EDUCATION AND DIABETES MELLITUS

Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

_REVIEW_

Education and diabetes mellitus Marina Kosti1, Maria Kanakari2 1.RN Nursing Department A, TEI Athens ,Greece 2.Undergraduate Nurse, Department A, TEI Athens ,Greece 1.

ABSTRACT Background: Diabetes mellitus is a multifactorial disease that requires long-term care since it involves major changes in both physical and psychosocial dimension of each patient. Diabetes education is a critical element of care that improves patient outcomes. Aim: The aim of the present study was to review the literature about the education in Diabetes mellitus management. Method: The method of this study included bibliographic research of the literature from reviews and researches, mainly in the PubMed data base, which referred to education in Diabetes mellitus management. PubMed was searched using the following key search terms: “Diabetes mellitus”, “selfmanagement”, “education” while the research covered the period 1999-2012. Results: According to the literature, education should not be a mere transmission of information, but a dynamic, holistic, planned care based on individual’s needs (patient-centred approach). Furthermore, education promotes self-management and health-related behaviour modification. Moreover, education should be consistent with individual’s learning skills and psychosocial state. Diabetes education should be reinforced after its' completion and enhance

in depth understanding of the significance of check-up and

follow-up. Last but not least effective education requires good communication among diabetic patients and health professionals. Conclusions: The overall goal of diabetes education is to help individuals and their families gain the necessary knowledge, life skills, resources and support needed to achieve optimal health. Key words: Diabetes mellitus, self-management, education. CORRESPONDING AUTHOR

Kosti Marina, Axariou 58, Anthoupoli, Peristeri, Athens Email: [email protected]

INTRODUCTION iabetes mellitus (DM) consists an

D

and mortality. The disease

enormous public health problem

take dimensions of an epidemic is often

globally, associated with high morbidity

called

expected to

"the scourge of modern times."

Education and diabetes mellitus

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HEALTH SCIENCE JOURNAL® Volume 6, Issue 4 (October – December 2012)

Furthermore,

the disease involves a

recognized since ancient times in the 2nd

variety of implications, such as personal,

century BC, when the Greek physician

family, social as well as high cost for the

Aretaeus from Cappadocia described its'

National Health System for each country

symptoms. From that time onwards, the

due to long hospitalization, diagnostic

pathogenesis of diabetes still has not

tests, e.t.c.

1-5

been fully understood and draws a great

Diabetes is a disorder characterized by

deal of attention by the vast majority of

impaired metabolism of carbohydrates,

literature.1-5

proteins and fats due to inadequate or

Almost three decades ago, maintenance

inefficient activity of insulin. Type II

of

diabetes

insulin

therapeutic goal by health professionals,

resistance (reduced sensitivity of cells to

particularly for those suffering from

insulin), a relative insulin deficiency, or

insulin-dependent diabetes. Nowadays,

both. Type II diabetes usually develops

the increase in Diabetics' life expectancy

in adulthood, and most patients are

has

obese. 1-5

complications such as micro and macro

The World Health Organization estimates

vascular

that

macro-angiopathy). Furthermore, over

the

is

characterized

total

number

by

of

diabetics

worldwide will reach 333 million in 2025 from 135 million in 1995.

1-5

Regarding

the

patients'

life

highlighted

was

the

complications

last

decades

much

the

main

issue (micro progress

of and in

outcome of diabetes mellitus treatment

western world Diabetes mellitus is one of

has been within the field of

self

the most common chronic since in 2007,

management

the

it was estimated that there were 246

reports of patients who lived 40-50 years

million people with diabetes compared to

without

194 million in 2003.

1

and

some

care.

severe

Indeed,

complications

This significant

following "treatment ", indicated that

increase is expected to take place both

the key-element to confront the disease

in developing and developed countries

is

and is mainly attributed to the modern

diabetes.1-5

way

of

living

including

the

effective

management

of

sedentary

lifestyle, stress and unhealthy nutritional

Diabetes mellitus and education

dietary habits.1-5

During recent years, the important role

Diabetes

is

not

a

contemporary society but

disease

of

of education regarding Diabetes mellitus

it has been

self management has been demonstrated Page | 655

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Health Science Journal © All rights reserved

www.hsj.gr


by

numerous

Interestingly, education

studies, many

about

globally.

patients

their

seek

therapeutic

through education patients can : a) optimize

metabolic

self-monitoring

of

including

blood

or

glucose,

of this issue. Furthermore, it has been

administration, b) relieve the symptoms

acknowledged that treatment of

of

the

practices,

urine

regimen thus confirming the significance the

dietary

control

disease

or

medicine

handle

disease is more related to lifestyle and

emergencies

less related to the quality of the provided

exacerbations, c)

health care and services.6-10

complications such as micro-and macro-

Therefore, education promoting health-

vascular complications,

related behaviour modification through

more positive attitude to the disease,

knowledge as well as enhancing

and

the

e)

and

with

disease-related

prevent and manage

support

the

d) adopt of a clinician-patient

belief that patients themselves are the

relationship and plan of care including

main manager of their own health has

follow-up.1-5,11,12

come

On the contrary, failure of attending

to

practice.

the

6-10

patients

forefront

However,

prefer

in

of

clinical

the roles making

that

medical

education frequent

is

held

responsible

re-hospitalizations,

for

disease

decisions (i.e., active, collaborative, or

complications and poor life quality. Not

passive roles) appear to be related to the

surprisingly, these

level of participation (active or not) in

follow lifestyle modifications suggested

decision-making about their treatment.

by health care professionals or are

Those who prefer active or collaborative

reluctant

roles have higher odds of participation in

recommended medical guidelines and be

their therapeutic regimen.3 Therefore,

actively engaged in self-managing their

enhancing active patient participation in

diabetes.13

medical decision-making

should be an

Education is a fairly complex process,

integral part of education approach.

which varies among people and the main

However, more attention should be paid

question arising from literature is when

to those with less than high school

is the right time is to start education, for

education because they are at risk of

example immediately after diagnosis or

poorer understanding of

when the patient has overcome the

their required

to

patients do not

comply

with

the

self-care.3

anxiety of the first days. However,

Educated patients can positively affect

education should be delivered as soon as

the outcome of the disease. Indeed,

possible after a newly diagnosed type II


Page | 656


diabetes

mellitus whereas

different

treatment option. It is worth noting that

strategies appear to be necessary for

the design of educational intervention

patients with a longer diabetic duration

requires an overall approach including

to

involvement

achieve

education.

meaningful Diabetes

diabetic

education

in

of

health

professionals,

patients and their families as well as

recently diagnosed diabetic patients has

fulfillment of

more favorable clinical outcomes, as

needs and preferences.14-17

compared to the outcomes of patients

The

with a longer duration of diabetes prior

education should be dynamic and needs

to education.1,2

to reflect current evidence and practice

A patient-centred approach focused on

guidelines.7 The including contents are:

patients' needs, resources, values and

fundamental knowledge about Diabetes,

coping strategies is a prerequisite for

principles about nutrition and physical

starting therapeutic patient education.

activity, prevention of complications and

This approach allows patients to improve

modification

their knowledge and skills not only

Additionally,

concerning their illness but also their

curriculum

treatment. It is a commonly held view

skills

that needs vary

injection

according to

several

patients' expectations,

contents

of

the

of

curriculum

risk

the

contents

include

specific

such

as

of

factors. of

the

the

technical

subcutaneous

insulin,

of

use

(sc) of

demographic and clinical parameters,

glucometer and self-monitoring of blood

such

or

as age,

cultural

socio-economic

background,

status,

personality,

urine

glucose

levels.

Equally

important is the implementation of

severity of disease, complications, prior

daily

experiences, level of understanding of

involving meal planning snack according

instructions, acceptance of the disease,

to the daily requirements and

etc.14-16

administration according to the level of

Another

significant

control

glucose, insulin

glucose. Other important parameter that

setting a realistic goal of

need to be integrated in the contents of

behavior changing. Patients should not

the curriculum is accurate and elaborate

be trapped into unrealistic expectations,

informing about possible complications.

but be fully informed about the real

For example, informing about prevention

dimensions of their condition and decide

and treatment of diabetic foot including

with

early recognition of the diabetic foot,

health

professionals

related

to

to

education is

area

program

a

the

best

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daily

self-care,

proper

footwear,

physician,

disease

management

modification of the way of living and

organization, and other providers plays

adherence

also an important role.

to

the

instructions

of

22-26

healthcare team.1,2,17-21

Whatever

The following

approach is, the cornerstone of its'

education

step while designing an

involves the selection of

success

the is

method

the

use

of

of

simple

teaching methods : lecture, discussion

understandable

language

and

scientific

that

demonstration.

method

The

depends

choice

on

staff

of and

terms

individual’s

education

without

depends

personality

on and

environment availability, and patients

comprehension

characteristics. Information should be

important factors for education success

presented

materials,

are appropriate learning environment

audio-visual media and physical objects.

and duration of sessions. In particular,

The use of media, where the student has

the learning environment should be quiet

the opportunity to see the techniques

for ensuring greater understanding of the

and skills required for an effectively

instructions,

management contributes to a better

attendance distraction. If the program is

learning.

a group one, participants should be

through

written

Additionally,

the

ability.

and

and

Equally

avoidance

of

implementation of these skills under the

maximum ten, while session

educator’s supervision is of significant

should not be long, that is, more than 60

value.1-4

minutes.1-4,16,17

The teaching methods are individual

Educational interventions delivered by a

approach

and

group

single educator, in less than ten months,

education

approach.

the

with more than 12 hours and between 6

individual approach predominates over

and 10 sessions give the best results but

the group for the reason that it is

more research is needed to confirm this.

designed based on individual needs,

In general it can be concluded that

however,

group

group-based education approach results

implying

communication

structured Although

education

approach

with

other

period

in improvements in clinical, lifestyle and

patients experiencing the same problem

psychosocial outcomes.1

seems to be more beneficial in promoting

Assessment

of learning. Communication with other

seems to be the most neglected aspect.

support groups or communication and

In particular, understanding of acquired

coordination of services between patient,

knowledge both in theory and practice


of

education

outcomes

Page | 658


should

be

re-evaluated.

Moreover,

The effectiveness of education is not

expression enables

only assessed by the accuracy of the

the discussion of fears and concerns,

knowledge acquired once in a time but

such as anxiety, anger, despair, guilt.

needs

Furthermore, re-evaluation reveals areas

strength

where

weakens or

encouragement of

gaps

in

knowledge

impede

re-evaluation of

because

education

the

outcomes

knowledge changes over

effective management such as inability of

time. A well-designed program demands

solving acute problems or handling signs

regular reinforcement involving follow-

and symptoms of complications etc.

up

Diabetes patients who

thereafter on

treatment

goals

discuss their

program an

completion systematic

and basis.

management

Regular, and sustained reinforcement

strategies with their physicians tend to

with encouragement may be required for

have better clinical outcomes than those

individuals with type II diabetes for

who do not.1-4

various

It is widely

and

after

reasons.

Specifically,

either

known, that daily life of

patients are not susceptible to learning

diabetic patients is disrupted by the need

on a training period, or initial education

for regular monitoring of blood glucose,

program may be inadequate, or even new

taking medication and balancing the

methods (medical and educational) have

effects

been

of

activity

and

nutrition.

discovered.

Moreover,

patient's

Moreover, patients experience constant

needs change or new needs arise. For all

threat of severe and devastating diabetic

the above reasons, annual attendance of

complications or bothersome symptoms

reinforcement

throughout their lives. Consequently,

review

Diabetes exerts

a major psychological

presentation of new topics, such as

distress on the lives of patients who

diabetes complications, obesity, and dys-

often need psychological support and

lipidemia is crucial.1-4,7

counseling.1-4

Reinforcement of

At the other side of the spectrum,

long-term blood glucose control, as the

comorbid

chronic

(e.g.,

person remains adherent to what has

depression

and

or

been taught, checks the accuracy of

can

pose

acquired knowledge, has access to new

diabetes

self-

data or even facilitates the development

psychosocial significant

illness

chronic

problems

barriers

to

management.7

pain)

of

education

including

self-management

and

a the

education ensures

of new practices and new behavior Page | 659

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www.hsj.gr


patterns. In addition, reinforcement of

It is worth mentioning that

education should be supported by other

delivered

programs or events, such as patients

evaluation

weekend trips, celebrations for diabetics

qualities

families, etc.1-4

personal) more than the actual content

In diabetes self-management education,

and quality of the intervention.

the close involvement of patients and

matter

care

progamme delivered by different persons

givers

is

encouraged.

communication

has

been

Effective shown

to

by

one

of

of

person

person's

(clinical,

fact

education requires

ability

and

pedagogical

the

same

and As a

education

in the same settings might not give the

influence patient decisions about their

same results.1-4

health

behaviors

Well trained and experienced educators

associated with health outcomes. More

who take into account the patient’s

in

with

perspective on health inspire confidence

emotional

to the patients and provide them the

practices

detail,

it

accurate support,

and

provides

patients

information, opportunities

decision-making,

for

shared

agreement

on

the

opportunity to find out the right way to disease management through correcting

nature of their medical problems and the

their

need for follow-up.3

professionals ought to improve their

A multidisciplinary team is responsible

performance through feedback and/or

for

reports

designing

assisting

in

the

curriculum

and

delivery

of

the

mistakes.

on

Finally,

patient

health

progress

in

compliance with protocols.1

education. The ever-changing health care environment nurses,

apart

from

registered

registered

dietitians,

pharmacists,

evolves

other

professionals

such

behaviorist,

exercise

as

Conclusions

and

Taken for granted the enormous impact

health

of diabetes mellitus on each patient is

physician,

understandable

why

this

disease

is

physiologist,

considered as matter of major concern.

ophthalmologist, optometrist, podiatrist,

Education is an investment for both

e.t.c. Expert consensus supports the

patient and health professionals, as well

need

as the key to promote

for

specialized

diabetes

and

educational training beyond academic

and improve

diabetics' quality of life.

preparation for the primary instructors on the diabetes team.

7

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