education and management of diabetics

Dr. Dalia A. HamdyBPSc, MSc, PhD, RP (ACP), MRSC

[email protected]

II. ESTABLISHING A FOUNDATION FOR DIABETIC PATIENT SCREENING AND EDUCATION

EDUCATION & MANAGEMENT OF DIABETICS

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1. Identify Importance and applications of screening

2. List the self care recommendations for diabetic patients

3. Apply tools for patient management and follow up

4. Employ counselling skills to educate the diabetic patient

Learning Objectives

Education & Management of Diabetics (DH/AY/NK, April 16, 2014)

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Hopkins M., Silver R. Patient Self-Care. 2nd Edition. Canadian Pharmacists Association; 2010. Chapters 27 & 28

Blackburn DF, Mansell K, Arnason T . Therapeutic Choices. 2nd Edition. Canadian Pharmacists Association; 2011. Chapter 31

2013 Canadian Diabetes Association Guidelines.

http://guidelines.diabetes.ca/

References


http://guidelines.diabetes.ca/

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Screening every 3 years is recommended in people over 40 years of age

Annual screening is recommended in people at high risk.

High risk patients CANRISK Who fall in the table below

Individualized Screening & Diagnosis


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High risk patients

• I am 40 years old or older• Diabetes runs in my immediate family (Dad, Mom, Brother, Sister and/or children)• Either or both of my parents are Aboriginal, African, Asian, Hispanic, or South Asian• I have been told I have prediabetes• I am a woman who had gestational diabetes during pregnancy• I am a woman and at least one of my babies weighed 9lbs or more• I have heart disease (history of heart attacks, strokes, TIA (mini-strokes))• I have kidney, nerve or certain eye conditions that are associated with diabetes• I am overweight• I carry my excess weight around my belly• I have high blood pressure• My good cholesterol (HDL) blood level is low• I have high triglycerides• I have any of the following:

• Obstructive Sleep Apnea• Depression• Bipolar disorder• Schizophrenia• HIV infection• Polycystic ovary syndrome• Acanthosis nigricans

• I take certain medications including: • Anti-inflammatory steroids• Antipsychotic medications


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Early identification of prediabetes Prediabetes :

impaired fasting glucose, impaired glucose tolerance an A1C of 6.0% to 6.4%, each of which places individuals at high risk of developing diabetes and its complications

Reducing the risk of developing diabetes


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“This isn’t a diet, it’s your new lifestyle.”

• Life style changes remain the most important intervention to delay the development of diabetes. • Low calorie, low fat, low saturated fat, high fibre diets • moderate intensity exercise for 150 minutes per week

Reducing the risk of developing diabetes



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Statins >40 years, macrovascular and microvascular disease>30 years + >15 years diabetics

ACEIs or ARBs Drugs of choice for treatment of hypertension in diabetics-clinical macrovascular disease- >55 years-microvascular disease- use in women (reliable contraception)

Low dose ASA-macrovascular disease

CV risk reduction for diabetic patients


10Education & Management of Diabetics (DH/AY/NK, April 16, 2014)

Tools suggested by CDA 2013


Autonomy!


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Wear diabetic identification at all times

Achieve healthy lifestyle

BGL at target level

Blood pressure and Cholesterol levels at target levels

Patient Self-Care Recommendations


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Do not smoke

Exercise

Foot Care

Regular checkups doctor, dentist, eye specialist



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Vaccination (Influenza every winter and pneumonia once)

Attend diabetes education sessions




Thank You

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education and management of diabetics

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