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Self-care initiatives for improved diabetes management

Self-care initiatives for improved diabetes management

Mnagement S, Walker NS, Viabetes DH, Website performance optimization tools al. Caloric balance Access Journal of Clinical Caloric balance. International Diabetes Federation. In many communities, pharmacists are among the most accessible health care professionals. A number of reviews have attempted to determine which QI interventions have the best evidence for improved outcomes 12,18, The needs of diabetic patients are not only limited to adequate glycemic control but also correspond with preventing complications; disability limitation and rehabilitation. pdf [cited ].

Self-care initiatives for improved diabetes management -

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Skip to content. The Role of Self-Care in Diabetes Management. But what exactly is self-care in diabetes management, and why is it important?

What is Self-Care? Diabetes Self-Management Education DSME First, you need to be trained on how to manage your type of diabetes best. Some key topics covered in DSME programs include: Understanding the different types of diabetes and their effects on the body The importance of regular blood glucose monitoring and interpreting the results Developing a personalised meal plan based on individual needs and preferences The benefits of regular physical activity and how to incorporate it into daily routines Recognizing and managing the signs and symptoms of high and low blood sugar levels Identifying and managing stress and other emotional issues related to diabetes Proper use of medications and insulin therapy, if applicable These programs often include individualised assessments, goal setting, problem-solving, and ongoing support from qualified professionals.

Gaining a Better Overview of Blood Sugar Levels Over Time Managing blood sugar levels is a crucial aspect of diabetes self-care. Physical Self-Care Physical self-care is essential for maintaining good health and managing diabetes effectively. Regular physical activity has numerous benefits for people with diabetes, including: Improved insulin sensitivity, which helps the body use insulin more effectively Lower blood sugar levels and better overall blood sugar control Increased energy and reduced fatigue Weight management, which reduces the risk of diabetes-related complications Lower blood pressure and cholesterol levels, reducing the risk of heart disease Experts recommend 3 at least minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity exercise per week, along with muscle-strengthening activities on two or more days per week.

Mental Self-Care Mental self-care involves taking care of your mental and emotional health. Some effective mental self-care strategies for people with diabetes include: Practicing mindfulness e. Yoga, Journaling, Breathing Methods, Meditation etc. to increase awareness and reduce stress Seeking professional help, such as counselling or therapy, to address emotional challenges related to diabetes Engaging in hobbies and activities that bring you joy and relaxation Building a solid support network of your family, friends, and fellow people with diabetes Prioritizing sleep and maintaining a consistent sleep schedule to promote mental and emotional well-being These practices will help you manage the emotional and mental toll of living with the condition and improve your quality of life.

Enriched Information for Your Healthcare Team Your healthcare team plays a critical role in your diabetes management, but they can only help you as much as the information you provide them.

Conclusion Strive to build self-care practices and do them on a daily basis as they help you manage your condition more effectively and improve your quality of life. Sources: Bonoto BC, de Araújo VE, Godói IP, de Lemos LL, Godman B, Bennie M, Diniz LM, Junior AA.

Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth. doi: PMID: ; PMCID: PMC El-Gayar O, Timsina P, Nawar N, Eid W.

Mobile applications for diabetes self-management: status and potential. J Diabetes Sci Technol. Lin EH, Von Korff M, Alonso J, Angermeyer MC, Anthony J, Bromet E, Bruffaerts R, Gasquet I, de Girolamo G, Gureje O, Haro JM, Karam E, Lara C, Lee S, Levinson D, Ormel JH, Posada-Villa J, Scott K, Watanabe M, Williams D.

Mental disorders among persons with diabetes—results from the World Mental Health Surveys. J Psychosom Res. Epub Oct Bădescu SV, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean AM, Zăgrean L.

The association between Diabetes mellitus and Depression. J Med Life. Tags: blood sugar diabetes diabetes management exercise important stress. Share This Article. Share on Facebook Share on Facebook Tweet Share on Twitter Pin it Share on Pinterest Share on LinkedIn Share on LinkedIn.

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Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The use of simple decision support tools, such as clinical flow sheets, has been associated with improved adherence to clinical practice guidelines Clinical outcomes improve with CDSS when combined with both feedback and case management; for example, insulin adjustment algorithms for people with type 2 diabetes 18,70, Audits and feedback lead to improvements in professional practice This is particularly effective when combined with benchmarking Clinical information systems CIS that allow for a population-based approach to diabetes assessment and management, such as electronic health medical records EMRs and electronic patient registries, have been shown to have a positive impact on evidence-based diabetes care 17,29,74— Practice-level clinical registries give an overview of an entire practice, which may assist in the delivery and monitoring of patient care.

In addition to providing clinical information at the time of a patient encounter, CIS can also help promote timely management and reduce the tendency toward clinical inertia Provincial and national registries are also essential for benchmarking, tracking diabetes trends, determining the effect of QI programs and resource planning.

A large study based on observational data support the premise that federal policies in the United States encouraging the meaningful use of EMRs, may improve the quality of diabetes care, with sites using EMRs achieving better outcomes than those that were paper-based Another study showed that, among people with diabetes, the use of an outpatient EMR was associated with a reduction of emergency visits and hospitalizations Physician and patient reminders, which generally require a CIS, have also shown benefit 17, Patient reminders can include interventions that facilitate scheduling, attendance or availability to provider of patient information integral to the visit e.

self-monitoring of blood glucose [SMBG]. In a systematic review, interventions of benefit were, for scheduling: phone calls, letters, text and patient portal; for attendance: letter, phone calls, SMS, email reminders, and financial incentives; and for visit information: web-based programs case management , phone calls, SMS, mail reminders, decision support systems linked to guidelines, and registries integrated with EMR and health records Facilitated relay of information to clinicians, which has been shown to improve care, may include electronic or web-based methods through which people with diabetes provide self-care data for the clinician to review.

Generally, it is the person with diabetes who is facilitating the relay. Ideally, this should occur in case management with a team member who has prescribing or ordering authority 17, Environmental factors, such as food and housing security, the ability to lead an active lifestyle, as well as access to care and social supports, also impact diabetes outcomes.

Community partnerships should be considered as a means of obtaining better care for people with diabetes. For example, in addition to the diabetes health-care team, peer- or lay leader-led self-management groups have been shown to be beneficial in persons with type 2 diabetes 83, Support for diabetes care at the level of the health-care system, such as the national and provincial systems, is essential.

A number of provinces have adopted an expanded CCM 85 that includes health promotion and disease prevention Many provinces and health regions also have developed diabetes strategies, diabetes service frameworks and support diabetes collaboratives.

Some trials on diabetes-specific collaboratives have been shown to improve clinical outcomes 26,66, Provider incentives represent another area of health system support. Some provinces have added incentive billing codes for the care of people with diabetes so that health-care providers can be financially compensated for the use of evidence-based flow sheets as well as time spent collaborating with the person with diabetes for disease planning Pay-for-performance programs, which encourage the achievement of goals through reimbursement, are more commonly used outside of Canada.

To date, these programs have had mixed results 89— A recent review of systematic reviews of QI strategies stated that they were unable to find any high-quality systematic reviews on financial incentives and the quality of diabetes care Various payment systems have been studied, but it is still unclear which of these improve diabetes outcomes 92, Incentives to physicians to enroll people with diabetes and provide care within a nationwide disease management program appear to improve quality of care 27 , as does infrastructure incentive payments that encourage the CCM A meta-analysis that included physician incentives as a QI has shown mixed results for improved outcomes.

Capitation payments and the addition of team-based care has shown moderate improvements in processes related to diabetes care 94 ; however, pay-for-performance programs introduced in the United Kingdom had limited effect on outcomes 17, Many studies of QI have used multiple strategies Those that intervened on the entire system of chronic disease management produced the greatest effect e.

case management, team changes, registries, facilitated relay, continuous QI and were not dependent on starting A1C. A number of reviews have attempted to determine which QI interventions have the best evidence for improved outcomes 12,18, Systematic reviews suggest that multifaceted interventions, using a variety of clinicians in a structured way with organizational support, yield the best results 12,18, Educational interventions to physicians alone did not yield any positive results but, when delivered as interactive education with simulated participants and feedback, decreased A1C One review showed mixed results for pharmacists, with improvement in A1C seen when the pharmacist intervention was multicomponent, including: counselling, patient education, telephone coaching, management and regular reviews to support SMBG, adherence support and reminders of checks for diabetes complications Structured care typically includes multiple QI interventions.

For example, the Diabetes Care in General Practice DCGP study, with 19 years of follow up, was a multicentre, cluster-randomized 6-year trial using a multitude of QI with SMS in the form of goal setting, clinical information with registries and regular follow up, decision support in the use of guidelines, delivery system design with the use of interprofessional teams with feedback and medical education, and showed a decrease in all diabetes-related endpoints, fatal and nonfatal MIs The Diabetes Shared Care Program was a retrospective cohort study of , people with diabetes randomly assigned to an integrated model of care that used multicomponent QIs vs.

usual care and demonstrated a lower risk of CV events, stroke and all-cause mortality in the intervention group Telehealth also called telemedicine or telecare is the provision of health care remotely by means of a variety of telecommunication tools, including telephones, smartphones and mobile wireless devices, with or without a video connection Although not a specific component of the CCM, telehealth technologies may help facilitate many of the QI strategies In case management, the frequency of contact has been shown to be important and telehealth may facilitate this This may be particularly beneficial in rural settings with limited access 19, A mixed systematic review that looked at quantitative as well as qualitative studies in telehealth showed that telehealth technologies in type 2 diabetes produce a variety of outcomes, including improved health status, such as reduced A1C, increased quality of care guideline adherence , decreased health service use cost and increased patient satisfaction and knowledge.

This review defined the multiple telehealth technologies from simple interventions e. telemonitoring to more complex 97 Table 2. No single technology appears to be superior, but tailoring of the technology for the patient and implementation, as well as user interface, appears to improve adoption and outcomes 96, Another systematic review of information technology found that telehealth in both type 1 and type 2 diabetes populations is a more effective intervention in reducing A1C compared with other information technology strategies Two other systematic reviews and meta-analysis of randomized controlled trials involving both type 1 and type 2 showed meaningful reduction in A1C , In general, A1C improvement is most likely to occur when telehealth systems allow for medication adjustment Another review found the effect on A1C to be greater in type 2 and argued that this was because the average age was higher and benefited from increased frequency of remote monitoring , It made no difference if the intervention had been done by the nurse or physician There was a trend of a decreasing effect in glycemic control over time, suggesting that contact with the person with diabetes may need to intensify to minimize a trend of decreasing intervention impact over time.

Social networking services SNS which allow the user to set up an online profile and interact with a defined list of other users, thereby engaging with an online community, has been shown in a meta-analysis of randomized controlled trials to improve glycemic control SNS has not typically been included in telehealth, but these studies present a novel way of using SNS to include direct access to a health-care professional and real-time feedback.

This review found SNS more effective when compared to usual care in improving systolic and diastolic BP, triglycerides TG and total cholesterol and, particularly in type 2 diabetes, reducing A1C. This may be because SNS is better suited to target modifiable lifestyle risk factors, which are more associated with type 2 diabetes.

Systematic reviews have found that telehealth is 1 of 3 QI strategies with consistent evidence for improvement in glycemia and CV risk factors in people with diabetes In addition to telemonitoring of health data, such as glucose readings or BP and disease management, telehealth technologies may be used for conferencing or education of team members and teleconsultation with specialists.

Benefits are noted regardless of whether the teleconsultation is asynchronous or synchronous , Improve glycemic and CV risk factor control in type 1 and type 2 diabetes [Grade A, Level 1 ,, ].

A1C, glycated hemoglobin; BMI , body mass index; BP , blood pressure; CCM , chronic care model; CV , cardiovascular disease; LDL-C , low-density lipoprotein; QOL , quality of life; SMBG, self-monitoring of blood glucose; SNS , social networking services. Literature Review Flow Diagram for Chapter 6: Organization of Diabetes Care.

From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses: The PRISMA Statement. PLoS Med 6 6 : e pmed For more information, visit www.

Clement reports personal fees for speaking and CME development from Novo Nordisk; personal fees from Eli Lilly, Sanofi, AstraZeneca, Boehringer Ingelheim, Abbott, and Janssen Pharma, outside the submitted work.

Susie Jin reports personal fees and other support from Abbott, Janssen, and Sanofi Canada; personal fees from Ascensia Diabetes Care, Astra, Lilly; and other support from Novo Nordisk Canada Inc. Sherifali has received investigator-initiated funding from AstraZeneca.

No other author has anything to disclose. All content on guidelines. ca, CPG Apps and in our online store remains exactly the same. For questions, contact communications diabetes. Become a Member Order Resources Home About Contact DONATE.

Next Previous. Key Messages Recommendations Figures Full Text References. Chapter Headings Introduction CCM in Diabetes Components of the CCM that Improve Care Multicomponent Quality Improvement Initiatives Telehealth Other Relevant Guidelines Relevant Appendix Author Disclosures. Key Messages Diabetes care should be: Organized around the person living with diabetes and their supports.

The person with diabetes should be an active participant in their own care, be involved in shared-care decision making and self-manage to their full abilities. Facilitated by a proactive, interprofessional team with training in diabetes and the ability to provide ongoing self-management education and support.

Organized within the context of the expanded chronic care model and delivered using as many of the components of the model as possible in particular, self-management education and support; interprofessional team-based care with expansion of professional roles; collaboration with the primary care provider and monitoring with medication adjustment and case management.

Structured, evidence based and supported by clinical information and decision support systems that include patient registries, clinician and patient reminders, facilitated relay of information, audits, feedback and benchmarking. Any of the above strategies may be facilitated with telehealth technologies.

Key Messages for People Living with Diabetes Know the members of your diabetes team and stay connected with them. Remember you are the most important member of the team. Be prepared to learn how to care for your diabetes on a daily basis.

Also, be ready to share in decision making regarding how you will care for your diabetes and health. Prepare for visits with your diabetes health-care team: Have laboratory tests done prior to the visit so the results will be available to review at the visit.

Be prepared to set and update your personal goals for caring for your diabetes and health. Be prepared to share any issues that may affect your ability to care for your diabetes on a daily basis, including any fears or anxiety you may have. Bring your medication bottles or an up-to-date medication list, including nonprescription drugs and supplements.

Also, bring your glucose meter and insulin pen device if you use one. Bring or upload your most recent glucose monitoring results as well as other health behaviour records e. food and exercise diary , as well as a health-care diary in which you have recorded important health events e.

visits with health-care providers, surgeries, illnesses, vaccinations. Share the information you learn during your visits with your diabetes health-care team with all of your health-care providers and diabetes team members. If travel distance or time is a barrier to your care, ask your team about telehealth telephone, web-based or virtual diabetes support and visits.

Helpful Hints Box: Organization of Care R ecognize: Consider diabetes risk factors for all of your patients and screen appropriately for diabetes. R egister: Develop a registry for all of your patients with diabetes. Introduction In Canada, there is a care gap between the clinical goals outlined in evidence-based guidelines for diabetes management and actual clinical practice 1,2.

The chronic care model and organization of diabetes care In many ways, optimal diabetes care delivery reflects the essential components of the CCM Figure 1. CCM in Diabetes Review of the various CCM components and their effectiveness indicate that the more components reflected in the practice, the better the outcomes [see multi-component QI initiatives] 10,12,15,18— Components of the CCM that Improve Care Delivery system design The team.

Self-management support Self-management support SMS is an umbrella term used by the CCM model, which includes self-management education, and is the cornerstone of diabetes care in the CCM, enabling the person with diabetes to take a more active role in problem solving and personalized goal setting 17,48 see Self-Management Education and Support chapter, p.

Decision support Decision support or a clinical decision support system CDSS , which provides health-care practitioners with best-practice information at the point of care to help support decision making, has been shown to improve outcomes. Clinical information systems Clinical information systems CIS that allow for a population-based approach to diabetes assessment and management, such as electronic health medical records EMRs and electronic patient registries, have been shown to have a positive impact on evidence-based diabetes care 17,29,74— Community Environmental factors, such as food and housing security, the ability to lead an active lifestyle, as well as access to care and social supports, also impact diabetes outcomes.

Health systems Support for diabetes care at the level of the health-care system, such as the national and provincial systems, is essential. Multicomponent Quality Improvement Initiatives Many studies of QI have used multiple strategies Telehealth Telehealth also called telemedicine or telecare is the provision of health care remotely by means of a variety of telecommunication tools, including telephones, smartphones and mobile wireless devices, with or without a video connection Recommendations Diabetes care should: Be organized around the person living with diabetes and their supports.

The person living with diabetes should be an active participant in their own care and shared-care decision making; and self-manage to their full abilities; and Be facilitated by a proactive, interprofessional team with specific training in diabetes.

The team should be able to provide ongoing self-management education and support, and incorporate as many components of the CCM as possible [Grade A, Level 1A 11,12 for type 2 diabetes; Grade C, Level 3 27 for type 1 diabetes for both a and b ]. An interprofessional team with specific training in diabetes and supported by specialist input should be integrated within diabetes care delivery models in the primary care [Grade A, Level 1A 17,25 ] and specialist care [Grade D, Consensus] settings.

The role of the diabetes case manager should be enhanced, in cooperation with the collaborating physician [Grade A, Level 1A 17,25 ], to include interventions led by a nurse [Grade A, Level 1A 37,38,40 ], pharmacist [Grade B, Level 2 45,47 ] or registered dietitian [Grade B, Level 2 42 ] to improve coordination of care and facilitate timely changes to diabetes management.

The following individuals should work with an interprofessional team with specialized training in these areas of diabetes as part of a collaborative, shared care approach: Children with diabetes [Grade D, Level 4 54 ] Adolescents and emerging adults age 14—29 years with type 1 diabetes as part of a structured transitional program [Grade C, Level 3 ] People with type 1 diabetes [Grade C, Level 3 61 ] Women with pre-existing diabetes who require preconception counselling and prenatal counselling [Grade C, Level 3 55—57,59,60 and women with gestational diabetes [Grade D, Consensus].

Referral to an interprofessional team with specialized training may be considered for: Individuals with type 2 diabetes who are consistently not meeting cardiometabolic targets [Grade A, Level 1 30 ] Adults with depression and diabetes for collaborative care and, in particular, nurse case management for improvement in depression and glycemic control [Grade A, Level 1A 63 ].

Telehealth technologies may be used to: Improve self-management in underserviced communities [Grade B, Level 2 98 ] Facilitate consultation with specialized teams as part of a shared-care model [Grade A, Level 1A ] Improve clinical outcomes in type 2 diabetes, including a decrease in A1C, an increase in quality of care i.

guideline adherence , a decrease in health service use and cost, and an increase in patient satisfaction and knowledge [Grade A, Level 1A 97,, ] Improve glycemic and CV risk factor control in type 1 and type 2 diabetes [Grade A, Level 1 ,, ].

Abbreviations: A1C, glycated hemoglobin; BMI , body mass index; BP , blood pressure; CCM , chronic care model; CV , cardiovascular disease; LDL-C , low-density lipoprotein; QOL , quality of life; SMBG, self-monitoring of blood glucose; SNS , social networking services.

Other Relevant Guidelines Self-Management Education and Support, p. S36 Diabetes and Mental Health p. S Type 1 Diabetes in Children and Adolescents, p. S Type 2 Diabetes in Children and Adolescents, p.

S Diabetes and Pregnancy, p. S Type 2 Diabetes and Indigenous Peoples, p. Relevant Appendix Appendix 3. Author Disclosures Dr. References Harris SB, Ekoe JM, Zdanowicz Y, et al.

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Ensuring that all people with Self-care initiatives for improved diabetes management have the Self-carf and support they need to manage the Caloric balance. Diabetes Glutathione cream education and diabetws DSMES services empower people Caloric balance diabetes to reach their Self-caare and lifetime improvex for living well with diabetes. DSMES can also help lower health care costs by reducing hospitalizations, hospital readmissions, and emergency room visits for people with diabetes. DSMES services are especially critical for communities with limited resources and populations that have higher rates of diabetes and higher risk of complications. To reach more people, CDC is working to identify and remove barriers, including barriers to access and participation. Ipmroved Medical Informatics and Decision Caloric balance volume 14Initiatjves number: Cite this article. Metrics details. Management of diabetes mellitus is managemwnt Self-care initiatives for improved diabetes management involves controlling multiple risk factors that may lead to complications. Given that patients provide most of their own diabetes care, patient self-management training is an important strategy for improving quality of care. Web-based interventions have the potential to bridge gaps in diabetes self-care and self-management. Self-care initiatives for improved diabetes management

Author: JoJozilkree

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