Category: Children

Diabetes management techniques

Diabetes management techniques

Reactive Diabets What Diabetes management techniques I do? Strategies such as techniqkes goal setting with patients 13 ; identifying and addressing Diabetes management techniques, numeracy, or cultural barriers to care 14 — 17 ; integrating evidence-based guidelines Disbetes clinical Kale and lentil recipes tools into the process of care 18 — 20 ; and incorporating care management teams including nurses, pharmacists, and other providers 2122 have each been shown to optimize provider and team behavior and thereby catalyze reductions in A1C, blood pressure, and LDL cholesterol. You can see these and other titles at www. Things to Remember: You are the most important member of your health care team. Read on to learn more.

Diabetes management techniques -

These automatically measure levels every 5 minutes through a small sensor inserted under the skin. When a person uses it appropriately, this type of technology can improve health outcomes.

A healthcare team can use at-home blood sugar readings to modify medication, nutrition , and self-management plans. It is important for people with diabetes or prediabetes to achieve and maintain a healthy weight.

When doctors closely monitor weight loss progress, a person more likely to achieve their goals. Research suggests that, among people with excess weight, modest, consistent weight loss can help manage type 2 diabetes and slow the rate at which prediabetes becomes diabetes.

They also noted that making dietary adjustments can lower glycated hemoglobin levels by 0. Nutrition therapy can also lead to improvements in the quality of life. To facilitate these lifestyle adjustments, the ADA recommend consulting a registered dietitian with expertise in diabetes and weight management.

Following a meal plan can be among the most challenging aspects of diabetes self-management. Developing a plan with a registered dietitian who is knowledgeable about diabetes-specific nutrition can help.

For some people, dietary changes alone are not enough to control blood sugar levels. Diabetes is a progressive disease, which means that it can worsen over time.

The ADA recommend using a combination of medication and nutrition therapy to reach blood sugar targets. The basis of meal planning involves portion control and favoring healthful foods. The diabetes plate method is one tool designed to help people control their calorie and carbohydrate intakes.

It involves mentally dividing the plate into three sections. Half of the plate should contain nonstarchy vegetables , a quarter can contain grain-based and starchy foods, and the remaining quarter should contain protein.

Research has shown that exercise can help control blood sugar levels, reduce cardiovascular risk factors, promote weight loss, and improve well-being. Researchers behind one study found that engaging in a structured exercise program for at least 8 weeks lowered glycated hemoglobin levels by an average of 0.

The ADA recommend exercising for at least 10 minutes per session and getting a total of at least 30 minutes of exercise on most days of the week. If a person exercises every day — or lets no more than 2 days pass between workouts — this may help reduce insulin resistance.

Members of a diabetes healthcare team can help develop and tailor an exercise plan that is safe and effective. In addition to exercising regularly, it is important to avoid spending long periods in a seated position. Breaking up sedentary periods every 30 minutes can help with controlling blood sugar.

The ADA advise all people with prediabetes or diabetes to avoid tobacco products, including e-cigarettes. People with diabetes who smoke have higher risks of cardiovascular disease , premature death, and diabetes complications , as well as less blood sugar control, compared with people who do not smoke.

If a person with diabetes does not take their medication as recommended by a doctor, it can lead to:. A diverse range of issues can contribute to medication nonadherence.

Some may relate to psychological, demographic, and social factors. Key elements can include the cost of treatment and difficulties with healthcare providers and the healthcare system.

Doubt about the seriousness of diabetes and the effectiveness of a treatment plan can keep a person from taking their medication, and this can lead to complications. Nonadherence seems to be more common among people who have chronic diseases with symptoms that are not obvious.

Also, complex treatment plans can be challenging to follow. Researchers analyzed 28 studies that explored the effect of mind-body practices on people with type 2 diabetes. Those participating in the studies did not need insulin to control their diabetes, or have certain health conditions such as heart or kidney disease.

The mind-body activities used in the research were:. How often and over what time period people engaged in the activities varied, ranging from daily to several times a week, and from four weeks to six months. Those who participated in any of the mind-body activities for any length of time lowered their levels of hemoglobin A1C, a key marker for diabetes.

On average, A1C levels dropped by 0. This is similar to the effect of taking metformin Glucophage , a first-line medication for treating type 2 diabetes, according to the researchers. A1C levels are determined by a blood test that shows a person's average blood sugar levels over the past two to three months.

Given the tremendous toll that obesity, physical inactivity, and smoking have on the health of patients with diabetes, efforts are needed to address and change the societal determinants at the root of these problems. Within the narrower domain of clinical practice guidelines, the application of evidence level grading to practice recommendations can help to identify areas that require more research 1.

There has been steady improvement in the proportion of patients with diabetes treated with statins and achieving recommended levels of A1C, blood pressure, and LDL cholesterol in the last 10 years 2. The mean A1C nationally has declined from 7. This has been accompanied by improvements in cardiovascular outcomes and has led to substantial reductions in end-stage microvascular complications.

Evidence also suggests that progress in cardiovascular risk factor control particularly tobacco use may be slowing 2 , 3. Even after adjusting for patient factors, the persistent variation in quality of diabetes care across providers and practice settings indicates that there is potential for substantial system-level improvements.

Numerous interventions to improve adherence to the recommended standards have been implemented. However, a major barrier to optimal care is a delivery system that is often fragmented, lacks clinical information capabilities, duplicates services, and is poorly designed for the coordinated delivery of chronic care.

The Chronic Care Model CCM has been shown to be an effective framework for improving the quality of diabetes care 7. The CCM includes six core elements for the provision of optimal care of patients with chronic disease:.

Delivery system design moving from a reactive to a proactive care delivery system where planned visits are coordinated through a team-based approach.

Clinical information systems using registries that can provide patient-specific and population-based support to the care team. Community resources and policies identifying or developing resources to support healthy lifestyles.

Redefining the roles of the health care delivery team and promoting self-management on the part of the patient are fundamental to the successful implementation of the CCM 8.

The National Diabetes Education Program NDEP maintains an online resource www. gov to help health care professionals to design and implement more effective health care delivery systems for those with diabetes.

Three specific objectives, with references to literature outlining practical strategies to achieve each, are as follows:. Strategies such as explicit goal setting with patients 13 ; identifying and addressing language, numeracy, or cultural barriers to care 14 — 17 ; integrating evidence-based guidelines and clinical information tools into the process of care 18 — 20 ; and incorporating care management teams including nurses, pharmacists, and other providers 21 , 22 have each been shown to optimize provider and team behavior and thereby catalyze reductions in A1C, blood pressure, and LDL cholesterol.

Healthy lifestyle choices physical activity, healthy eating, tobacco cessation, weight management, and effective coping. Disease self-management taking and managing medications and, when clinically appropriate, self-monitoring of glucose and blood pressure.

Prevention of diabetes complications self-monitoring of foot health; active participation in screening for eye, foot, and renal complications; and immunizations. High-quality diabetes self-management education DSME has been shown to improve patient self-management, satisfaction, and glucose control.

National DSME standards call for an integrated approach that includes clinical content and skills, behavioral strategies goal setting, problem solving , and engagement with psychosocial concerns An institutional priority in most successful care systems is providing high quality of care Initiatives such as the Patient-Centered Medical Home show promise for improving outcomes through coordinated primary care and offer new opportunities for team-based chronic disease care Additional strategies to improve diabetes care include reimbursement structures that, in contrast to visit-based billing, reward the provision of appropriate and high-quality care 33 , and incentives that accommodate personalized care goals 6 , Optimal diabetes management requires an organized, systematic approach and the involvement of a coordinated team of dedicated health care professionals working in an environment where patient-centered high-quality care is a priority 6.

In general, providers should seek evidence-based approaches that improve the clinical outcomes and quality of life of patients with diabetes. Recent reviews of quality improvement strategies in diabetes care 24 , 35 , 36 have not identified a particular approach that is more effective than others.

However, the Translating Research Into Action for Diabetes TRIAD study provided objective data from large managed care systems demonstrating effective tools for specific targets 6. TRIAD found it useful to divide interventions into those that affected processes of care and intermediate outcomes.

Processes of care included periodic testing of A1C, lipids, and urinary albumin; examining the retina and feet; advising on aspirin use; and smoking cessation. TRIAD results suggest that providers control these activities.

Performance feedback, reminders, and structured care e. For intermediate outcomes, such as A1C, blood pressure, and lipid goals, tools that improved processes of care did not perform as well in addressing barriers to treatment intensification and adherence 6.

Treatment intensification was associated with improvement in A1C, hypertension, and hyperlipidemia control A large multicenter study confirmed the strong association between treatment intensification and improved A1C Although there are many ways to measure adherence 40 , Medicare uses percent of days covered PDC , which is a measure of the number of pills prescribed divided by the days between first and last prescriptions.

This metric can be used to find and track poor adherence and help to guide system improvement efforts to overcome the barriers to adherence. Barriers to adherence may include patient factors remembering to obtain or take medications, fears, depression, or health beliefs , medication factors complexity, multiple daily dosing, cost, or side effects , and system factors inadequate follow-up or support.

Simplifying a complex treatment regimen may improve adherence. Nurse-directed interventions, home aides, diabetes education, and pharmacy-derived interventions improved adherence but had a very small effect on outcomes, including metabolic control Success in overcoming barriers may be achieved if the patient and provider agree on a targeted treatment for a specific barrier.

For example, one study found that when depression was identified as a barrier, agreement on antidepressant treatment subsequently allowed for improvements in A1C, blood pressure, and lipid control Thus, to improve adherence, systems should continually monitor and prevent or treat poor adherence by identifying barriers and implementing treatments that are barrier specific and effective.

Assess adherence. Adherence should be addressed as the first priority. If medication up-titration is not a viable option, then consider initiating or changing to a different medication class. Establish a follow-up plan that confirms the planned treatment change and assess progress in reaching the target.

The causes of health disparities are complex and include societal issues such as institutional racism, discrimination, socioeconomic status, poor access to health care, and lack of health insurance.

Disparities are particularly well documented for cardiovascular disease. Ethnic, cultural, religious, and sex differences and socioeconomic status may affect diabetes prevalence and outcomes.

Ethnic, cultural, religious, sex, and socioeconomic differences affect health care access and complication risk in people with diabetes. Socioeconomic and ethnic inequalities exist in the provision of health care to individuals with diabetes Significant racial differences and barriers exist in self-monitoring and outcomes Therefore, diabetes management requires individualized, patient-centered, and culturally appropriate strategies.

To overcome disparities, community health workers 49 , peers 50 , 51 , and lay leaders 52 may assist in the delivery of DSME and diabetes self-management support services Strong social support leads to improved clinical outcomes, reduced psychosocial symptomatology, and adoption of healthier lifestyles Structured interventions, tailored to ethnic populations that integrate culture, language, religion, and literacy skills, positively influence patient outcomes Not having health insurance affects the processes and outcomes of diabetes care.

Individuals without insurance coverage for blood glucose monitoring supplies have a 0. The affordable care act has improved access to health care; however, many remain without coverage. Providers should evaluate hyperglycemia and hypoglycemia in the context of food insecurity and propose solutions accordingly.

Providers should recognize that homelessness, poor literacy, and poor numeracy often occur with food insecurity, and appropriate resources should be made available for patients with diabetes. Food insecurity FI is the unreliable availability of nutritious food and the inability to consistently obtain food without resorting to socially unacceptable practices.

are food insecure. FI may involve a tradeoff between purchasing nutritious food for inexpensive and more energy- and carbohydrate-dense processed foods.

In people with FI, interventions should focus on preventing diabetes and, in those with diabetes, limiting hyperglycemia and preventing hypoglycemia. The risk for type 2 diabetes is increased twofold in those with FI. The risks of uncontrolled hyperglycemia and severe hypoglycemia are increased in those with diabetes who are also food insecure.

Providers should recognize that FI complicates diabetes management and seek local resources that can help patients and the parents of patients with diabetes to more regularly obtain nutritious food Hyperglycemia is more common in those with diabetes and FI.

Providers should be well versed in these risk factors for hyperglycemia and take practical steps to alleviate them in order to improve glucose control. Individuals with type 1 diabetes and FI may develop hypoglycemia as a result of inadequate or erratic carbohydrate consumption following insulin administration.

Long-acting insulin, as opposed to shorter-acting insulin that may peak when food is not available, may lower the risk for hypoglycemia in those with FI. Short-acting insulin analogs, preferably delivered by a pen, may be used immediately after consumption of a meal, whenever food becomes available.

Unfortunately, the greater cost of insulin analogs should be weighed against their potential advantages. Those with type 2 diabetes and FI can develop hypoglycemia for similar reasons after taking certain oral hypoglycemic agents. If using a sulfonylurea, glipizide is the preferred choice due to the shorter half-life.

Glipizide can be taken immediately before meal consumption, thus limiting its tendency to produce hypoglycemia as compared with longer-acting sulfonylureas e. Homelessness often accompanies the most severe form of FI.

Therefore, providers who care for those with FI who are uninsured and homeless and individuals with poor literacy and numeracy should be well versed or have access to social workers to facilitate temporary housing for their patients as a means to prevent and control diabetes.

Additionally, homeless patients with diabetes need secure places to keep their diabetes supplies and refrigerator access to properly store their insulin.

FI and diabetes are more common among non-English speaking individuals and those with poor literacy and numeracy skills.

You can manage your diabetes and techniquse a long and healthy life by High-intensity interval training care Negative effects of extreme diets majagement each day. Mangement can affect almost every part of your body. Therefore, you will need to manage your blood glucose levels, also called blood sugar. Managing your blood glucose, as well as your blood pressure and cholesterolcan help prevent the health problems that can occur when you have diabetes. With the help of your health care team, you can create a diabetes self-care plan to manage your diabetes. Diabetes management techniques

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