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Complications of Type 2 Diabetes Mellitus

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Ben Taing

on 20 January 2014

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Transcript of Complications of Type 2 Diabetes Mellitus

Complications of Type 2 Diabetes Mellitus
Models of Care & Recent Innovations
How the Australian Government addresses Diabetes Mellitus

Preventing Diabetes
Supporting People with Diabetes
Investing in Diabetes Research
Monitoring Diabetes
Australian Type 2 Diabetes Risk Assessment Tool (DOHAG 2008)
Role of the Multidisciplinary Team
What is a multidisciplinary team?
• Wide range of Health care professionals working together to deliver comprehensive patient care to ultimately improve health outcomes and satisfactions of clients (Mitchell, Tieman & Shelby-James 2008)

Where can you access care?
• Government
• Non-government
• Private health sectors
• General practice unit
• General or teaching hospitals (Department of Health WA 2008).

Role of the Multidisciplinary team
• Each member brings ones own unique set of expertise to the table and approaches the issue from their own perspective
• Assessments, planning and implementation of care conducted separately (Government of South Australia n.d.)

Challenges from a Nursing Perspective & Interventions
Illness trajectory & Its changing impact
Impact on the patient and family
Chronic health problem
Impact on family

Video - Our Voices: Type 2 Diabetes

A challenge from a Patient and Family Perspective & Interventions
Patient perspective
"So when I was diagnosed with diabetes, I thought I was going to die"
"I was afraid I could not live a normal life"
"How I would cope at home"
"It will limit my social relationships and friendships"

"I believe that despite my diabetes I can still be useful"
"I can still enjoy life"
"A positive attitude will help me cope with diabetes"
(Blogger.com n.d.; Mulvaney et al 2006;

Financial and Social Costs
NHMRC funding into diabetes research

From 2000 to 2007, $188.5 million was invested into research related to diabetes (National Health and Medical Research Council 2011).
Diabetes Australia today welcomed the latest report from the Australian Institute of Health and Welfare, which puts the direct health-care expenditure of diabetes at $1.5 billion for 2008-09 (Diabetes Australia 2013).

Overview of Presentation
Impact on the patient and family
Illness trajectory & Changing impacts on the patient
Models of care & recent innovations
Role of the multidisciplinary team
A challenge related to the management of the disease from a nursing perspective with an intervention
A challenge related to the disease from a patient and family perspective with a possible intervention
Financial and social costs
Who are the Members?
• Design and deliver medical nutritional therapy
• Advocates for better nutritional diet and what foods are required to achieve the goal to improve wellbeing
• Aim of the intervention is to facilitate long term behavioural changes ensuring proper management of health through nutrition, diet and other lifestyle modifications i.e. exercise (Department of Health WA 2008).

Diabetic Educator
Impart knowledge in regards to the disease processes, methods of self-management that encompasses
• Healthy eating i.e. low fat, sugar and salt diet, more vegetables
• Being active
• Monitoring i.e. blood sugar levels, lipids and blood pressure
• Risk reduction i.e. cessation of smoking
• Medication Adherence (Department of Health WA 2008).

Who are the Members?
• Early detection and management of diabetic retinopathy and other ocular problems
• Recommended that mandatory screening are conducted every two years (Department of Health WA 2008).

Psychologist and social workers
• Aids in adjustment to the disease process, behavioural changes to reduce risk of developing anxiety and depression

Exercise Physiologist
• Prevent onset of diabetes for those at risk by designing and delivering clinical exercise interventions
• Provides supportive and individualised education experience that motivates patients for long term change (Department of Health WA 2008).

Who are the Members?

• Play a vital role in prevention, early detection and management of a chronic diabetic foot ulcer or any other lower extremity related issue
(Mitchell, Tieman & Shelby-James 2008).

Subjective perception of a disease
End Stage complications have the greatest perceived burden
Research by Peyrot et al (2005) link diabetes with psychiatirc illness i.e. Depression
Study by Price (2004) within 2 years 13% of patients develop depression post amputation r/t to neuropathy
Health education play a major role in reducing diabetic complication

Overview of Complications
The Complications
• Associated with both nerve damage (peripheral neuropathy) and poor blood circulation (PVD)
• 13% have peripheral neuropathy
• 14% have PVD
• Results in undetected foot ulcers, that potentially may become infected leading to a possible amputation
• Diabetes in the leading cause of lower limb complications (Diabetes Australia 2012).
• Affects the nerves behind the eye
• 15% have develop retinopathy
• x2 more likely to develop glaucoma in comparison to non-diabetes
• Both cause severe vision impairment or blindness (Diabetes Australia 2012).
• Diabetic nephropathy is the most cause of end-stage renal dysfunction
• Caused by high levels of blood glucose that damages the delicate blood filtering capillaries in the kidney
• 16% have this condition (Diabetes Australia 2012).

Cardiovascular Disease
• Develop in conjunction with hypertension
• 70% of diabetes has hypertension
• 29% have experienced at least one previous episode CVD (angina, coronary heart disease or a stroke
• Risk of mortality is 2 times higher than those who are non-diabetic
• Study by AusDiab over a span of 5 years illustrate 34% die of CVD within the time frame (Diabetes Australia 2012).

Psychological Disorders
• 41% suffer from psychological decline
• Only 10% receive treatment (Diabetes Australia 2012).
Diabetes Models of Care
Community Awareness and Prevention of Diabetes
Prevention and Early Diagnosis in High Risk Group
Optimal Initial and Long Term Management
Early Detection and Optimal Management of Complications
Coordinated Prevention and Management of Acute Episodes (DOHWA 2008)
Aim of Diabetes Model of Care
Prevent and Delay onset of Diabetes
Prevent and Slow progression of diabetic complications i.e. CVD, Nephropathy, Retinopathy and lower limb amputation
Improve quality of life in people who have diabetes
Reduce inequalities in diabetic service provision particularly for Aboriginal and Torres Strait Islanders / those from a disadvantaged group (DOHWA 2008)
Increase capacity of GP-Multidisciplinary team to prevent and manage diabetes and its complications.
Develop an efficient interface between general practice and diverse community base prevention and management.
Improvement in accessibility and quality of self management education.
Enhancing service quality.
Improved local service coordination.
Improved access to and effectiveness of specialist service. (DOHWA 2008)
Diabetic Care Project
New care facilitator role created to collaborate with care team to support patient care.
Education and training program to support practitioners and people with diabetes to increase their understanding on diabetes management.
New chronic disease management IT tool to support care planning, enable information sharing and reduce administration through secured portal.
New funding scheme program for people with diabetes who are in need
. (DOHAG 2012)
Family perspective
Family serve great significance in moral support in the diagnosis of type two DM
Family members with type TWO DM can provide negatively and positively influence on adolescent-management
How can family members help:
-Influence change

(Diabetes Australia n.d.; FamilyDoctor.org 2010; Mulvaney et al 2006)
-Plans and strategies in regards to management are not implemented
-Australia is ranked as one of the fattest developed nations
-41% of males and 25% of females were classified as over weight
-18% of males and 17% of females were classified as obese
-Potential complications: neuropathy, retinopathy, nephropathy, cardiovascular and psychological complications
(Diabetes Australia n.d.)

-teaches you to adopt and active lifestyle
-provides knowledge and skills to facilitate
lifestyle changes
(Diabetes Australia Vic n.d.)
Chronic Health Problem
Cardiovascular disease - Atherosclerosis, hypertension, and stroke are common problems affecting individuals with diabetes
Other disease related to diabetes - eye, kidney, nerve and circulatory diseases

2003, 56% diabetic patient has a disability.
2/5 had a profound or severe core activity limitation, needed help with self-care, mobility and communication.

Social isolation – not interacting with friends/family members.
Low self-esteem.
Suicidal thought.

Impact on Family
Interferes with work - loss of family income, face a huge challenge in understanding and adapting to the condition
Decrease quality of life.

Cost For Diabetic Patients
The costs of type 2 diabetes are not limited to the costs of the disease itself, but include the costs of associated diseases and conditions.
Type 2 diabetes cost around $6 billion in Australia.
Healthcare cost for each diabetic patient is $4,025 ~ $9,645 (Baker IDI Heart and Diabetes Institute 2012).
2012, almost 8.2 million dispensed prescription records were for diabetes medicines
11% of claimed scripts were for insulin and 89% were for other blood glucose-lowering drugs.
Metformin - almost 50% of the non-insulin blood glucose-lowering drugs, around 3.6 million scripts claimed in 2012.
Between 1992 and 2012, the annual number of scripts dispensed for insulins and analogues, metformin and other blood glucose-lowering drugs claimed through the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) has gradually increased (AIHW 2013).

By 2023, type 2 diabetes is projected to become the leading specific cause of disease burden for men and the second leading cause for women.
The number of Australians diagnosed with diabetes is expected to grow to 3.5 million by 2033 (Diabetes Australia 2013).

In 2013, the cost of type 2 diabetes range up to $6.57 billion a year.
The complications of diabetes can increase the costs of managing the disease by as much as 12 times (Diabetes Australia 2013).

(Diabetes Australia 2012)
Diabetes Mellitus
Type 2
Challenges r/t illness from a
Nursing perspective
Impact on Pt & Family
Financial and social costs
Illness trajectory & Changing impacts on Pts
Role of the Multidisciplinary Team
Models of Care & Recent innovations
Challenges r/t to management from a nursing perspective & interventions
Microvascular complications
Poor wound healing
Amputation > loss of mobility and decrease QOL
Medication, foods
Diet restriction
decrease sugar diets
Holistic Care
Obesity > HTN > increase cholesterol > Stroke
Epidemic (Highly prevalent in AUS)
Depression > Social Exclusion
Knowledge r/t to Diabetes >
Bad choices
Reference List
Australian Institute of Health and Welfare, 2013, ‘Health service use‘, Australian Government, viewed 30 October 2013, <http://www.aihw.gov.au/diabetes/health-service-use/>.

Australian Institute of Health and Welfare, 2013, ‘Diabetes impacts‘, Australian Government, viewed 30 October 2013,

Blogger.com n.d., ‘Artiga’, viewed 22 October 2013, <http://artiga123.blogspot.com.au/>.

Diabetes Australia, 2013, ‘Diabetes National Election
Agenda 2013 – 2015’, Diabetes Australia, Australia.

Diabetes Australia, 2013, ‘Cost of Diabetes’, Diabetes Australia, Australia.

Department of Health, 2012, ‘Work of the Australian Government on diabetes’, Department of Health, Australian Government, viewed 4 Novemnber, <http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-diabetes-gov#sup>.

National Health and Medical Research Council, 2011, ‘Diabetes’, Australian Government, viewed 31 October 2013, < http://www.nhmrc.gov.au/grants/research-funding-statistics-and-data/diabetes>

Department of Health WA 2008, Diabetics model of care, viewed 19 October 2013, <http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Diabetes_Model_of_Care.pdf>.

Australian Government Department of Health 2012, viewed 15 Oct 2013 http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-diabetes-gov

Australian Government Department of Health Endocrine Health Network 2008, viewed 15 October 2013 http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Diabetes_Model_of_Care.pdf
The Australian Government is aware of the significant burden that diabetes has on individuals and their families and is committed to working towards the broad prevention of the disease, and its associated complications, in the Australian community.

The Government has committed $872.1 million over six years (from 2009) under the COAG National Partnership Agreement on Preventive Health (NPAPH). This is the largest single commitment to health promotion by an Australian government.

The NPAPH seeks to address the rising prevalence of lifestyle related chronic disease by laying the foundations for healthy behaviours in the daily lives of Australians through settings such as communities, early childhood education and care environments, schools and workplaces, supported by national social marketing campaigns (Measure Up and an anti-smoking campaign). (Department of Health 2012).
Government of South Australia n.d., Strathalyn and District Health service: How a multidisciplinary team works?, viewed 19 October 2013, <http://www.ruraldoc.com.au/assets/Publications/Conference%20Presentations/publication-conference-How%20a%20multi-disciplinary%20team%20works-Ms%20Merridy%20Chester%20and%20Mr%20Brett%20Webster-13-05-24.pdf>.

Mitchell, G.K., Tieman, J.J. & Shelby-James, T.M. (2008). Multidisciplinary care planning and teamwork in primary care. MJA, 188(8), p.S63.

Diabetes Australia 2012, Diabetes the silent pandemic and its impact on Australia, viewed 20 October 2013, < http://www.diabetesaustralia.com.au/Documents/DA/What's%20New/12.03.14%20Diabetes%20management%20booklet%20FINAL.pdf>.

Abbott Diabetic Care 2012, Diabetic disease process information and progression, United Kingdom, viewed 20 October 2013, < http://www.abbottdiabetescare.co.uk/the-disease-process-of-diabetes>.

Fonseca, V.A. 2008, ‘Defining and characterising the progression of type 2 diabetes’, British Journal of Diabetes & Vascular disease, vol. 8, no. 2, pp. 53-59.

Diabetes Australia n.d., Diabetes in Australia, Canberra, viewed 22 October 2013, <http://www.diabetesaustralia.com.au/en/Understanding-Diabetes/Diabetes-in-Australia/>.

Diabetes Australia Vic n.d., Diabetes prevention, Victoria, viewed 22 October 2013, <https://www.diabetesvic.org.au/diabetes-prevention/diabetes-prevention>.

FamilyDoctor.org 2010, Helping a Family Member Who Has Diabetes, viewed 22 October 2013, <http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes/treatment/helping-a-family-member-who-has-diabetes.html>.

Mulvaney, S. A., Schlundt, D.G., Mudasiru, E., Fleming, M., Vander Woude, A. M., Russell, W. E., Elasy, T. A. & Rothman, R. 2006, ‘Parent Perceptions of Caring for Adolescents With Type 2 Diabetes ’, Diabetes Care, vol. 29, no. 5, pp. 993-997, American Diabetes Association, viewed 22 October 2013.

Compliance vs Adherence
Compliance: "the extent to which a person's behaviour coincides with medical advice".
Adherence: “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviours to produce a therapeutic result”.

(Delamater 2006)
Non-adherence rates for chronic illness regimens and for lifestyle changes are up to 50%.
Research has shown better adherence for medication use than for lifestyle change. In other studies, adherence rates of 65% were reported for diet but only 19% for exercise.
Daily Self monitoring of blood glucose was reported by only 39% of patients treated with insulin and just 5% of those treated with either oral medications or diet and exercise (Delamater 2006).

Factors related to Adherence
Demographic factors
Ethnicity, low socioeconomic status, education

Psychological factors
Perception of the condition and treatment, higher levels of stress, anxiety, depression, and eating disorders

Social Factors
Support from family, friends,

Health care provider and medical system factors
Availability, frequency and satisfaction with support provided (Delamater 2006).

Assessment of diabetes management factors
Understanding why, how and when consumers stray from healthy behaviours.

Effective behavioural interventions
Patient-centered approaches, collaborative relationship, communicate clearly, and provide direction and advice (Colagiuri et al 2009).

Language can reveal negative attitudes
Language can reflect unrealistic ideas about diabetes (Speight et al 2011).
Can language influence outcomes?

Speight, J., Conn, J., Dunning, T., & Skinner, T., 2011, A new language for diabetes, Diabetes Australia

Colagiuri R, Girgis S, Eigenmann C, Gomez M, Griffiths R. National Evidenced Based Guideline for
Patient Education in Type 2 Diabetes. Diabetes Australia and the NHMRC, Canberra 2009. Pages 68-87

Delamater, A.M., 2006, Improving patient adherence, Clinical Diabetes, Vol 24, no 2, pp 71-76
(Speight et al 2011).
Used of medication
Cost of type 2 diabetes
In The Future
Preventing diabetes
Full transcript