and education.

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Issues addressed in education

One of the major issues in diabetes education is recognition that diabetes is a serious disease in all ages and stages of the disease.

The goal of diabetes education therefore is to assist people to develop the skills and strategies they need to manage diabetes.

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Promoting self-management Glycemic control Insulin use Lifestyle changes

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Methods used to promote self-management Increasing knowledge

People with diabetes need a basic level of information in order to manage their diabetes

Providing skills The most important skill that the diabetes educator

can teach is how to apply this knowledge in their daily lives

Changing attitudes and behavior Diabetes educators should empower people with

diabetes to take charge of their own disease.

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Glycemic control Diabetics should be made aware of the

importance of glucose control in delaying or preventing cardiovascular disease and other complications.

They often given schedules of when screening for complications should take place. They should ask their doctor for tests to be done.

Prevention of complications is a key part of the discussion the educator will have with the individual with diabetes.

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Insulin use Insulin use should be discussed in detail with IDDM patients Individuals should be encouraged to learn to adjust their

own insulin for changes in day to day activity. Improved therapy is recognized by most healthcare

providers in most countries, yet, actual implementation is difficult since rapid acting insulin, insulin pens and pumps for delivery are not available in all regions.

Insulin management for people with Type 2 diabetes is often not discussed as soon as it should be. When a person with Type 2 has done well on oral agents, and is not at target blood glucose levels, the switch to insulin should be made.

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Lifestyle changes Lifestyle issues and negotiating for change are part of the

discussion between the educator and the patient. The educator will help individuals to recognize areas for change and then support them through these changes.

Different concepts and theories are used to determine practice; the most widely accepted theories are: Empowerment, which recognizes the right of the diabetic to be

the primary decision maker in the management of their condition The Trans-theoretical Model of Change that focuses on initiating

an appropriate intervention for the readiness of the individual to make a change

The Health Belief Model, which relates to the belief patterns of the individual.

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Strategies and tools

The new trend in diabetes education is “Pattern management”.

Patients are taught to look for patterns in their lives and adjust their meals, activity and medication to achieve the best blood glucose levels possible.

It is based on blood glucose meter test results.

Patients are encouraged to test, to interpret the results and make adjustments to plans.

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Strategies and tools

Diabetes educators are moving from telling diabetics what to do to a more collaborative model where the individual decides what he or she wants to do.

The educator responds by helping the person with diabetes to discover if the chosen activities allow him or her to maintain target blood glucose levels.

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Summary

Diabetes education is a key component of diabetes management.

The main aims of diabetes education are to enhance knowledge and foster behavior change in order to promote self-management.

The diabetes educator's role is to help people with diabetes learn to manage their disease.

The main challenges for diabetes educators are common to most regions and include the availability of education, disease perceptions and the cost of diabetes education.

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THANK YOU

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role of diabetes education

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