Educational Strategies for Diabetes Care - Paper Example

Introduction

According to Global Public Health (Arrendo et.al 2018), the number of people living with diabetes, globally, continues to rise along with its high morbidity and mortality levels. According to the International Diabetes Federation (2017), over 425 million people are currently living with diabetes mellitus across the globe. This number will continue to increase due to an ageing population, growth of population size, urbanization and the high prevalence of obesity and a sedentary lifestyle (International Diabetes Federation [IDF], [15]). Over 90% of this population have type 2 diabetes mellitus.

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The main consideration in diabetes is to prevent its complications. In the case of Type 2 diabetes this involves lifestyle changes and diabetes therapies either oral hypoglycemic agents or insulin. Therefore, the most important consideration in delivering diabetes care to reduce costly complications (heart disease, stroke, blindness, kidney failure and foot amputation), is to engage and support people with diabetes in developing effective self-management behaviours to reduce glucose levels to the near normal range. An essential component in achieving this is the provision of effective diabetes self-management education. While many countries with advanced health care systems have developed such programmes, it can be more challenging to deliver these programmes in low to middle income countries. This project explores the provision of diabetes education for people with Type 2 diabetes on one Caribbean island, Anguilla, and to provide information that might be helpful in improving that provision.

Anguilla

Anguilla, a British Dependent Territory, is the easternmost and northernmost of the Leeward Islands in the Caribbean (see figure 1). It has a total land area of just 35 square miles and the island is made up mostly of coral and limestone. The island has no rivers and as such, fresh water is very scarce. The island’s dry claylike soil and constant droughts makes farming difficult and it is also prone to environment health risks (Nash 2008).

In 2017, the United Nations characterized Anguilla as a small island developing state (UN-OHRLLS 2011). In 2018, the island’s Gross Nation Income (GNI) stood at $877.14 million, hence according to the World Bank classification Anguilla is a low income country, which is any country with a GNI below $1,006 million. Anguilla’s economy is also vulnerable and has been adversely affected by external shocks such as the 2007-2008 global financial crisis; and extreme weather conditions such as hurricanes. For example, in 2017, following hurricane Irma the island lost approximately 97% of its gross domestic product (GDP). (Anguilla Economic brief 2018). The dynamics associated with external economic shocks, natural disasters, and limited resources on a small island means that delivering comprehensive healthcare can be challenging. (Madzar 2017). Therefore, delivering diabetes education in this context brings additional challenges; hence this project will consider how diabetes education can be best provided within that perspective. This chapter sets out the background and context for the study, considering:

Diabetes Mellitus

Diabetes is a condition that affects the body’s ability to regulate glucose levels leading to hyperglycaemia as a result of either insulin insufficiency or resistance or both (Slomski, 2014). There are three common forms of diabetes; these include: type 1, type 2, and gestational diabetes (Slomski, 2014). According to Slomski (2014) type 1 diabetes is characterized by the inability of the body to produce insulin due to the autoimmune destruction of the beta cells. People with type 1 diabetes will require insulin either via subcutaneous injection or through an an insulin pump to regulate glucose levels and prevent hyperglycaemia. Type 2 diabetes is the most common type of diabetes (Grillo-Ardila, 2017), which involves the body not being able to produce sufficient insulin or cannot effectively use the insulin produced (insulin resistance).

Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a temporary form of diabetes that affects expectant mothers during pregnancy, however, having GDM increases the risk of future Type 2 diabetes (Grillo-Ardila, 2017). Pre-diabetes refers to a condition where blood glucose levels in an individual are slightly higher than usual but still not so high to be characterized as type 2, these patients are at high risk of developing type 2 diabetes (Slomski, 2014). Diabetes is associated with high risk of morbidity and mortality because the its progression can cause damage to many organs of the body. It causes nerve damage, renal and cardiovascular complications leading to adverse effects of blindness, end stage renal disease, and amputations. (Schiotz et al., 2012). Diabetes complications can be reduced if there is a prevention plan to keep glucose levels close to the normal range. Achieving this is largely predicated on personal self-management behaviours such as taking medications, monitoring glucose levels and lifestyle changes. In order to support effective self-management people need access to structured diabetes education programmes.

Chronic Medical Conditions

Diabetes is one of the commonest chronic medical conditions, affecting around 347 million adults worldwide. Structured patient education programmes reduce the risk of diabetes-related complications four-fold. Internet-based self-management programmes have been shown to be effective for a number of long-term conditions, but it is unclear what are the essential or effective components of such programmes. If computer-based self-management interventions improve outcomes in type 2 diabetes, they could potentially provide a cost-effective option for reducing the burdens placed on patients and healthcare systems by this long-term condition. Objectives: To assess the effects on health status and health-related quality of life of computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Search methods: We searched six electronic bibliographic databases for published articles and conference proceedings and three online databases for theses (all up to November 2011). Reference lists of relevant reports and reviews were also screened. Selection criteria: Randomised controlled trials of computer-based self-management interventions for adults with type 2 diabetes, i.e. computer-based software applications that respond to user input and aim to generate tailored content to improve one or more self-management domains through feedback, tailored advice, reinforcement and rewards, patient decision support, goal setting or reminders. Data collection and analysis: Two review authors independently screened the abstracts and extracted data. A taxonomy for behaviour change techniques was used to describe the active ingredients of the intervention.

Conclusion

Main results: We identified 16 randomised controlled trials with 3578 participants that fitted our inclusion criteria. These studies included a wide spectrum of interventions covering clinic-based brief interventions, Internet-based interventions that could be used from home and mobile phone-based interventions. The mean age of participants was between 46 to 67 years old and mean time since diagnosis was 6 to 13 years. The duration of the interventions varied between 1 to 12 months. There were three reported deaths out of 3578 participants. Computer-based diabetes self-management interventions currently have limited effectiveness. They appear to have small benefits on glycaemic control (pooled effect on glycosylated haemoglobin A1c (HbA1c).