María Jesús Salido Rojo
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Diabetes Education the Key to a Difference in Outcomes

By María Jesús Salido Rojo | Wed, 07/06/2022 - 15:00

Diabetes mellitus has the highest prevalence in Mexico of any chronic noncommunicable disease, estimated at 16.9 percent of the adult population aged 20 to 79 (IDF, 2021). Given the magnitude and significance of the number of Type 2 diabetes cases, in 2016, the Mexican Ministry of Health jointly with the National Health Safety Committee issued an epidemiological  emergency declaration for the entire country.

Aside from public health, diabetes directly affects the work productivity of Mexicans. It is the leading cause of death in people aged 45 to 65 and the  leading reason for occupational disability pensions as a result of chronic complications (INEGI, 2020). The impact of diabetes on indicators such as absenteeism, sick leave, disability and/or presenteeism is simply unacceptable.

We know  that 87.8 percent of people living with diabetes receive medical treatment to control the disease but only half of those diagnosed apply some preventive measure to avoid or delay any complication from the condition and only 25 percent had evidence of having adequate control of the disease (HbA1c 7 percent or below), with an even lower proportion having modified their lifestyle (diet and physical activity), according to ENSANUT 2018-2019.

Against this alarming backdrop, we have to be highly effective and focus on high-impact strategies, as there is no successful healthcare strategy without a change in patient behavior; change that will only come through the implementation of education, digital technology and data intelligence  to help patients make the right decisions, empower them and help them take control of their health and their lives.

Diabetes treatment must therefore be adaptive to the patient's day-to-day, based on their lifestyle areas where no healthcare system is consistently present.

Learning vs Education

Diabetes education is the fundamental tool for patients to understand their health condition and to improve behavioral habits and positive attitudes toward self-care.

Are we really helping patients through the process of awareness, acceptance, training and self-management though? How do we transform the management approach from a system that has historically understood the patient as a passive subject to one focused on behavior and habits? How do we take advantage of new technologies to evolve from traditional, one-way, decontextualized education systems to a truly immersive, personalized and meaningful learning experience? How do we move from managing the illness to managing health?

We understand education as a dynamic teaching-learning process that must be provided under a well-structured, personalized model, establishing clear objectives, with a scientific methodology using well-selected educational and teaching strategies, while being constantly evaluated, both qualitatively and quantitatively, considering clinical and behavioral indicators.

The 7 Self-Care Behaviors

The American Association of Diabetes Educators (AADE), now the Association of Diabetes Care and Education Specialists (ADCES), developed an educational model of care based on seven self-care behaviors essential for every person living with diabetes to achieve effective diabetes management:

  1. Healthy eating
  2. Being physically active
  3. Monitoring
  4. Taking medication
  5. Problem-solving (everyday challenges)
  6. Reducing risks
  7. Healthy coping (living with diabetes)
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Over and above rigorous, validated, useful content, these must be structured and streamlined in accordance with real user needs.

Patient training should be:

Fun: No learning without pleasure. We must immerse participants in a game setting and stimulating environment that encourages participation naturally and organically, through intrinsic motivation based on social and meaningful rewards.

Personalized: Each patient is different. An education strategy must consider this uniqueness. Onboarding should be adapted to the patient's profile and content management should be based on the patient's interests and performance. Artificial intelligence is already helping us,  in what we call precision medicine, so let's apply it to precision-learning environments as well.

Contextualized: If content reaches users in a way that is disconnected from their needs in the here and now, it will lose effectiveness. We need to give patients educational pills when they need them and on the concepts they need at the time to make decisions.

Collaborative: Patients do not live in isolation. We need support networks that integrate their entire social ecosystem, family, friends, other patients ... and that encourage mutual help, the sharing of advice, problems and good practices, so that a positive “Social Contagion” dynamic is generated.

As for the means to implement educational programs, these must be adapted to the conditions and characteristics of the population, taking into account the current lifestyle, which is why digital technologies are crucial in the process, with mHealth and telemedicine as allies.

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Currently in Mexico, diabetes education is a recent growth discipline and its involvement in diabetes patient care is still very limited. Public and private health plans should consider this as a strategic element.

The lack of diabetes education is as serious as the lack of medication, and it is worth recalling the words of Dr. Elliott Joslin, considered the father of diabetes education, who said that, "Education is not a part of the treatment of diabetes, it is the treatment."

 

 

 

REFERENCES

International Diabetes Federation; IDF Diabetes Atlas 2021 – 10th edition. available at: link

Instituto Nacional de Estadística y Geografía (INEGI); Estadísticas a propósito del Día mundial de la diabetes (14 November); 14 November 2021; link

Centro Nacional de Programas Preventivos y Control de Enfermedades del Gobierno de México; Declaratoria de Emergencia Epidemiológica EE-4-2016 para todas las Entidades Federativas de México ante la Magnitud y Trascendencia de los casos de Diabetes Mellitus; 19 October 2017.

Barraza-Lloréns M, Guajardo-Barrón V, Picó J, García R, Hernández C, Mora F, Athié J, Crable E, Urtiz A (2015) Carga económica de la diabetes mellitus en México, 2013. México, D.F.: Funsalud.

Instituto Nacional de Salud Pública (INSP); Encuesta Nacional de Salud y Nutrición 2018-19: Resultados Nacionales; Subdirección de comunicación científica y publicaciones Secretaría de Salud, Cuernavaca, México; 2020.

American Diabetes Association (ADA); Standards of Medical Care in Diabetes—2022; Diabetes Care The journal of clinical and applied research and education; January 2022 Volume 45, Supplement 1; available at link

American Association of Diabetes Educators. AADE7 self-care behaviors. American Association of Diabetes Educators (AADE) Position Statement.Chicago: American Association of Diabetes Educators (2014); available at link