Health Delivery

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A multidisciplinary effort to improve the quality of chronic disease care

Although chronic diseases are leading causes of death and disability, they are neglected elements of the global health agenda. Of all deaths worldwide in 2005, 60% were caused by chronic diseases – principally cardiovascular diseases and diabetes (32%), cancer (13%), and chronic respiratory diseases (7%). Because the increase in chronic diseases is underappreciated, and their economic impact underestimated, many countries take little interest in their prevention, and leave the responsibility for management to individuals.


Barriers to self-management in people affected by chronic disease

Diabetes healthcare providers are no strangers to the self-management model. Indeed, it could be said that diabetes is the field in which the self-management model has been most thoroughly developed and implemented. The marriage of expert clinical care with self-management by the individual is an ideal union and an increasingly common objective. It is an excellent goal – one that is achievable by many. Yet a number of systematic barriers to self-management exists.

Challenges to diabetes self-management in developing countries

In developing countries, financial and human resources are limited despite serious needs and multiple health challenges. More than three-quarters of the people with diabetes worldwide live in developing countries. Between 2000 and 2025, the rise in the number of people with the condition in these countries will be around 170%. In  the developing world, diabetes, like other chronic diseases, is often ignored in terms of healthcare priorities; the focus remains largely on immediate and acute care rather than on prevention.

Self-monitoring of blood glucose for people with type 2 diabetes: the need for better understanding

Diabetes increases a person’s risk of developing multiple health complications. But the risk of these can be significantly reduced by close control of blood glucose. Although directly monitoring glucose levels to inform adjustments in insulin levels is now a proven part of self-management for people with type 1 diabetes, the role of glucose monitoring for people with type 2 diabetes is less well established.

IDF guideline on self-management of blood glucose

In October 2008, the IDF Task Force on Clinical Guidelines, in conjunction with the Self-Monitoring of Blood Glucose nternational Working Group, convened a workshop in Amsterdam to address the use of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes who are not treated with insulin. The recently published guidelines on the use of SMBG in people with type 2 diabetes were developed based on the findings of that workshop. A summary of the findings and recommendations is provided in this article.

Diabetes self-management education and support: the key to diabetes care

Diabetes education can be delivered using a variety of methods and in a range of settings: a lecture on, say, carbohydrates and glucose monitoring; an individual face-to-face meeting with an educator or a dietitian; a group session where an educator and people with diabetes can all act as educational resources. It can take place  in a classroom, an office or under a tree, supported by professionally produced photographs and posters or hand-drawn signs.

Improving self-care in young people with diabetes - the importance of self-efficacy

Young people are given responsibility in different ways and at different rates across cultures and families. However, families from different backgrounds face similar challenges in supporting the self-care of a young person with diabetes. Learning to consistently carry out daily diabetes self-care tasks involves the help and support of relevant people across the lifespan: parents, siblings, friends, extended family, spouses/partners, and ultimately, children.

A behavioural therapy approach to self-management: the Flinders Program

Chronic diseases, including diabetes, represent the most prevalent problem in healthcare today. They are the most common cause of disability and consume the largest part of health expenditures internationally. Most diabetes care is provided by people with diabetes and their family or supporters. Therefore, understanding how to enhance diabetes self-management is of primary importance in addressing this growing burden. The effective self-management of type 2 diabetes is closely linked to environmental factors and a person’s lifestyle.

Engaging in a shared vision for self-management: the WISE approach

In recent years, many initiatives from many sources have been aimed at improving people’s ability to manage a chronic medical condition – ranging from top-down policy programmes to small-scale projects developed by individuals. Work related to the care of people with diabetes has generally been at the forefront of this type of research. Policy-related programmes tend to focus on the most effective use of health services, and initiatives coming from individuals are more likely to be about sharing experiences of an effective treatment.

The Aboriginal Diabetes Initiative - tackling type 2 diabetes in Canada

In 2005, the Government of Canada provided a renewed investment of 190 million CAD over five years to maintain and enhance the Aboriginal Diabetes Initiative. The main goal of the Initiative is to reduce type 2 diabetes and its complications through a range of culturally relevant health promotion and prevention services, delivered by trained health service providers and diabetes workers. Supported by Aboriginal Diabetes Initiative funding, Aboriginal communities across Canada are working to prevent and  manage type 2 diabetes. Amy Bell reports.

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