Diabetes: Introduction and Section 1 Improving Care and Promoting Health

Diabetes: Introduction and Section 1 Improving Care and Promoting Health


Well, hi everybody this is Dr. Jennie Peters, and I’m going to be talking about diabetes. So as you probably already know and taking care of numerous diabetics in your nursing career diabetes is complicated it’s complex and therefore I have a lot of slides so I’m taking these slides directly from the American Diabetes Association. They are the updated 2019 Guidelines they have fantastic slides and information on here So instead of making my own I am going to use these I’m not allowed to alter them in any way Which is why there are so many slides so I’m gonna do this in sections. So It might help you so you can kind of watch it each section when is convenient for you or and take a break and I’m not one to read through slides either because I know you guys can read slides So I’m gonna do the best I can to just give an overview of what’s on each slide and add some anecdotal information In addition so this first part here is just an overview basically of the guidelines There’s twelve slides on here. So I’m just gonna start this Here, alright, and this screen just says that we’re not allowed to reproduce it. And this is from the standards of medical care and diabetes of 2019 you can Get that online on the a DA website. You can print it out. I’m not sure if you can order copies But that probably is an option. I have an article that I will make sure that Dr. Parr VIII gets it uploaded so you don’t have to worry about that Now these are the standards and how do we determine what the guidelines are? well we have evidence and then we have committees that go through and make sure that this evidence is From really good studies and I’ll show you slide in a minute. And then also we need funding To do this too. So it’s out of the American Diabetes Association to make these guidelines And it mentions it does not use any industry support So there’s been some recent changes more in process because with technology and so many changes in diabetes care and medications There’s a lot of things that they need to look at continuously. So what they did is Making it more online so you can update it frequently the organizations and the Committees can do that. And now what they’re doing is taking proposals from the community, which is kind of nice because it’s not just specific Organizations that they take comments from or proposals and Now it’s going to be from the community consensus report scientifically reviews clinical and research conferences Hmm, all right, so also this is a living document meaning it’s a live document so there’s always might be updates to this and When they’re going to make any updates is if there’s approval of new medications specific devices or if there’s some research that came out that supports a change or Recommendation or the evidence level of recommendation, which I’ll show you an evidence table All right. So this is the evidence table. You should have seen this by now for evidence-based care now remember levels a B and C and C and E and Level a is the best so it’s comes from really well-designed random Randomized control double-blind studies usually so that’s good and then level B are also really good studies Those are usually cohort perspective or Analysis of a specific population and then C is more of a poorly controlled study So it’s not that they’re not recognizing it as a study. They would put a recommendation But then they’ll also say what was a C. So maybe it wasn’t a well-designed study There’s good, these are all the table of contents so like I said gonna like put these into different slide sets for you and Videos, so it’ll be helpful for you. Alright, so section one, this is general Just how are we going to care for the population? and some statistics a lot of people don’t meet targets for their a1c blood pressure or lipids and Just you know, there’s a high percentage of people that are walking around that are not diagnosed with diabetes They’re not diagnosed with pre-diabetes and they already have it Metabolic syndrome is one condition That is under diagnosed. And so I’m going to really emphasize that As I started with metabolic syndrome, so I will tell my story as I go through this and I’m not your typical Person that you’d see with metabolic syndrome So meaning that my BMI has always been under 25 and I’ve never had an issue really with my weight So I will go through that story and tell you and I want you to be aware that not all diabetics are overweight and even time talking type 2 we know diabetics that are type 1 we usually will see them more on the underweight side or thinner but type 2 Well, typically we do see it’s a weight issue and insulin resistance You can be of a normal BMI, but still have some insulin resistant issues. There’s some genetic components So as we know that people are meeting the targets There’s a chronic care model that it’s we’re trying to change to prevention now we can’t prevent once Diagnosis diagnosed but we want to try to prevent diabetes in the first place, but this chronic care model We’re trying to get more of a proactive Care delivery rather than being reactive because our society and it just it started You know over a century ago of becoming reactive due to all the infectious diseases and illnesses and then antibiotics So it is a reactive society also, how are we making decisions and we need to make sure that these registries are up to date because that’s going help us gather data to Determine whether treatments are working or whether they’re not working as well as community resources In every single city every single neighborhood it starts with us. It starts with our community so population health is really important and This brings me to diabetes in population health. We need to work as a team And this is what this slide basically says, we cannot do this alone as providers We need to work together with people externally out of the office out of the Hospital and in and out in the community and I tell the patient that you are with me for 30 minutes Let’s just say for example, every three months you are in your own environment for the rest of time so we need this to be a team effort on the patient’s part also and this talks about social context where We as I said on the last slide to refer to Community resources and also we should also not just only provide them Professionals as are their family members. Are there other people that do have a lot of wisdom and knowledge about diabetes So let’s not underestimate the lay population that may know more than what we think they know and we can educate

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