Tuesday, May 17, 2011

Educating Patients with Diabetes Mellitus

In diabetes mellitus (especially type 1 diabetes), the patient must spend life rather complicated treatment, right to expect the necessary amount of insulin which is necessary to introduce to balance effect of food (which is evaluated using a system of "bread units), taking into account the level of blood glucose before meal, the effect of physical activity, comorbidities, etc.

In order to successfully manage their own blood glucose levels, the patient must undergo a special training program "Diabetes School". Usually it is held in the form of group sessions, total duration of at least 20-25 hours of study in type 1 diabetes and at least 15-20 hours of type 2 diabetes.

Such training has been called a structured and fundamentally different from simple conversations with patients (or read them lectures) for those or other topics related to diabetes. For structured learning characteristically follow a specially prepared program, divided into topics and learning steps within these themes. Teaching the next block of the material begins only after the group had learned the previous one. The level of knowledge of patients is monitored by means of questionnaire at the beginning and end of the course. Sufficient attention should be given the practical activity of patients: problem solving ("how to act in a particular case"), development of skills of self-control blood glucose, insulin injection techniques, etc.).

Not every endocrinologist (capable of competently treat patients with diabetes) is capable of without the proper training to conduct group training. In this regard, there are special methods of preparation "educator" (which may include doctors (mostly in Russia) or nurses (often overseas)).

When type 2 diabetes, such training is no less important than in type 1 diabetes. Courses for patients with type 2 diabetes not receiving insulin and receiving, are distinct. Education in these categories should always be carried out separately. For patients without insulin emphasis is on nutrition, weight loss. The program also includes a self-blood glucose, proper docking of hypoglycaemia, prevention of complications of diabetes. The result of well-conducted study is to reduce weight, the actual inclusion of glucose-lowering effect of dieting, which reduces the dosage of OSSP. It is shown that the frequency of self-control is correlated with the quality of diabet.

When type 2 diabetes on insulin therapy, in addition to the above, training is needed to the rules of insulin, as well as the fact that the carbohydrate content in foods should be distinguished from the caloric content. The degree of self-correction of insulin varies depending on the abilities and motivation of the patient: the increase / decrease the dose of ICDs for 2-4 units with a high / low blood sugar before eating (this patient is recommended to maintain approximately the same carbohydrate content in meals each day) to intensive diabetes management c calculated required dose of insulin before a meal on the "bread units" as in type 1 diabetes.

The problem, which often takes place in Russia lies in the fact that education in the School of diabetes, "runs the majority of patients, but very often it is formal in nature, conducted in violation of principles of group patient education. As a result, many patients retain the state of decompensation of diabetes and can not really control your blood sugar in spite of the training.

The most frequent errors in training:

Combining the classroom in patients with type 2 diabetes receiving and not receiving insulin (and even more so - with type 1 and type 2) Education in too large groups (more than 8-10 patients), which makes it impossible to work individually with each of them, control the assimilation of material and adjust therapy during the course.

Continuous reading of a series of lectures at the hospital in which hospitalized patients begin studying from 1 st class, but with what is currently Insufficient duration of the course. Lack of proper training and certification of "educator" (eg, conducting classes alternately all doctors belonging to the staff offices).

Lack of interactive learning and its integration with the treatment process. Complete the School of diabetes - is not just a series of lectures (and even more so - not videokurs demonstrated by patients), but detailed answers to questions from the audience, evaluation and self-correction therapy for each participant group. This provides not only the transfer of educational material, but also the creation of the listeners of motivation to adopt the new behaviors required for successful management of diabetes.

In the "Patients" were surveyed site visitors on how quality education they occurred.

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