Diabetes Education Edu

The magic capsule for primary and seco

W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

P o s t e r V I d e o - t a p e P r o c u r e L e c t u r e

L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
 Diabetes Education
The magic capsule for primary and second

W e I g h t DIABETES
l o s s H e aIS
l t hAN
y d IEPEDEMIC
e t E x e r c IDISEASE
s e !S c r e e n I n g

IS IT A PREVENTABLE DISEASE ?

WHAT AREP THE

o s t e r
WAYS OFV PREVENTION
I d e o - t a p e
?
P r o c u r e L e c t u r e

WHICH METHOD TO USE ?

WHERE DO WE GO NOWL o?w p r e v a l e n c e l e s s c o m p l I c a t I o n

 Historical story of diabetes prevention
Ancient Greek scientist
500 B.C.

Polyuria ? :
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

He described a disease characterized by:

Polyuria. P o s t e r V I d e o - t a p e P r o c u r e L e c t u r e
Lack of pain.
Weakness.
Fluid output greater than fluid intake.
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n

Treat by:
Diet containing a minimum amount of food.
Regulated mode of life. Celsus

De Medicina ( English translation).

 Diabetes is preventable dise

The proven methods in prevention of

W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

diabetes are:

1. Lifestyle
P o s t e rmodification.
V I d e o - t a p e P r o c u r e L e c t u r e

2. Drug use.

3. Future methods: L Vaccine

o w p r e v a l e n c e l e s s c o m p l I c a t I o n
Genetic ?
 Historical story of diabetes prevention

Two early studies suggested that changes in life style can

W e I g h t
l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g
prevent diabetes:

1. Prevention of type 2 diabetes mellitus by Diabetologia 34,

diet and physical
P o s t e r exercise 1991
V I d e o - t a p e P r o c u r e L e c t u r e

2. Effects of diet and exercise in preventing Diabetes care 20,

NIDDM in people with impaired glucose
tolerance: the Da Qing IGT and Diabetes study 1997.
1997.
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
 Historical story of diabetes prevention

Four recent well designed randomized controlled trails:

1. Prevention of type 2 diabetes mellitus N Engl J Med 344,

by changes in lifestyle among subjects
W e I g h t l o s s with impaired
H e a l t h yglucose
d I e t tolerance
E x e r 2001
c I s e S c r e e n I n g

2. Diabetes prevention research group: N Engl J Med 346,

Reduction in the evidence of type 2 diabetes
with lifestyle intervention or Metformin 2002

Diabetes Pprevention
o s t e r research Vgroup:
I d e o - t a p e P rDiabetes
o c u r e care 23, L e c t u r e
The diabetes prevention program: baseline
characteristics of the randomized cohort 2000

3. Diabetes prevention program: Diabetes care

Design and methods for a clinical trial in
the prevention in type 2 diabetes
L o w p1999
r e v a l e n c e l e s s c o m p l I c a t I o n

4. Prevention of pancreatic cell function and

Diabetes 51, 2002
prevention of type 2 diabetes by pharmacological
treatment of insulin resistance in high risk
Hispanic women 2002
 The Finnish Study 2001

Number 522
Age (mean) 55 years
BMI (mean) 31 kg/m2
Clinical condition IGT
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g
Control group:
Received brief diet and
Exercise counseling
Intervention group:
ReceivedP ointensive
s t e r individualized
V I d e o - t a p e P r o c u r e L e c t u r e
instruction on weight reduction,
Food intake, and guidance on
increasing physical activity
Lifestyle

Duration (mean) L o w
3.2 years p r e v a l e n c e 58% l e s s c o m p l I c a t I o n
 Diabetes Prevention Program (DPP)

Number 3,234
Age (mean) 51 years
BMI (mean) 34 kg/m2
Clinical condition IGT
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g
Lifestyle group:
Intensive nutrition and exercise
counseling
Treatment group:
Two masked
P o s t emedications:
r V I d e o - t a p e P r o c u r e L e c t u r e
1. Biguanide Metformin.
2. Placebo. Lifestyle Metformin

Duration (mean) 2.8 years

L o w
58%
p r e v a l e n c e
31%
l e s s c o m p l I c a t I o n
 The Troglitazone in Prevention of Diabete

Number 235
Age (mean) Younger
BMI (mean) 28 kg/m2
Clinical condition GDM
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g
Placebo group:
Received Placebo
Tested group:
Received Troglitazone which is
Withdrawn
P o s tfrom
e r the groupV I d e o - t a p e P r o c u r e L e c t u r e
Named Thiazolidinediones class Troglitazone

Duration (mean) 2.5 years

56%
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
 STOP-NIDDM trail

Number 1,429
Age (mean) 55 years
BMI (mean) 31 kg/m2
Clinical condition IGT
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g
Placebo group:
Received Placebo
Tested group: Acarbose
Received Acarbose from the group
named Po-glucosidase
s t e r inhibitor
V I d e o - t a p e
25% P r o c u r e L e c t u r e

To
Duration (mean) 3.3 years

L o w p r e v a l e n c e
36% l e s s c o m p l I c a t I o n
 Lifestyle in prevention of type 2 Cumulative probability of remaining free of Diabetes
1
diabetes
0.9
Education pill:
reduce weight >5%.
0.8
Fat <30% of energy consumption.
Fiber intake >15gm per 1000kcal.
Intervention group
Moderate exercise for 30 min/day. 0.7

Control group

Education dosing: 0.6

Seven sessions with nutritionist in 1 year st

then 0.5

W e I g h t One
l o session
s s every
H e athree
l t h ymonths.
d I e t E x e r c I s e 0 1
S c r e 2e n I nStudy
g3 years 4 5 6

Self-reported
Individual guidance on physical
change activity. and exercise Habits during the first year
in dietary
Variable Intervention group Control group
P value
Number 253 (%) Number 247 (%)
Decrease fat consumption P o s t e r 87V I d e o - t a p e 70P r o c u r e L e c t u r e
0.001
Increase vegetables consumption 72 62 0.01
Decrease sugar consumption 55 40
0.001
Increase exercise
Success 36
in achieving the goals 16
of the intervention by one year 0.001
Variable L o w p r e v group
Intervention a l e n c e Control group
l e s s c o m p l I c a t I o n
P value
Number 253 (%) Number 247 (%)
Weight reduction >5% 43 13 0.001
Fat intake <30% 47 26 0.001
Saturated fat intake <10% 26 11 0.001
Fiber intake 15g/1000 kcal 25 12 0.001
Exercise >4 hr/week 86 71 0.001
N Engl J Med,, Vol. 344 May 3, 2001
 Public education
Health
HealthEducation
Education
The expected relation between:
W e I g h t l o s s the level
H e a of public
l t h y d I health
e t E x e r c I s e S c r e e n I n g
education and the prevalence of
diabetes. 125 Level of Education

No data available to prove this Degree of disease prevention

because: 100
1. P o s t e r
Public education V I d e o - t a p e P r o c u r e L e c t u r e
standardization.
2. Multi-factorial disease. 75
3. Ethnic and cultural factor.
4. Long duration trials.
5. Life-style modification difficulty.
50
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
Involvement level: 25
Individual.
Family.
Community. 0
Nation.

Risk factors:
Controllable vs non-controllable
 Risk factors for type 2 Diabetes
Which factors?
Education effect

Uncontrollable: Individual conditions:

Age. Age 45 years No
Genetic. Overweight
Overweight( BMI( BMI2525
kg/m2
kg/m2
) ) Yes
Yes
Ethnicity. First degree relative with diabetes No
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g
Associated diseases: Habitual
Habitualphysical
physicalinactivity
inactivity Yes Yes
- Hypertension Ethnic risk No

Pre-diabetes conditions:
Controllable: IGF
IGF ororIGT
IGT Yes
Yes
Weight. P o s t e r VHistory
I d e o - t a p e P r o c u r e L e c t u r e
HistoryofofGDM GDM or or
bigbig
baby
baby> 4> kgm4 kgmYes Yes
Exercise.
Associated disease: Associated conditions:
- Hyperlipidemia Hypertension 140/90 mmHg Yes/No
- Polycystic disease
- Vaculopathy HDL 0.9
HDL 0.9mmol/l
mmol/l triglyceride
triglyceride
2.822.82
mmol/l
mmol/l Yes
Yes
Polycystic
Polycysticovary
ovarydisease
disease(PCOS)
(PCOS) Yes
Yes
L o History
History
w p r e of
v of
avascular
l vascular
e n c e disease
disease l e s s cYes
o m p l I c a Yes
t I o n
 Education 21%
21%
A share between doctors and 79%
79%
patient

Patient share is an important

W e I g h t lissue
o s s that need
H e a special
l t h y dtraining
I e t for
E x e r c I s e S c r e e n I n g
Doctor Patient
the treating physician. Doctor Patient
Before
Beforetraining
training
Patient involvement in education
is only 21% which
P o change
s t e r to 47% V I d e o - t a p e P r o c u r e L e c t u r e

after training.

47% 53%
47% 53%
Continuity and patient load was
not tested which will affect the L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
out-come.

Doctor Patient
Doctor Patient
After
Aftertraining
training
Therapeutic education
education of
of Patients
Patients Assal,
Assal, 2000
2000
 Diabetes Education according to the source

Physicians are the highest in providing patients with diabetes education but they are the
least effective.
The most effective method is the special training classes with >75% effect but not practical.
The role of diabetes educator (nurse) is as effective >75% and more practical.
Others ie; teachers, volunteersetc need to be evaluated.

W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

% Receiving education % Effective education

P o s t e r V I d e o %
- t Effective
a p e education
P r o c u r e L e c t u r e
% Receiving education
100 100
100 100

75 75
75 75

50 50
50 50
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n

25 25
25 25

0 0
0 0
Doctor Diatition Nurse Class Other Doctor Diatition Nurse Class Other
Doctor Diatition Nurse Class Other Doctor Diatition Nurse Class Other

Massachusetts Results from the Behavioral Risk Factor Surveillance System (BRFSS) 1996
 Education of physicians vs patients:
401 intervention group focused on improving the skills and knowledge of general
practitioners (EMC).
413 second intervention group focused on patients education and self management (DS).
105 reference group choosing patients from regular clinics (RG).

W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

P o s t e r V I d e o - 0.2
t a p Change
e P r o c(%)
in HbA1c u r e L e c t u r e
0.2 Change in HbA1c (%)
Patient education and self management 0.1
Patient education
decrease HbA1c by and selfcomparing
0.51% management
to the 0.1
decrease HbA1c by 0.51% comparing to the 0
reference group. 0 DS EMC
reference group. -0.1 DS EMC
-0.1
Improving GPs skill and knowledge decrease -0.2
Improving GPs skill and knowledge decrease L -0.2
HbA1c by 0.23% comparing to the reference o w p r e -0.3
v a l e n c e l e s s c o m p l I c a t I o n
HbA1c by 0.23% comparing to the reference
group. -0.3
group. -0.4
-0.4
-0.5
The patient involvement through education in -0.5
The management
their patient involvement through
give extra education
0.28% decreaseinin -0.6
their management give extra 0.28% decrease in -0.6
the mean HbA1c.
the mean HbA1c.

Diabetic Medicine, 20, 846; 2003

 Model of Public Education

Education
Educationprogram
program
Knowledge
Risk factors
What to do
Reduce weight >5%.
WReduce
e I g h t weight
l o s s >5%. H e a l t h y d I e t E x e r c I s e
Factors:
S c r e e n I n g Weight loss
Age distribution
Fat <30% of energy consumption. Problem size
Healthy diet
Fat <30% of energy consumption. Illiteracy rate
Cultural factor
Health system
Fiber intake >15gm per 1000kcal. Physical activity
Fiber intake >15gm perP1000kcal.
o s t e r
Health beliefs
V I d e o - t a p e P r o c u r e L e c t u r e

Moderate exercise for 30 min/day. Behavior

Moderate exercise for 30 min/day. Eating less
Healthy diet
Exercise plan

L o w p r e v a l e n c e l e s s c o m p l I c a t I o n

Decrease Decrease
costs Prevalence
 Model of Diabetes Education

Education program Knowledge

Diabetes general
Diabetes
Certified educator. Factors: management
W e I g h t l Education
o s s H system.
e a l t h y d I e t Age E x e r c I s e S c r e e n I n g
Sex
Same language. Duration of
Patients Education materials. DM

Support group.
Culture
Education
Good
Integrated into level control
Language
lifestyle. P o s t e r Health V I d e o - t a p e P r o c u r e L e c t u r e

Assisted by local system Behavior HbA1c

Health Blood glucose
health beliefs
Skill performance
care providers. Compliance/Adheren Weight loss
ce
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n

Decrease Decrease
medical costs complications
 Educology Pharmacology

Definition: Definition:
Using education as a tool for disease Science of drug effect on human body and
prevention or treatment. its role in disease treatment.

Material: Material:
Large verity of methods. Active compound.
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

Efficacy: Efficacy:
More effective than drugs. Effective according to the dose.

Action: Action:
Long term. Short term.
P o s t e r V I d e o - t a p e P r o c u r e L e c t u r e

Side effect: Side effect:

None. May be.

Cost: Cost:
50 SR annually.* 4000 SR annually.*
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
Acceptance: Acceptance:
Less accepted.** More accepted.**

* The National Saudi Diabetes Registry 2004.

** Diabetic Medicine Vol 24, 1997.
 Factors related to each method
Educology Pharmacology

Age at education. Age.

Literacy rate. Disease related.

W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g
Culture effect. Indication.

Easy administration. Different routes

(bioavailability).
Can be doneP by
o s tany
e r body. V I d e o - t a p e P r o c u r e L e c t u r e
Prescribe by physician.
No side effect.
Side effect.
Accumulative effect.
Dose related.
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
Effect loss with time.
Effect with use only.
 Is Physician Advice (patient education) effective?
Weight loss Exercise
Medication

Age:
65 Reference group for age Effective
45-64 0.75 1.21 0.88
W e I g h t 18-44
l o s s H e 0.15
a l t h y d I e t E x 0.96
e r c I s e S c 0.31
r e e n I n g

Sex: Non-effective
Male Reference group for sex
Female 0.75
P o s t e r 0.89
V I d e o - t a p e 1.30
P r o c u r e L e c t u r e

Ethnicity:
White Reference group for race Non-effective
Black 0.95 1.19 1.16
Hispanic 2.14 L o1.30
w p r e v a l e n c e 0.80 l e s s c o m p l I c a t I o n

Other 2.20 1.14 0.88

Effective Less effective Effective

Diabetes care, Volume 26, Number 3, 602-607; March 2003

 Physical activity

% Insufficient activity
100
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

There is no difference
between adults with or 75
without diabetes in the
percentagePof insufficient
71 69
o s t e r V I d e o - t a p e P r o c u r e L e c t u r e
physical activity 50

This data indicate that there 25

is a large space for exercise
in both primary and L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
secondary prevention. 0
Diabetics Non-Diabetics

Therapeutic education of Patients Assal, 2000

 Education is Knowledge
and behavior % Heard of HA1c
Patient education: 100
97
Have you heard about HbA1c? 75

- Age group: 18-30 97%

31-64 31% 50
>65 13%

W e I g h t - Younger
l o s s patients
H e a l have
t h y better
d I e t E x e r c I 25
s e S c r e e n I n31g
education.
- Type of diabetes effect. 13
- The target group 30-65 0
18-30 31-64 >65
Age
P o s t e r V I d e o - t a p e P r o c u r e L e c t u r e

Patient behavior:
15%
37%
How many times did you check your
feet? 31%
L o w p r e v a l e n c e
17% l e s s c o m p l I c a t I o n
None 15%
1-2 times 31%
3-5 times 17%
> 5 times 37%
None 1-2 times 3-5 times > 5 times

Number of times feet were checked in one year

Therapeutic education of Patients Assal, 2000

 A Saudi twin families:

W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

Mohamed and his twin

Abdullah are76 years old, 15
both have type
P o s t2
e rdiabetes V I d e o - t a p e P r o c u r e L e c t u r e
managed currently with
insulin. 10 Mohameds family

Mohamed has 13 children

while Abdullah has 17 5
children. Abdullahs family
L o w p r e v a l e n c e l e s s c o m p l I c a t I o n
Follow-up started 1989 with
yearly OGTT. 0
Mohameds family refused 0 5 10 15
education on prevention but
Abdullahs family agree.
 Weight

If you dont know, you have to learn

Diet Activity
W e I g h t l o s s H e a l t h y d I e t E x e r c I s e S c r e e n I n g

If you learn, you have to implement

P o s t e r V I d e o - t a p e P r o c u r e L e c t u r e

If you implement, you have to do it right

L o w p r e v a l e n c e l e s s c o m p l I c a t I o n

If you do it right, it has to be always.

 Eat healthy
Do exercise
Watch your weight.

Mass Education