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Review of literature on home care management of diabetes mellitus

June 19, 2017; Accepted Date: July 29, 2017; Published Date: August 04, 2017 Citation: Keywords Diabetes Mellitus DM ; Management; Therapeutic education; Self-management; Self-efficacy Introduction Diabetes Mellitus DM is a chronicprogressive, non-communicable disease characterized by an increase in blood glucose secondary to an absolute or relative efficiency in insulin signaling, the major regulating hormone of glycaemia. According to the World Health Organization WHO [ 1 ] in the 2016 world report on DM, prevalence of this diagnosis and the number of people affected are increasing in the whole world.

By 2014, 422 million adults 8. Indeed, world prevalence normalized for age appears to have almost doubled during this period, increasing from 4. In addition, DM accounts for approximately 1.

Education and diabetes mellitus

However, hyperglycemia has been linked to an additional 2. The complications of DM also entail important socioeconomic consequences for the patients and their families, as well as for local and world public health systems, owing to direct and indirect medical costs, which appear to be more severe in developing countries [ 1 ]. In Venezuela, Type 2 DM DM2 represents one of the main causes of morbimortality, with serious repercussions in lifestyle, being closely associated with feeding habits, stress management and sedentary habits, among other determinants [ 2 ].

  1. Rev Med Interna Caracas 32.
  2. Motivations and personal needs, family environment and socio-labor conditions are very important to ensure therapeutic success. Taking into account, the importance of the doctor—patient relationship as both a facilitator and barrier to adherence, it may be vital to incorporate communication skills training CST for physicians and patients so as to enable effective informational exchange.
  3. The disease expected to take dimensions of an epidemic is often called "the scourge of modern times. In turn, each person must recognize and be convinced of the benefits that provides perform physical activities on a regular basis.

In 2014, Lopez et al. It was also found that hypertensionhypercholesterolemia, disglycemia and DM were more prevalent in females. In contrast, the WHO report [ 1 ] shows an estimated prevalence of 8. This review aims to critically summarize current literature on therapeutic education as a strategy for prevention and treatment in DM.

Management in Diabetic Patients Paraphrasing Ruiz [ 7 ] on the definition of management as the art of handling resources and processes aimed at achieving goals associated with results defined in terms of efficacy and efficiency, it is reasonable to apply the same principle to the management of people with DM. Thus, management of DM implies day-to-day fulfillment of processes leading to optimize resources, skills and abilities, aptitudes and values to attain goals of metabolic control that minimize the onset of acute and chronic complications at the lowest cost and with the best quality of life for patients and family alike.

  • Motivations and personal needs, family environment and socio-labor conditions are very important to ensure therapeutic success;
  • It is a commonly held view that needs vary according to several demographic and clinical parameters, such as age, socio-economic status, cultural background, personality, severity of disease, complications, prior experiences, level of understanding of instructions, acceptance of the disease, etc [ 14 - 16 ];
  • Effective communication has been shown to influence patient decisions about their health practices and behaviors associated with health outcomes;
  • Relevant articles were selected and collated based on the broader objective of the review, i;
  • On the other hand, substituting foods with high index or glycemic load for foods of lower index or load can modestly improve glycemic control evidence C;
  • Nutritional patterns appropriate to individual needs The ADA and the Diabetes UK establish a degree of recommendation type A that the individuals with prediabetes or diabetes should receive individualized "nutritional medical treatment", necessary to achieve treatment goals, from the time of diagnosis [ 35 ].

It is important to underline that management of DM should provide an environment promoting the rational use of human and material resources that play a role in achieving individual health, through a number of practices that promote in patient, family and health providers the achievement of optimum results and intended goals. In general terms, management is considered to be the product of a permanent interaction between thinking and acting, reflection and decision, requiring unique characteristics that define a profile oriented to efficiency, effectiveness and effectiveness in function of the achievement of planned objectives and goals [ 8 ].

Because current times demand a medical care model where transdisciplinarity is the norm, it is of utmost importance to establish harmony between laymen, academics, scientists and clinicians, with the firm intention of contributing to the integral formation of patients, family, caregivers and health professionals.

This models should actively involve knowledge cognitive abilityskills sensory-motor capacityand aptitudes and values affective capacity. Accordingly, management of a diabetic must be approached with an integral view that allows optimization of professional resources and encourages a more active role of patients in self-management [ 9 ]. This may be reinforced through establishment of norms and protocols that facilitate their widespread application.

The main goal of this management is to establish an educational program structured therapeutic education in a participatory and integral way that, through facilitation or mediation of access to information and knowledge in DM, promotes development of skills and abilities that lead to the promotion of self-responsibility empowerment of patients in controlling their clinical condition, in order to achieve optimum metabolic control and thus improve their quality of life.

Therefore, it is imperative that educational actions promote permanent self-management, from the time of diagnosis and subsequently as needed. Thus, the great merit of education in DM would be that through informing and training patients, they will be able to transform their attitudes to the clinical condition. Therapeutic Education as a Management Strategy Therapeutic education involves the set of educational activities essential for the management of chronic diseases, carried out by health professionals trained in the field of education, aiming to assist the patient or groups of patients and their families.

The ultimate goal is to enable and empower patients to participate actively in their treatment and prevent avoidable complications, while maintaining or improving the quality of life [ 10 ]. Indeed, education is one of the main pillars in the treatment of DM2, as contemplated in the Declaration of Saint Vincent [ 11 ], which advocates for the need and importance of continuing education for all those with DM, their families, friends and close acquaintances, as well as the health care team.

This proposition arises from the emblematic findings from the DCCT Diabetes Control and Complications Trial study in 1993 [ 12 ], which demonstrated that strict metabolic control along with a structured diabetes education program prevented a considerable percentage of chronic complications from diabetes.

Therapeutic education is a dynamic process which evolves and adapts through each of the stages of clinical care, including initial assessment, collection of data obtained at the interview, clinical examination and the findings resulting from biochemical exploration, and establishment of diagnosis or clinical judgment.

Therapeutic education should set educational objectives for each of these stages, facilitated by the continuous evaluation of both the process and the results between the healthcare team and the patient and families. This assessment should be systematic and permanent, with the purpose of optimizing the goals of metabolic control and therefore the patient's quality of life [ 13 ].

Although there is much evidence to support this idea, only a minority of people receive appropriate therapeutic education [ 13 ]. There is considerable evidence reporting the effectiveness in the short-term less than 6 months of educational interventions in the control of DM2 [ 14 - 17 ].

A structured diabetes education program carried out by a multidisciplinary group that works as a team should be able to handle the same terms and maintains the guidelines and goals outlined, achieves that patients improve their metabolic control, adherence to established treatment, changes in diet and physical activity [ 18 ]. In addition, recognition of the importance and severity of DM implies considering behavioral factors that may be modified by education of the patient as an indispensable part of the treatment.

The education of both type 1 and type 2 Diabetic Mellitus DM should be approadred in the same way concerning therapeutic adherence, nutritional program and participation in exercise physical activities.

Hewers in type 1 DM the goods are stricter and it should emphasize concerning adherence and pacification therapeutics to insulin to keep in mind the education to minimize incidence of hypoglycemia.

According to this interpretation, empowerment can be a means to an end such as reducing poverty or preventing conflict or can be considered an end review of literature on home care management of diabetes mellitus itself an individual who is empowered.

It is important to emphasize that the process happens within the individual and only through his own understanding of reality can change the structures of power. In this sense, empowerment must be understood as a model, as a strategy of motivation, promotion, awareness and self-management that aims to positively affect the patient.

Motivations and personal needs, family environment and socio-labor conditions are very important to ensure therapeutic success.

The health professional should have the ability to monitor the patient's emotional states, as well as employ adaptive strategies and empathic communication, considering the beliefs, paradigms and perceptions of the patient and their environment. These include discovering in the patient what motivates you to take care of your health, reflect on the things that drive you to continue with diet and exercise.

Management and Education in Patients with Diabetes Mellitus

The interrelation with other patients who have achieved success in therapeutics, self-monitoring of their own progress, theoretical and practical knowledge related to diabetes condition, metabolic control goals, success and difficulties of the day to day are factors to have into account in motivating achievement. The motivational force depends on the value that it assigns to the reward and the expectation that it has to achieve it Self-efficacy.

It is the belief of the person in him and in his ability, which makes him carry out an action. It is important to emphasize that the processes related to diabetes education are initially affective, later become sensory motor and finally cognitive.

In the same vein, the praxis of self-efficacy requires changing the paradigm of the health professional, from feeling responsible for patients to feel the patients responsible for their clinical condition; that is, responsibility must be transferred to the patient of his own condition.

This means that health professionals act as collaborators who provide patients with information, experience and help to make the best possible self-management of DM in each case, with decisions based on the patient's own health priorities and social environment Figure 1 [ 21 ].

Model for therapeutic education in DM. Self-management in the Management of Diabetes Given the complexity of the care a person with DM has to deal with to maintain health and quality of life, it is necessary to promote self-management. In this scenario, Orem [ 23 ] calls self-care the process that encompasses all activities to promote and maintain well-being throughout life in an independent way. At the same time, he states that carrying out self-care, is based in the capacity that the person has to fulfill those activities.

In agreement with the nature of this care, Kozier et al. According to Colliere [ 22 ], the nature of care involves healing, and refers to activities related to the need to cure everything that hinders life; requires bringing medicines to cure or eliminate the course of a pathological process disease.

In addition, the person who helps in self-care, being the one who helps and supports health professional, family, community person must have clear and precise knowledge of both types of care, their nature and object: According to this, the existence of three systems is considered: The support-educational system emphasizes that the person with diabetes requires help in decision-making, as well as support in controlling positive and encouraging behaviors to incorporate them in the fulfillment of their self-care.

That is, help in acquiring skills to ensure self-monitoring of capillary glycemia, foot care, oral hygiene, insulin administration, adherence to a healthy diet and physical activity. In relation to the above, Orem [ 23 ] and Kozier et al. On the other hand, for the understanding and fulfillment of their contributions, it is imperative that caregivers know the culture, religion, beliefs and social landscape of their patients, as well as what the disease represents for them and how it affects the relationships with their environment.

It is important to emphasize that the National Institute of Nursing Research, which is part of the National Institute of Health of the United States, in the eighties proposed the term self-management instead of self-care. In a general sense, self-management is defined as the daily care by the patients themselves of chronic diseases in their course [ 2627 ]. Although these concepts are interrelated, self-management is considered by many authors [ 262930 ] as the tasks that healthy people perform at home to prevent diseases, rather than just attending to an existing disease.

Conceptual and theoretical descriptions of self-management in relation to components, processes, and outcomes have review of literature on home care management of diabetes mellitus and evolved since the 1980s when Corbin and Strauss [ 31 ] identified three sets of activities associated with having a chronic disease, namely: Medical care, behavior management and emotional management.

Nursing scientists subsequently described five major self-management processes that consist of the ability to solve problems, make decisions, use resources, partner with health care providers, and act [ 27 ]. Within the theoretical framework of individual and family self-management, it was proposed that self-management has three dimensions: This theory also review of literature on home care management of diabetes mellitus the specificity of processes to include knowledge and beliefs, self-regulation skills and capabilities, and social facilitation, and further classified the results into proximal and distal categories [ 29 ].

For his part, Pinto [ 32 ] proposes a model of home care that he considers fundamental, because it integrates the transpersonal relationship person-caregiver health professional, family member or community memberexemplifies the process of human-to-human care, and demonstrates the need for a mix of scientific knowledge of the caregiver and the art of intrapersonal experience.

It moves toward healthy outcomes, defined as protection and commitment to the well-being of the person and his family at the same time.

  1. However, these training programs need to take into account individual patient characteristics. Select your language of interest to view the total content in your interested language Viewing options.
  2. Diabetes education should be reinforced after its' completion and enhance in depth understanding of the significance of check-up and follow-up.
  3. It should been understood that the transmission of information on the pathophysiological aspects of diabetes and its complications is not the only and exclusive thing to be treated in an educational program.

This continuity demands optimum personal management; Procurement of required and coordinated services; Use of easily accessible technology; Techniques for organizing care or self-care; Development of goals; Compliance and evaluation. In summary, it requires planning, intervention, monitoring and evaluation of care, to facilitate and monitor the appropriate use of resources over time, encourage feedback and rational communication, accessibility and flexibility of the person and the team.

All these are integrated characteristics in each one of the processes developed by the model proposed by Pinto [ 32 ].

The American Association of Diabetes Educators, together with Covey [ 33 ], proposed the "7 self-care behaviors" Table 1which should perfectly develop the patient to achieve greater control of diabetes and all its implications.

Sl No Self-care behaviors in patients with DM 1 Establishment of food patterns appropriate to the individual needs 2 Be active and practice regular physical activity 3 Daily monitoring of blood glucose and food care 4 Pharmacological adherence according to the doctor's instructions 5 Solve acute problems hypoglycemia, hyperglycemia 6 Psychosocial adaptation and motivation to achievement 7 Reduce risk of chronic complications Table 1: Self-care behaviors [ 33 ].

Actions to promote healthy behaviors can be achieved through the following objectives [ 34 ]: Nutritional patterns appropriate to individual needs The ADA and the Diabetes UK establish a degree of recommendation type A that the individuals with prediabetes or diabetes should receive individualized "nutritional medical treatment", necessary to achieve treatment goals, from the time of diagnosis [ 35 ].

All members of the health care team should know the principles of nutrition therapy in diabetes and support their unrestrictedly implementation [ 36 ]. In this sense, education in Carbohydrate Counting CHO is important to patients with DMT1, especially if it involves patients with continuous insulin infusers. People with a review of literature on home care management of diabetes mellitus insulin regimen, a consistent intake should been considered and a meal simple plan is needed in individuals with oral hypoglycemic or in older adults.

In terms of energy balance, weight control should be the main nutritional strategy for the glycemic control in people with DM who are overweight or obese type-A evidence. In this sense, the main requirement of a diet plan to lose weight is that the total energy intake should be less than the amount of energy that you drop. In addition, to achieve optimal glycemic control, attention should been focused on total energy consumption rather than on the dietary energy source macronutrient composition.

Evidence suggests that there is no ideal percentage of carbohydrates, proteins and fats for all people with diabetes; therefore, the distribution of macronutrients should been based on the individualized assessment of dietary patterns, preferences and metabolic goals.

The pattern of Mediterranean consumption reported the largest decline in A1C at 1 year -1. Vegetables, fruits, whole grains, grains and low-fat dairy products evidence B. On the other hand, substituting foods with high index or glycemic load for foods of lower index or load can modestly improve glycemic control evidence C. In relation to the fats seems to be more important the quality of the fat than the amount evidence B.

Polyunsaturated fats ensure an intake of omega-3s, with the additional benefits reported in decreasing cardiovascular risk and healthy habits B. Blue fish consumption should been promoted review of literature on home care management of diabetes mellitus least 2 times per week B.

Nutrition education should guide the consumption of adequate amounts of micronutrients through natural sources. It is very important to familiarize patients, family, caregivers and health professionals with nutritional labeling, portion control, and the exchange list. Physical activity and diabetes For the treatment of DM and for the prevention and treatment of cardiovascular problems, it is more convenient to prescribe aerobic than anaerobic exercise, particularly resistance, strength and elasticity exercises, to maintain and improve cardiorespiratory, muscular, Mobility and, indirectly, the body composition [ 37 ].

In order that physical activity is safe and beneficial from the outset, a series of previous recommendations should been followed: Detailed medical evaluation is need before beginning any exercise program.