Diabetes Education … Educology

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Diabetes Education … Educology
The magic capsule for primary and secondary prevention
W e I g h t
l o s s
H e a l t h y

P o s t e r
d I e t
E x e r c I s e
V I d e o - t a p e
L o w
p r e v a l e n c e
S c r e e n I n g
P r o c u r e
l e s s
L e c t u r e
c o m p l I c a t I o n
Diabetes Education
The magic capsule for primary and secondary prevention
W e I g h t
l o s s
H eIS
a l tAN
h y EPEDEMIC
d I e t
E x e DISEASE
r c I s e
DIABETES
!
S c r e e n I n g
IS IT A PREVENTABLE DISEASE ?
o s t e r
V I d e o - t a p e
WHAT ARE PTHE
WAYS OF PREVENTION
?
P r o c u r e
L e c t u r e
WHICH METHOD TO USE ?
WHERE DO WE GO NOW ?L o w
p r e v a l e n c e
l e s s
c o m p l I c a t I o n
Historical story of diabetes prevention
Ancient Greek scientist
500 B.C.
Polyuria ? :
W e I g h t
l o s s
H e a l t h y
d I e t
E x e r c I s e
• He described a disease characterized by:
• Polyuria.
P o s t e r
V I d e o - t a p e
• Lack of pain.
• Weakness.
• Fluid output greater than fluid intake.
L o w
p r e v a l e n c e
• Treat by:
• Diet containing a minimum amount of food.
• Regulated mode of life.
De Medicina ( English translation).
S c r e e n I n g
P r o c u r e
l e s s
Celsus
L e c t u r e
c o m p l I c a t I o n
Diabetes is preventable disease
The proven methods in prevention of diabetes are:
W e I g h t
l o s s
1.
H e a l t h y
d I e t
E x e r c I s e
S c r e e n I n g
Lifestyle modification.
P o s t e r
2.
Drug use.
3.
Future methods:
V I d e o - t a p e
P r o c u r e
L e c t u r e
Vaccine
Genetic ?
L o w
p r e v a l e n c e
l e s s
c o m p l I c a t I o n
Historical story of diabetes prevention
Two early studies suggested that changes in life style can prevent
l o s s
H e a l t h y d I e t
E x e r c I s e
S c r e e n I n g
diabetes:
W e I g h t
1.
2.
Prevention of type 2 diabetes mellitus by
diet and physical
1991 V I d e o
P o s t e exercise
r
Diabetologia 34,
- t a p e
Effects of diet and exercise in preventing
NIDDM in people with impaired glucose
tolerance: the Da Qing IGT and Diabetes study 1997.
L o w
p r e v a l e n c e
P r o c u r e
L e c t u r e
Diabetes care 20,
l e s s
c o m p l I c a t I o n
Historical story of diabetes prevention
Four recent well designed randomized controlled trails:
1.
W e I g h t
l o s s
2.
Prevention of type 2 diabetes mellitus
by changes in lifestyle among subjects
with impaired
H e a l t hglucose
y d I e tolerance
t
E x2001
e r c I
N Engl J Med 344,
s e
Diabetes prevention research group:
Reduction in the evidence of type 2 diabetes
with lifestyle intervention or Metformin 2002
P o s t e r
V I d e o - t a p
Diabetes prevention
research group:
The diabetes prevention program: baseline
characteristics of the randomized cohort 2000
3.
4.
S c r e e n I n g
Diabetes prevention program:
Design and methods for a clinical trial in
the prevention in type 2 diabetes
L o1999
w p r
N Engl J Med 346,
e
P rDiabetes
o c u r e
care 23,
L e c t u r e
Diabetes care
e v a l e n c e
Prevention of pancreatic  cell function and
prevention of type 2 diabetes by pharmacological
treatment of insulin resistance in high risk
Hispanic women 2002
l e s s
c o m p l I c a t I o n
Diabetes 51, 2002
The Finnish Study 2001
Number
Age (mean)
BMI (mean)
Clinical condition
W e I g h t
l o s s
H e a l t h y
522
55 years
31 kg/m2
IGT
d I e t
E x e r c I s e
Control group:
Received brief diet and
Exercise counseling
Intervention group:
ReceivedP intensive
individualized
o s t e r
V I d e
instruction on weight reduction,
Food intake, and guidance on
increasing physical activity
Duration (mean)
3.2 years
L o w
o - t a p e
p r e v a l e n c e
S c r e e n I n g
P r o c u r e
L e c t u r e
Lifestyle
58%
l e s s
c o m p l I c a t I o n
Diabetes Prevention Program (DPP)
Number
Age (mean)
BMI (mean)
Clinical condition
W e I g h t
l o s s
H e a l t h y
3,234
51 years
34 kg/m2
IGT
d I e t
E x e r c I s e
Lifestyle group:
Intensive nutrition and exercise
counseling
Treatment group:
Two masked
P o s tmedications:
e r
V I d
1.
Biguanide Metformin.
2.
Placebo.
Duration (mean)
2.8 years
L o w
S c r e e n I n g
e o - t a p e
Lifestyle
58%
p r e v a l e n c e
P r o c u r e
L e c t u r e
Metformin
31%
l e s s
c o m p l I c a t I o n
The Troglitazone in Prevention of Diabetes (TRIPOD)
Number
Age (mean)
BMI (mean)
Clinical condition
W e I g h t
l o s s
H e a l t h y
235
Younger
28 kg/m2
GDM
d I e t
E x e r c I s e
Placebo group:
Received Placebo
Tested group:
Received Troglitazone which is
Withdrawn
P o sfrom
t e r the group
V I d
Named Thiazolidinediones class
Duration (mean)
e o - t a p e
P r o c u r e
Troglitazone
L e c t u r e
56%
2.5 years
L o w
S c r e e n I n g
p r e v a l e n c e
l e s s
c o m p l I c a t I o n
STOP-NIDDM trail
Number
Age (mean)
BMI (mean)
Clinical condition
W e I g h t
l o s s
H e a l t h y
1,429
55 years
31 kg/m2
IGT
d I e t
E x e r c I s e
Placebo group:
Received Placebo
Tested group:
Received Acarbose from the group
named -glucosidase
inhibitor
P o s t e r
V I d e o
Duration (mean)
Acarbose
- t a p e
25%
P r o c u r e
L e c t u r e
To
3.3 years
L o w
S c r e e n I n g
p r e v a l e n c e
36%
l e s s
c o m p l I c a t I o n
Lifestyle in prevention of type 2 diabetes
Cumulative probability of remaining free of Diabetes
1
Education pill:
• reduce weight >5%.
• Fat <30% of energy consumption.
• Fiber intake >15gm per 1000kcal.
• Moderate exercise for 30 min/day.
0.9
0.8
Intervention group
0.7
Education dosing:
• Seven sessions with nutritionist in 1st year then
• One session every three months.
• Individual guidance on physical activity.
W e I g h t
l o s s
H e a l t h y
d I e t
Control group
0.6
0.5
E x e r c I s e
0
1
years 4
S c r e 2e n I nStudy
g3
5
6
Self-reported change in dietary and exercise Habits during the first year
Variable
Decrease fat consumption
Increase vegetables consumption
P o s t e r
Intervention group
Control group
Number 253 (%)
Number 247 (%)
87
70
72
V I d e o - t a p e
62
P value
0.001
P r o c u r e
L e c t u r e
0.01
Decrease sugar consumption
55
40
0.001
Increase exercise
36
16
0.001
Success in achieving the goals of the intervention by one year
Variable
Intervention
L o w p r egroup
v a l e n c e
Control group
Number 253 (%)
Number 247 (%)
Weight reduction >5%
43
13
0.001
Fat intake <30%
47
26
0.001
Saturated fat intake <10%
26
11
0.001
Fiber intake 15g/1000 kcal
25
12
0.001
Exercise >4 hr/week
86
71
0.001
l e s s
c o m P
p value
l I c a t I o n
N Engl J Med,, Vol. 344 May 3, 2001
Public education
W e I g h t
The expected relation between:
l o s s the level
H of
e public
a l t h health
y d I eeducation
t
E
and the prevalence of diabetes.
No data available to prove this because:
1.
Public education standardization.
2.
Multi-factorial disease.
P o s t efactor.
r
3.
Ethnic and cultural
4.
Long duration trials.
5.
Life-style modification difficulty.
Involvement level:
Individual.
Family.
Community.
Nation.
Risk factors:
Controllable vs non-controllable
Health Education
x e r c I s e
S c r e e n I n g
125
Level of Education
Degree of disease prevention
100
V I d e o - t a p e
P r o c u r e
L e c t u r e
75
50
L o w
p r e v a l e n c e
25
0
l e s s
c o m p l I c a t I o n
Risk factors for type 2 Diabetes
Which factors…?
Education effect
• Uncontrollable:
W e I g h t
• Age.
• Genetic.
• Ethnicity.
l o s s
H e a l t h
• Associated diseases:
Individual conditions:
y
- Hypertension
- Hyperlipidemia
- Polycystic disease
- Vaculopathy
E
n g
Pre-diabetes conditions:
• Controllable:
P o s
• Weight.
• Exercise.
• Associated disease:
d I e t
• Age  45 years
• Overweight ( BMI 25 kg/m2 )
relative with
x• eFirst
r c Idegree
s e
S cdiabetes
r e e n I
• Habitual physical inactivity
• Ethnic risk
t e r
• IGF or IGT
I d e o - t a p e
c u r
• VHistory
of GDM or big babyP>r 4o kgm
Associated conditions:
e
• Hypertension 140/90 mmHg
• HDL 0.9 mmol/l  triglyceride 2.82 mmol/l
• Polycystic ovary disease (PCOS)
L •oHistory
w p r of
e vvascular
a l e n cdisease
e
l e s s
No
Yes
No
Yes
No
Yes
Yes
L e c t u r e
Yes/No
Yes
Yes
cYes
o m p l
I c a t I o n
Education
21%
A share between doctors and patient
W e I g h t
79%
• Patient share is an important
issue that need special training for
lthe
o s streatingH physician.
e a l t h y d I e t
E x
S c r e e n I n g
Doctor
Patient
Before training
• Patient involvement in education
is only 21% which change to 47%
after training. P o s t e r
• Continuity and patient load was
not tested which will affect the
out-come.
e r c I s e
V I d e o - t a p e
P r o c u r e
53%
47%
L o w
p r e v a l e n c e
l e s s
Doctor
Therapeutic education of Patients Assal, 2000
L e c t u r e
c o m p l I c a t I o n
Patient
After training
Diabetes Education according to the source
•
•
•
•
Physicians are the highest in providing patients with diabetes education but they are the least effective.
The most effective method is the special training classes with >75% effect but not practical.
The role of diabetes educator (nurse) is as effective >75% and more practical.
Others ie; teachers, volunteers…etc need to be evaluated.
W e I g h t
l o s s
H e a l t h y
% Receiving education
d I e t
E x e r c I s e
% Effective education
P o s t e r
V I d e o - t a p e
100
100
75
75
50
50
L o w
25
0
0
Diatition
Nurse
Class
Other
P r o c u r e
p r e v a l e n c e
25
Doctor
S c r e e n I n g
Doctor
l e s s
Diatition
Massachusetts Results from the Behavioral Risk Factor Surveillance System (BRFSS) 1996
Nurse
L e c t u r e
c o m p l I c a t I o n
Class
Other
Education of physicians vs patients:
•
•
•
W e I g h t
l o s s
401 intervention group focused on improving the skills and knowledge of general practitioners (EMC).
413 second intervention group focused on patients education and self management (DS).
105 reference group choosing patients from regular clinics (RG).
H e a l t h y
d I e t
E x e r c I s e
P o s t e r
S c r e e n I n g
V I d e o - t a p Change
e
P r o c(%)
u r e
in HbA1c
0.2
Patient education and self management decrease
HbA1c by 0.51% comparing to the reference group.
0.1
0
Improving GPs skill and knowledge decrease HbA1c by
0.23% comparing to the reference group.
L o w
The patient involvement through education in their
management give extra 0.28% decrease in the mean
HbA1c.
-0.1
DS
EMC
-0.2
p r e -0.3
v a l e n c e
-0.4
-0.5
-0.6
Diabetic Medicine, 20, 846; 2003
L e c t u r e
l e s s
c o m p l I c a t I o n
Model of Public Education
Education program
• Reduce
weight >5%.
W e I g h t l o s s
Knowledge
Risk factors
What to do
H e a l t h y
d I e t
• Fat <30% of energy consumption.
• Fiber intake >15gm per 1000kcal.
P o s t e r
E x e r c I s e
Age distribution
Problem size
Illiteracy rate
Cultural factor
Health system
Health beliefs
V I d e o - t a p e
Weight loss
Healthy diet
Physical activity
P r o c u r e
L e c t u r e
Behavior
• Moderate exercise for 30 min/day.
Eating less
Healthy diet
Exercise plan
L o w
Decrease
costs
S c r e e n I n g
Factors:
p r e v a l e n c e
Decrease
Prevalence
l e s s
c o m p l I c a t I o n
Model of Diabetes Education
Knowledge
Education program
W e I g h
Patients
• Certified educator.
t • lEducation
o s s
H e a l t h y d I e
system.
• Same language.
• Education materials.
• Support group.
• Integrated into lifestyle.
P o shealth
t e r
• Assisted by local
care providers.
Factors:
t
Diabetes general
Diabetes management
Age E x e r c I s e
Sex
Duration of DM
Culture
Education level
Language
Health system
Health beliefs
V I d e o - t a p e
S c r e e n I n g
Good control
P r o c u r e
Behavior
Weight loss
Skill performance
Compliance/Adherence
L o w
Decrease
medical costs
p r e v a l e n c e
Decrease
complications
HbA1c
L e c t u r e
Blood glucose
l e s s
c o m p l I c a t I o n
Pharmacology
Educology
Definition:
Definition:
Material:
Material:
Science of drug effect on human body and its role
in disease treatment.
Using education as a tool for disease prevention
or treatment.
W e I g h t
Large verity of methods.
l o s s
H e a l t h y
d I e t
E x e r c I s e
Active compound.
S c r e e n I n g
Efficacy:
Efficacy:
Action:
Action:
Effective according to the dose.
More effective than drugs.
Long term.
P o s t e r
Short term.
V I d e o - t a p e
Side effect:
Side effect:
Cost:
Cost:
4000 SR annually.*
50 SR annually.*
Less accepted.**
*
**
The National Saudi Diabetes Registry 2004.
Diabetic Medicine Vol 24, 1997.
L e c t u r e
May be.
None.
Acceptance:
P r o c u r e
L o w
p r e v a l e n c e
Acceptance:
More accepted.**
l e s s
c o m p l I c a t I o n
Factors related to each method
Pharmacology
Educology
•
Age at education.
•
Age.
•
Literacy rate.
•
Disease related.
W e I g h t
•
l o s s
H e a l t h y
Culture effect.
d I e t
E x e r c I s e
S c r e e n I n g
•
Indication.
•
Different routes (bioavailability).
•
Easy administration.
•
Can be done by
P oany
s t e body.
r
•
No side effect.
•
Side effect.
•
Accumulative effect.
•
Dose related.
•
Effect loss with time.
•
l e s s
Effect with use only.
V I d e o •
- t a p Prescribe
e
P by
r o cphysician.
u r e
L o w
p r e v a l e n c e
L e c t u r e
c o m p l I c a t I o n
Is Physician Advice (patient education) effective?
Weight loss
Age:
W e I g h t
Sex:
65
45-64
18-44
l o s s
Male
Female
Ethnicity:
White
Black
Hispanic
Other
0.75
0.15
H e a l t h y
0.75
Reference group for age
1.21
0.96
d I e t
E x e r c I s e
Reference group for sex
0.89
P o s t e r
0.95
2.14
2.20
Exercise
V I d e o - t a p e
Reference group for race
1.19
1.30
L o1.14
w p r e v a l e n c e
Effective
Less effective
Diabetes care, Volume 26, Number 3, 602-607; March 2003
Medication
0.88
0.31
Effective
S c r e e n I n g
Non-effective
1.30
P r o c u r e
1.16
0.80
0.88
L e c t u r e
Non-effective
l e s s
Effective
c o m p l I c a t I o n
Physical activity
% Insufficient activity
W e I g h t
•
l o s s
H e a l t h y
d I e t
100
E x e r c I s e
There is no difference between
adults with or without diabetes
in the percentage of insufficient
physical activity
P o s t e r
S c r e e n I n g
75
71
V I d e o - t a p e
P r o c u r e
69
L e c t u r e
50
•
This data indicate that there is a
large space for exercise in both
primary and secondary
L o
prevention.
25
w
p r e v a l e n c e
l e s s
c o m p l I c a t I o n
0
Diabetics
Therapeutic education of Patients Assal, 2000
Non-Diabetics
Education is Knowledge and behavior
% Heard of HA1c
Patient education:
100
97
Have you heard about HbA1c?
- Age group:
W e I g h t
18-30
31-64
>65
75
97%
31%
13%
50
patients
l o- Younger
s s
H e ahave
l t h better
y d I education.
e t
E x e r c I 25
s e
S c r e e n I n31g
- Type of diabetes effect.
- The target group 30-65
13
0
18-30
31-64
>65
Age
Patient behavior:
P o s t e r
V I d e o - t a p e
How many times did you check your feet?
None
1-2 times
3-5 times
> 5 times
15%
31%
17%
37%
P r o c u r e
L e c t u r e
15%
37%
31%
L o w
p r e v a l e n c e
None
17%
1-2 times
l e s s
c o m p l I c a t I o n
3-5 times
> 5 times
Number of times feet were checked in one year
Therapeutic education of Patients Assal, 2000
A Saudi twin families:
W e I g h t
•
•
•
•
l o s s
H e a l t h y
d I e t
E x e r c I s e
Mohamed and his twin Abdullah
are76 years old, both have type 2
diabetes managed
with V I
P o s t ecurrently
r
insulin.
Mohamed has 13 children while
Abdullah has 17 children.
Follow-up started 1989 with
yearly OGTT.
L o w
Mohamed’s family refused
education on prevention but
Abdullah’s family agree.
S c r e e n I n g
15
d e o - t a p e
P r o c u r e
L e c t u r e
10
Mohamed’s family
5
p r e v a l e n c e
l e s s
Abdullah’s family
c o m p l I c a t I o n
0
0
5
10
15
Weight
If you don’t know, you have to learn……
W e I g h t
l o s s
H e a l t h y
d I e t
E x e r c I s e
Diet
S c r e e n I n g
Activity
If you learn, you have to implement……
P o s t e r
V I d e o - t a p e
P r o c u r e
If you implement, you have to do it right ……
If you do it right, it has to
L o be
w p ralways.
e v a l e n c e
l e s s
L e c t u r e
c o m p l I c a t I o n
Eat healthy…
Do exercise…
Watch your weight.
Mass Education

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