Question

Strategies for improving diabetes care: A patient-centered communication style that incorporates patient prefer- ences, assesses literacy and numeracy and addresses cultural barriers.

Answer 1

Prevention of diabetes

The diabetes prevention program research group (2002) reported that type 2 diabetes can be prevented with appropriate changes in lifestyle.

Medical management

• The main goal of treatment is to normalize insulin activity and blood glucose level to reduce development of complications
• Intensive therapy must be initiated with caution and must be accomplished by thorough education of patient and family and by responsible behaviour of patient
• Careful screening of patient for capability and responsibility is a key step in initiating intensive therapy
• Therapeutic goal of diabetes management is to achieve normal blood glucose level without hypoglycemia while maintaining a high quality of life

Diabetes management have 5 steps

1. Nutritional therapy
2. Exercise
3. Monitoring
4. Pharmacologic therapy
5. Education

Nutritional therapy

• Consistently following a meal plan is one of the most challenging aspects of diabetes management
• It may be more realistic to restrict calories only moderatly
• For patients who have lost weight incorporating new dietary habit into their lifestyles,diet education,behavioral therapy,group support,and ongoing nutrition counseling are encouraged to maintain weight loss

Exercise

• Exercise is extremely important in diabetes management because of it's effect on lowering blood glucose and reducing cardiovascular risk factors
• Exercise lowers blood glucose levels by increasing uptake of glucose by body muscles and by improving insulin utilization
• In general a slow gradual increase in exercise period is encouraged
• Walking is a safe and beneficial form of exercise that requires no special equipments and can be performed anywhere
• Exercise 3 times each week with no more than 2 consecutive days without exercise

Monitoring glucose level and ketones

• Blood glucose monitoring is a cornerstone of diabetes management and self monotoring of blood glucose level has dramatically altered diabetes care
• It is a method of capillary blood glucose testing in which patient pricks their finger and applies a drop of blood to a test strip that is read by a meter.
• For most patient it is recommended 2-4 times daily

Pharmacologic therapy

It include

• Insulin therapy
• Oral antidiabetic agents(sulfonylureas)
• other pharmacologic therapy(pramlintide)

Education

• Develop a diabetes education plan
• educate patient about basic skill
• Assssing readiness to learn
• educating experienced patients
• educate patient to self administering insulin
• Eduacting patient about selfcare
• Education about continuing and transitional care