Ya.Enkhjargal diabetes educator

Diabetes is a complex disorderManagement of type 2 diabetes needs

considerable expertise in order to:match medication to individual ‘phenotype’manage complex drug regimensprovide strong support for

patient education

Diabetes interdisciplinary professional team

ADF protion the

strategy of

providing diabetes

care by

interdisciplinary

professional team.

Diabetes education Goal:

Diabetes educations outcomes improvements in patient self- managements knowledge attitudes quality of life.

Considering the patient perspective

??

?I have no symptoms so how can my condition be serious?

?I am afraid of the unknown

I am anxious that my therapy will cause side effects

What if my therapy fails?

I am afraid of needing insulin

I am afraid of the unknown

???

?I am afraid of needing insulin

Some misconceptions about diabetes

“I don’t need to take my tablets I don’t feel ill”

“Complications only occur in patients wh“Complications only occur in patients who take insulin”o take insulin”

“33” ” Only old people get diabetes”

• Active

• Expresses views

• In control

• Decision maker

• Active listening

• Negotiation

• Provides information (when required)

Use a patient-centered approach

INFORMATIONEXCHANGE

Healthcare professional Patient

Muhlhauser I, et al. Diabet Med 2000; 17:823–829.

PHILOSOPHY

TheoryATTITUDE

Educator Behaviour

If people have the right information and skills

they will make the right choices

Elaboration Likelihood Theory

I need to find out what is the best way to get my patients to understand me

Educator Behaviour

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

Slides current until 2008Bergenstal 1996

Who should monitor glycemia?

PatientSelf-monitoring of blood glucose

+DHealthcare professionalsRegular monitoring of HbA1c

What are the priorities in diabetes management?

Glucose?

Blood pressure?

Cholesterol?

Weight

Glycemic=

control

=

=Lipid

lowering= ВР

Blood glucose targets

1CDA 2003, 2ADA 2004, 3IDF 2005

HbA1C FG Abter2 h

Diabetes patient

<7% 4-7 mmol/L1

90-130 mg/dl*2

5-10 mmol/L1

<180 mg/dl2

Diabetes prevalenceIn 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)

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

Activity

Endocrinologistswere trained from 1996 were trained

31 nurses from each province were participated in training course of diabetes educator in 2005

Actual diabetes problems in MongoliaIn Bulgan,

Arkhangai

Gobisuber

Bayankhongor

Omnugovi hasn’t got endocrinologist

Actual diabetes problems in Mongolia

Diabetes patients 34.3% 2-3 any complication

/l.Tubshinzaya 1997/

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/

Actual diabetes problems in Mongolia

Mortality of diabetes /Ya.oyunchimeg 2004/

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

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

Hospital descriptionSCC hospital

Endocrinology ward

Diabetes patients in outpatient clinic of SCCH

Diabetes patients in endocrinology departments of SCCH

Diabetes specialist service in MongoliaDiabetes Patient first- endocrinologist then

refer to EducatorEducator makes an evaluation and provides

consultation. There are dietitians in every National HospitalSince 2008 District Hospitals are provided dietitians

through a special project. Podiatrist - None

Diabetes specialist service in MongoliaMongolian 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.

Availability of Diabetic Medications and AppliancesInsulin 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

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.

Diabetes Educationin Mongolia

Diabetes Educationin MongoliaGroup teaching-

hospital basedIndividual

CounselingWHO and IDF guides

are used when Blood Glucose monitoring is taught.

Patient’s education is free of charge.

Diabetes support groupsMongolian Diabetes Association is

formed of over 200 doctors and patients.

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.

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.

Undertaking the following actions in the future is properly run intoTo 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.

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.