Treating Diabetes Mellitus, a disease with varied acute and chronic complications, unlike any other acute illness, is not just a matter of taking a few pills or injections till the patient becomes symptom free.
Since no cure of the disease is in sight, the patient has to accept a lifetime with the disease, eliminating its symptoms and trying to avoid or reduce its complications with regular treatment, medications, along with changes in lifestyle.
To achieve these difficult goals, a considerable amount of time has to be spent in education so that the patient can actively participate in daily self-care to maintain metabolic control.
Education is not just a part of diabetes treatment; it is the principal treatment, according to World Health Organization (WHO).
“Education is the cornerstone of diabetic therapy and vital to the diabetic in the society,” says a report from the WHO.
Unfortunately, due to their clinical pre-occupation with diagnosis and management of diabetes and its associated disorders, physicians, not only in Saudi Arabia but also in other countries, do not have the luxury of spending adequate time with patients to sufficiently educate them.
The need for more diabetes educators to serve the numbers of people with the disease is the first major challenge in Saudi Arabia. In remote areas, where hiring good quality diabetologist to cover small population is not cost effective, a lot of patients can be reached and handled through a diabetes education facility.
However, the number of certified diabetic educators in these remote areas in Saudi Arabia may be zero. Patients in these areas may have to travel for hours or even days to access specialist services. The sheer number of people with diabetes may overwhelm the resources available for treatment and education.
Since individuals are unique, their educational need will also vary -- with age, stage of the disease, culture and lifestyle of the people. Effective instruction can only be accomplished by a collaborative effort between educators and patients to identify individualized educational needs. Thus it is essential for the educators to get educated before they educate others!
What Are the Main Aims of Diabetes Education?
The key aims of diabetes education are to change behavior of people and promote self-management. The objective for continuing education is meant to increase the participant’s knowledge, skills and flexibility.
Self-management implies that the person with diabetes will understand the impact of factors such as food intake, exercise, stress and medication on blood glucose, and will be able to make appropriate adjustments to maintain glucose levels within a target level. Diabetes education consists of providing tools and the necessary support to patients as they learn to manage their disease.
Motivation
Motivation is what makes people learn what they learn and behave in the way they do. Intrinsic motivation is related to the life and personality of the individual and this is actually more powerful and longer lasting. Extrinsic motivation is constituted by reward, threat or pressure on the individual from outside and this can easily be offered by the diabetic clinic.
Such motivation is short term and hence ultimately less effective than intrinsic motivation and therefore presents a great challenge to the educator. Motivation has several advantages in building:
1. Self-confidence in patients;
2. Independence and flexibility of lifestyle;
3. Ensuring better compliance to treatment; and
4. Facilitating decision-making on the part of the patient.
What Are the Basic Goals of a Diabetes Educator?
1. To develop acceptance of the disease and its associated problems by the patient and his family;
2. To educate the patient about the disease, its cause, its course and possible problems involved;
3. To realize the importance of the diet regulation, regular exercise, treatment with pills or insulin injections, monitoring diabetes control with urine or blood tests, and share greater responsibilities in the day-to-day management of the disease; and
4. To make the patients more and more independent in taking their own decision regarding treatment.
Educating and imparting knowledge to diabetic patients is a complicated process. It depends up on the state of receptivity of the patient, methods of education, means of imparting knowledge, evaluation and follows up techniques, assessment of outcomes of education and continuity and flexibility.
Approaches to Diabetes Education
The most commonly practiced methods are:
* One to one education.
* Group education.
* Inter-group discussions, conferences.
* Visiting nurse, social workers.
* Placards, pictures and paintings.
* Printed literature leaflets, pamphlets, magazines and books.
* Audiotapes, videotapes.
* Camps.
* Public awareness programs.
Evaluation
Evaluation is the process of determining whether certain previously defined objectives have been achieved. It must be an integral part of any education. The outcome of education programs can be assessed firstly, in terms of their impact on the patient’s understanding of diabetes and his or her treatment; secondly, the degree of diabetic control; and thirdly the ability of the program to reduce the morbidity and mortality associated with diabetes by preventing micro-vascular and macro-vascular complications
Self-Management
Self-management means a person can be independent and participate safely in a wide variety of activities while living with diabetes. Participants need to know that behavior changes, based on their understanding of medication, nutrition and monitoring, can lead to increased flexibility and improvement in the metabolic control.
Individuals affected by diabetes must learn self-management skills and make lifestyle changes to effectively manage diabetes and avoid or delay the complications associated with this disorder. For these reasons, education is corner stone of treatment for all people with diabetes.
Effect of Education
Educational programs have been shown to be able to reduce the frequency of acute metabolic complications of diabetes. Early studies showed that the numbers of hospital admission through ketoacidosis were significantly decreased and the risk of severe hypoglycemia has also been reduced by diabetes teaching program.
The effects of education programs on the quality of glycemic control are however more contentious.
Diabetes education has had impressive results in reducing the frequency of certain chronic diabetic complication in high-risks groups, notably foot ulceration and amputations. This remains a major problem in diabetes care worldwide. In the US, for example, approximately 31,000 diabetic people undergo leg amputation each year and they account for 50 percent of all nontraumatic amputations.
High-risk patients can be identified by the presence of neuropathy, peripheral vascular disease, the presence of callus and other abnormalities and foot care education programs can be focused effectively on these individuals. Such programs can reduce the rate of amputations in the short term, by between 45 to 85 percent and can continue to protect against amputation up to ten years.
Education is a continuous process by which patients very much benefit in all aspects including awareness, knowledge, self-care bearing and psychological support regarding the disease; prescribed treatment, care, health and illness behavior. To deal with the great challenge of the global increase in diabetes prevalence, a diabetes education team has to intervene and introduce preventive steps in the community.
Nationwide education programs will make the public health care system more effective in Saudi Arabia and other developing countries. A diabetes educator can provide support by encouraging patients to talk about their concerns or fears about diabetes. He or she can also help the patients learn the things that they can control and offer ways to cope with the things, which cannot be changed.
When the patient is diagnosed for the first time, the diabetes educator can actively teach the self-management skills and help them to live their life with diabetes.
It must be remembered, that merely educating the patient is not sufficient. We may teach, but the patients may not understand and the latter is obviously very important if our program is to succeed. Unfortunately, as we know all know even if they understand, patients may not practice what we teach. The true success of diabetes educators only comes when their patients practice what they have been taught!
(Abdulaziz Al AlSheikh is country manager at LifeScan, a Johnson & Johnson company in Saudi Arabia and a world leader in diabetes care management. He is based in Riyadh.)
