A shift in diabetic care increases emphasis on self-management, education

A change in diabetic education and care from hospitals, suggested by the government, is set to change how those diagnosed with type 1 and 2 diabetes approach their illness.

Community diabetes education centres (DECs) and support groups focus on teaching individuals how to manage the illness on a daily basis, which works hand-in-hand with regular hospital visits and medication monitoring.

Brenda Hartman, who worked for the Durham Region Diabetes Network (DRDN) as a dietitian in diabetes education, says most doctors aren’t trained in educating their patients.

“Doctors are important in that they monitor medications but if a patient doesn’t understand how to use them effectively then the disease progresses faster,” she said. “(Faster) than if the patient is empowered and works hard to control their blood sugars early through diet, medication and exercise.”

DECs and support groups focus on self-management. Their goal is to teach diabetics how their disease works, how to change their diet and lifestyle to slow the damage to their body, and what financial aid they can apply for to help cover medicine. Education centres also focus on health-care issues linked to diabetes, such as eye sight, cardiovascular and foot care.

“High blood sugars over time can damage blood vessels in the eyes, kidneys, peripheral limbs and eventually the heart,” Hartman said.

The idea is you come not just for your diabetes, but for your whole health care surrounding your diabetes.

— Giselle Sicchia

Giselle Sicchia, of the Diabetes Regional Coordination Centre, a part of the Local Health Integration Networks, says the integration of health care is one of the benefits of the education centres.

“There are integrations of programs within the health-care setting,” Sicchai said. “The idea is you come not just for your diabetes, but for your whole health care surrounding your diabetes.”

In Scarborough, roughly eight out of every 100 people are diagnosed with some form of diabetes.

Diabetes facts:

  • In Scarborough, eight people in 100 have diabetes.
  • Some ethnic groups have a higher risk of contracting diabetes than others. A study done by the Institute for Clinical Evaluative Sciences states that those within the South Asian, Chinese and African communities develop diabetes at an earlier age, at lower body mass index (BMI) levels, and more often. The Canadian Diabetes Network adds that Aboriginal and Hispanic people are also more at risk.
  • According to the Canadian Diabetes Network, 80 per cent of new Canadians are at a higher risk for diabetes.
  • A sedentary lifestyle, unhealthy eating habits, high blood pressure and high cholesterol, as well as genetics and obesity can all contribute to the likelihood of contracting Type 2 diabetes.
  • Symptoms of diabetes can include: blurred vision, slow healing, fatigue, increased susceptibility to infection, tingling or numbness in hands and feet, increased urination, weight loss/gain, and frequent feelings of thirst.
  • Diabetes can lead to other chronic diseases such as blindness, heart disease, and kidney complications and failure, as well as foot issues.
  • Eighty per cent of Canadians with diabetes die from heart attack or stroke
  • Seven out of ten limb amputations stem from diabetes.
  • Diabetes is the single greatest cause of blindness in Canada.
  • Type 1 diabetics have no insulin produced in their bodies, and must inject insulin regularly. They make up roughly 10 per cent of diabetics.
  • Type 2 diabetics have some insulin in their bodies, but not as much as the body needs. Type 2 can often be regulated by diet, pills, and exercise, though sometimes an individual may use or may someday need insulin.

Sources: The Canadian Diabetes Association and the Public Health Agency of Canada

Sicchia says one reason diabetes is so prevalent in Scarborough is because certain ethnic groups carry a higher risk of contracting the illness.

“[Scarborough] has higher immigrant populations, who have a higher percentage of people at risk for diabetes,” she said. “Asians, Hispanics and the black population have a very high risk.”

Diabetic care can be found in Scarborough at The Scarborough Hospital (TSH) and Centenary Hospital diabetes clinic, the Scarborough Centre for Healthy Communities (a DEC), and several community support groups like the Canadian Diabetes Association’s chapter meetings.

Many of these places have people who can speak a variety of languages and have many information packages translated into several languages to be more accessible, Sicchia says.

Cathy Robb, a diabetes education specialist and nurse at Scarborough Hospital, explains that the DECs, support groups and the hospital all serve different functions.

“Acute patients are seen in hospital settings with all appropriate support readily available or after a critical event, stabilized then returned to a community centre for maintenance,” she said.

Hartman, who ran several community education sessions and support groups in Oshawa, suggests diabetics get involved with a community support group as well as visiting an education centre.

“They cater to individuals who may have been diagnosed by their doctors but not given any information, people who have had diabetes for a while but need to re-educate themselves, or people who were diagnosed but in denial,” she said.

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