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Together fight diabetes

Together fight diabetes . Ya.Enkhjargal diabetes educator . Diabetes is a complex disorder. Management of type 2 diabetes needs considerable expertise in order to: match medication to individual ‘phenotype’ manage complex drug regimens provide strong support for patient education.

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Together fight diabetes

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  1. Together fight diabetes Ya.Enkhjargal diabetes educator

  2. Diabetes is a complex disorder • Management of type 2 diabetes needs considerable expertise in order to: • match medication to individual ‘phenotype’ • manage complex drug regimens • provide strong support for patient education

  3. Diabetes interdisciplinary professional team ADF protion the strategy of providing diabetes care by interdisciplinary professional team.

  4. Diabetes education • Goal: • Diabetes educations outcomes improvements in patient self- managements knowledge attitudes quality of life.

  5. Considering the patient perspective ? What if my therapy fails? ? ? I am afraid of the unknown ? ? I am anxious that my therapy will cause side effects I am afraid of the unknown ? ? I have no symptoms so how can my condition be serious? I am afraid of needing insulin I am afraid of needing insulin ?

  6. Some misconceptions about diabetes “I don’t need to take my tablets I don’t feel ill” “33” ” Only old people get diabetes” “Complications only occur in patients wh“Complications only occur in patients who take insulin” o take insulin”

  7. Use a patient-centered approach Patient Healthcare professional • Active listening • Negotiation • Provides information (when required) • Active • Expresses views • In control • Decision maker INFORMATIONEXCHANGE Muhlhauser I, et al. Diabet Med 2000; 17:823–829.

  8. PHILOSOPHY ATTITUDE Theory Educator Behaviour

  9. If people have the right information and skills they will make the right choices I need to find out what is the best way to get my patients to understand me Elaboration Likelihood Theory Educator Behaviour

  10. Why is self-care important? • Not enough healthcare providers for day-to-day management • 24-hours-a-day management is necessary • Better long-term outcomes Bergenstal 1996 Slides current until 2008

  11. Who should monitor glycemia? + PatientSelf-monitoring of blood glucose DHealthcare professionalsRegular monitoring of HbA1c

  12. What are the priorities in diabetes management? Cholesterol? Weight = Glucose? Blood pressure? Glycemic= control Lipid lowering = = ВР

  13. Blood glucose targets 1CDA 2003, 2ADA 2004, 3IDF 2005

  14. Diabetes problems in Mongolia

  15. Diabetes prevalence • In 2000 • Prevalence of 3.1% for diabetes and 9.2% for IGT (J. Suvd et al, Diabet. Med. 19, 502–508 (2002) ) • In 2005 • Prevalence of 8.2% for diabetes and 12.2% for IGT (Mongolian Steps Survey on the Prevalence of Noncommunicable Disease Risk Factors, WHO report 2005)

  16. Diabetes SERVICES • Level 1 - Family clinics – Family doctor • Level 2 Province, District Hospitals- Endocrinologist and Educator • Level 3 National Hospitals Endocrinologist, Educator, Ophthalmologists, Nephrologists, Neurologist

  17. Activity • Endocrinologistswere trained from 1996 were trained • 31 nurses from each province were participated in training course of diabetes educator in 2005

  18. Actual diabetes problems in Mongolia • In Bulgan, • Arkhangai • Gobisuber • Bayankhongor • Omnugovi hasn’t got endocrinologist

  19. Actual diabetes problems in Mongolia Diabetes patients 34.3% 2-3 any complication /l.Tubshinzaya 1997/

  20. Actual diabetes problems in Mongolia The quality control study was shown 80% of registrated diabetic patients (3500 in 2006) were poor control (HBA1c over the 9%) Kh. Zolzaya/2003/

  21. Actual diabetes problems in Mongolia Mortality of diabetes /Ya.oyunchimeg 2004/

  22. Supplying of medicines and insulin for diabetes • 1/3 of medicines and insulin required for the scope of the nation is supplied • The medicines and insulin are not graned in Bulgan,Bayan-ulgii,Arkhangai and Covisumber

  23. Hospital description • SCC hospital • Endocrinology ward

  24. Diabetes patients in outpatient clinic of SCCH

  25. Diabetes patients inendocrinology departments of SCCH

  26. Diabetes specialist service in Mongolia • Diabetes Patient first- endocrinologist then refer to Educator • Educator makes an evaluation and provides consultation. • There are dietitians in every National Hospital • Since 2008 District Hospitals are provided dietitians through a special project. • Podiatrist - None

  27. Diabetes specialist service in Mongolia • Mongolian Health Insurance Law states that diabetes treatment cost should be subsidized by Government but in fact only 1/3 of insulin is being provided to Diabetic patients and it is of a poor quality. • Patient have to pay the remaining balance.

  28. Availability of Diabetic Medications and Appliances • Insulin and medications are supplied from Novo Nordisk in Russia. • Lately Oral Anti Diabetic Drugs are supplied from India, such as Oglo, Glizid MR, Glizid M, Metlong and these are available in all pharmacies. • However Diabetic patients pay for their medications and Blood Glucose Meters/Strips

  29. Diabetes Educationin Mongolia

  30. Diabetes Educationin Mongolia • Diabetes Education are available in 11 out of 21 Provinces and in 6 district hospitals and 3 national hospitals in Ulaanbaatar • The education is being conducted by Nurse, Dietitian and Doctor.

  31. Diabetes Educationin Mongolia • Group teaching-hospital based • Individual Counseling • WHO and IDF guides are used when Blood Glucose monitoring is taught. • Patient’s education is free of charge.

  32. Diabetes support groups • Mongolian Diabetes Association is formed of over 200 doctors and patients.

  33. Diabetes Educators Profile • In 2005 31 nurses have completed Diabetes Educator’s training course supported by WHO 16 of them are working now in Level 2 and 3.

  34. Diabetes Educators Profile • There is no local trainings of educators available in Mongolia either none of the present Educators have gone to trainings abroad. Educators are not being accredited in Mongolia yet.

  35. Undertaking the following actions in the future is properly run into • To continue and make more enriched the ongoing training on diabetes regarding the diabetes complication and forming the healthy ritual. • For the society and collective: • To form the healthy lifestyle and to organize the prophylactic activities. • For the individuals: • To learn the health education.

  36. Undertaking the following actions in the future is properly run into • The diabetes medical service for the diabetes shall be provided by the qualified team and create the legal environments. • To create the work place for the educators, nutritionist, and Diabetes interdisciplinary professional team.

  37. Thank you for your attention

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