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Patient-Centred T2DM care addressing nutrition and exercise

In document Quality of Life (Page 75-79)

Patient education has been increasingly recognized as an integral part of chronic disease management, particularly in self-managed conditions such as DM. It is considered the cornerstone of overall DM management.85 In the early days of DM treatment, after insulin-treatment had become available, the famous Dr. Elliott P. Joslin exposed hospitalized patients in his clinic to about 16 hours of teaching weekly, to help them understand the need for and ways to achieve optimal blood glucose regulation. Since then the concept of patient education has expanded.85 Nowadays, providing medical information, is not considered the only scope of DM education.

Knowledge is considered important and necessary, but not sufficient for adequate self-regulation of the disease. Rather the focus of education is on assisting patients to overcome attitudinal and motivational barriers, improve their self-management skills and feelings of self-efficacy.

International guidelines state that education is offered to facilitate patients to self-manage their DM and empower them to make informed choices in their lives. Education programs have moved away from didactic teaching, to adopt a more coping-oriented, Patient-Centered approach, using psychological techniques such as self-reflection, behavioral skills training and stress management techniques.85 Congruent with this change in focus, studies evaluating the effects of self-management education (SME) in DM have relied less on knowledge gain, and more on improvements in attitudes, self-efficacy beliefs and daily self-care behaviors. If self-care behaviors

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improve over time following SME, then we may expect to see subsequent sustained improvement in metabolic outcomes.85

DM and its complications pose considerable health burden; sub-optimal health behaviours including physical inactivity, high calorie intake, inadequate blood glucose self-monitoring, and poor adherence to medications are well established risk factors for T2DM and its complications.86 In response, various studies have evaluated educational and behavioural interventions designed to supplement medical management and help individuals with T2DM to modify risk factors for DM and its complications.86

Increased physical activity and dietary management implemented by health-care professionals is fundamental to initial treatment of T2DM and is recommended by international consensus.87 A PCC study, using nutrition and exercise workshops as interventions conducted by Prueksaritanond et al,26 among 78 patients with T2DM who regularly attended the outpatient clinic, of the family medicine department of Ramathibodi hospital, Mahidol University, in Thailand concluded that glycaemic control of T2DM subjects were improved by patient-centered- Care. The study also reported that eating and exercise behaviours as well as compliance and symptoms of DM were better.

Brown et al, 88 in a similar study on the Texas-Mexico border in Starr County of the US reported that the experimental group had significantly lower levels of HbA1c and fasting blood glucose at 6 and 12 months and higher DM knowledge scores than the control group.

Another study by Linstrom et al, 89 carried out in Helsinki, Finland, evaluated the effectiveness of life style intervention (diet and physical activity) and concluded that the intervention group showed significantly greater improvement.

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Andrews et al, 87 in a multicentre study done in south-west England, United Kingdom, showed that HbA1C and BMI significantly decreased in the diet and activity group compared with the usual care group at six months. However, they reported that blood pressure was similar throughout the study.

Gaede et al, 90 in a randomized controlled multi-factorial intervention, concluded that the intervention group had significant reduction in BMI and HbA1c. They also reported that the systolic and diastolic blood pressure decreased by 10 and 5 mmHg, respectively.

Another randomized controlled community-based nutrition and exercise intervention study conducted in Costa Rica by Goldhaber-Fiebert et al,90 submitted that glycaemic control of T2DM patients could be improved through community-based, group-centered public health interventions addressing nutrition and exercise.

Deakin et al,92 in Lancashire, UK, in a patient-centered group-based, self management programme reported that participants in the programme had improved glycaemic control, reduced total cholesterol level, body weight, BMI and waist circumference. The study also found that there was reduced requirement for DM medication; increased consumption of fruits and vegetables, self-empowerment, self management skills and treatment satisfaction.

In a study done by Ozer et al, 93 in Istanbul, in which they examined the influence of DM education on well-being; they reported that the mean anxiety score was significantly lower whereas positive well being and general well being scores and QOL were significantly higher in patients who participated in the program, than for patients who did not.

In a meta-analysis by Noris et al, 94 to evaluate the efficacy of self-management on HbA1C in adults with T2DM, they found that the HbA1c of the intervention group decreased by 0.76% more than

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the control group at immediate follow-up and by 0.26% at 1 to 3 months follow-up. They also found that the HbA1c decreased more with additional contact time between participants and educator. A decrease of 1% was noted for every additional 23.6 hours of contact.

Another study by Sarkisian et al, 95 which systematically reviewed DM self-care interventions for older African Americans or Latino adults, reported improved glycaemic control in the intervention arm compared with the control arm. They also found improved QOL in the intervention arm of one study.

However, in Nigeria, there are no published studies comparing the effects of Patient-Centered- Care addressing nutrition and exercise with Routine or Usual Care on the glycaemic control and QOL of patients with T2DM. This study therefore, will attempt to fill in this gap and compare the findings with those of other parts of the world.

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CHAPTER THREE METHODOLOGY

In document Quality of Life (Page 75-79)