Download Diabetes - Education - Network of Health Related Organisations of

Ya.Enkhjargal
diabetes educator
Diabetes is a complex disorder
 Management of type 2 diabetes needs considerable
expertise in order to:
 match medication to individual ‘phenotype’
 manage complex drug regimens
 provide strong support for
patient education
Diabetes interdisciplinary professional team
Diabetolog
ist
ADF protion the
strategy of providing
Dieticia
n
Educator
diabetes care by
Patient
interdisciplinary
professional team.
Other
specialists
Podiatrist
Pharmaci
st
Diabetes education
 Goal:
 Diabetes educations outcomes improvements in
patient self- managements knowledge attitudes
quality of life.
Considering the patient
perspective
What if my therapy
??
?
I am afraid
of the unknown
I am anxious that my
therapy will cause side
effects
?
I have no symptoms so
how can my condition
be serious?
?
fails?
?
I am afraid
of the unknown
?
I am afraid of needing
I am
afraid of
insulin
needing insulin
?
Some misconceptions about
diabetes
“I don’t need to take my tablets
I don’t feel ill”
“33” ” Only old people get diabetes”
“Complications only occur
in patients wh“Complications only occur
in patients who take insulin”
o take insulin”
Use a patient-centered approach
Healthcare professional
Patient
• Active listening
• Active
• Negotiation
• Expresses views
• Provides
information
(when required)
• In control
INFORMATION
EXCHANGE
• Decision maker
Muhlhauser I, et al. Diabet Med 2000; 17:823–829.
PHILOSOPHY
ATTITUDE
Theory
Educator Behaviour
If people have the right information and skills they
will make the right choices
I need to find out
what is the best way
to get my patients to
understand me
Elaboration
Likelihood Theory
Educator Behaviour
Why is self-care important?
• Not enough healthcare providers for day-
to-day management
• 24-hours-a-day management is necessary
• Better long-term outcomes
Bergenstal 1996
Slides current until 2008
Who should monitor glycemia?
+
Patient
Self-monitoring
of blood glucose
DHealthcare
professionals
Regular monitoring of
HbA1c
What are the priorities in diabetes
management?
Cholesterol?
Weight
=
Glucose?
Blood
pressure?
Glycemic=
control
Lipid
=
lowering
=
ВР
Blood glucose targets
HbA1C
Diabetes patient
<7%
FG
Abter2 h
4-7 mmol/L1
90-130 mg/dl*2
1CDA
5-10 mmol/L1
<180 mg/dl2
2003, 2ADA 2004, 3IDF 2005
Diabetes prevalence
 In 2000
 Prevalence of 3.1% for diabetes and 9.2% for IGT
(J. Suvd et al, Diabet. Med. 19, 502–508 (2002) )
 In 2005
 Prevalence of 8.2% for diabetes and 12.2% for IGT
(Mongolian Steps Survey on the Prevalence of
Noncommunicable Disease Risk Factors, WHO report 2005)
Diabetes SERVICES
 Level 1 - Family clinics –
Family doctor
 Level 2
 Level 3
Province, District HospitalsEndocrinologist and Educator
National Hospitals
Endocrinologist, Educator,
Ophthalmologists, Nephrologists, Neurologist
Activity
 Endocrinologistswere trained from 1996 were
trained
 31 nurses from each province were participated
in training course of diabetes educator in 2005
Actual diabetes problems
in Mongolia
 In Bulgan,
 Arkhangai
 Gobisuber
 Bayankhongor
 Omnugovi hasn’t
got
endocrinologist
Actual diabetes problems
in Mongolia
Diabetes patients 34.3% 2-3 any complication
/l.Tubshinzaya 1997/
Actual diabetes problems
in Mongolia
The quality control study was shown 80% of registrated diabetic
patients (3500 in 2006) were poor control (HBA1c over the 9%)
Kh. Zolzaya/2003/
Actual diabetes problems
in Mongolia
Mortality of diabetes
/Ya.oyunchimeg 2004/
Supplying of medicines and
insulin for diabetes
 1/3 of medicines and insulin required for the
scope of the nation is supplied
 The medicines and insulin are not graned in
Bulgan,Bayan-ulgii,Arkhangai and Covisumber
Hospital description
 SCC hospital
 Endocrinology ward
Diabetes patients in
outpatient clinic of SCCH
Diabetes patients in
endocrinology departments
of SCCH
Diabetes specialist service
in Mongolia
 Diabetes Patient first- endocrinologist then refer to
Educator
 Educator makes an evaluation and provides
consultation.
 There are dietitians in every National Hospital
 Since 2008 District Hospitals are provided dietitians
through a special project.
 Podiatrist - None
Diabetes specialist service
in Mongolia
 Mongolian Health Insurance Law states that diabetes
treatment cost should be subsidized by Government
but in fact only 1/3 of insulin is being provided to
Diabetic patients and it is of a poor quality.
 Patient have to pay the remaining balance.
Availability of Diabetic
Medications and Appliances
 Insulin and medications are supplied from Novo
Nordisk in Russia.
 Lately Oral Anti Diabetic Drugs are supplied from
India, such as Oglo, Glizid MR, Glizid M, Metlong and
these are available in all pharmacies.
 However Diabetic patients pay for their medications
and Blood Glucose Meters/Strips
Diabetes Education
in Mongolia
Diabetes Education
in Mongolia
 Diabetes Education are
available in 11 out of 21
Provinces and in 6
district hospitals and 3
national hospitals in
Ulaanbaatar
 The education is being
conducted by Nurse,
Dietitian and Doctor.
Diabetes Education
in Mongolia
 Group teaching-hospital
based
 Individual Counseling
 WHO and IDF guides
are used when Blood
Glucose monitoring is
taught.
 Patient’s education is
free of charge.
Diabetes support groups
 Mongolian Diabetes Association is formed of
over 200 doctors and patients.
Diabetes Educators Profile
 In 2005 31 nurses have
completed Diabetes
Educator’s training
course supported by
WHO 16 of them are
working now in Level 2
and 3.
Diabetes Educators Profile
 There is no local trainings
of educators available in
Mongolia either none of
the present Educators have
gone to trainings abroad.
Educators are not being
accredited in Mongolia
yet.
Undertaking the following actions in
the future is properly run into
 To continue and make more enriched the ongoing
training on diabetes regarding the diabetes
complication and forming the healthy ritual.
 For the society and collective:
 To form the healthy lifestyle and to organize the
prophylactic activities.
 For the individuals:
 To learn the health education.
Undertaking the following actions
in the future is properly run into
 The diabetes medical service for the diabetes shall be
provided by the qualified team and create the legal
environments.
 To create the work place for the educators, nutritionist,
and Diabetes interdisciplinary professional team.