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Role of the diabetes educator in a Mexican private center
Track 1. Education, Nutrition & Psychosocial Aspects of Diabetes Care P196 Education Program for Visually Impaired Diabetics EWA SEMETKOWSKA-JURKIEWICZ, Bogdan Wolnik, Monika Lukaszewicz, Maciej Nowakowski. Department of Diabetology, Medical University, Gdansk, Poland The aim of the present study was to assess treatment and education efficacy in blind diabetics.We studied 22 patients with diabetes mellitus,mean age - 58 yrs, diabetes duration - 24 yrs, body weight-73 kg and mean heigh 163 cm. All patients took 6 days course of education at Center of Diabetology, attention was mainly paid to dietary recommendations, physical actity,self-monitoring,and diabetic complication.At the baseline and after 3 months fasting plasma glucose,HbA1 c,cholesterol,triglicerydes concentration were measured.The level of knowledge of diabetes mellitus was chacked with a test containing questions.The mean plasma glucose decreased from 173+61mg/dl to 146+62mg/dl and HbA 1c decreased significantly (8.4+ 1 vs 7.2+0.9, p--001). Conclusion:This results demonstrate that education improves quality of life and metabolic control in blind diabetics.
P197 Viviendo la Vida Dnlce: Community Organizing in a Latino Dominant Environment DIANA N. DE LEON, Franco Reyna, Maria Hayes Bautista, Martha Herrera, Sherry Foldvary, Armida Duran. A case Study of a situation that will shortly occur in most large cities of the USA: the Latino community reaction to a community's nonresponse in addressing diabetes as it impacts the need of the Latino community. The Latino Community Diabetes Council (LCDC) was formed in 1996 by Latino professionals and individuals from local community organizations working on diabetes issues in one form or another. These individuals recognized the need to dialogue regarding the lack of organized efforts in the Latino community to adequately address the diabetes epidemic impacting the Latino community. Organizations such as the Multicultural Area Health Education Center (MAHEC), White Memorial Medical Center, University of California at Los Angeles (UCLA)-Center for the Study of Latino Health and Culture and the Los Angeles County Department of Health Services came together for the formation of a Latino based organization dedicated to diabetes. These public health strategies called for "Culturally Competent Community Organizing". Therefore, the standard areas of community participation, issue selection, community competence, commmunity empowerment and the development of critical consciousness were developed in the Latino community setting by Latino professionals. While North American philanthropy has often viewed Latinos as non-participants in community activity, LCDC provides an illustration of the unique ways in which Latinos participate in community activities by building on the natural cultural linkages between Latino providers, the new population of Latino professionals, Latino organizations and their community to harness the natural energy in these communities, and to provide a voice to those who have not yet been heard. LCDC grew structurally by securing in kind services, private and public funds for activities, establishing a corporate structure, and building upon linkages with a broader Latino constituency.
P198 Comic as an Education Method for Diabetic Patients and General Population CLAUDIA PIEPER, Antonino Homobono. Diabetes, Santa Casa da Misericordia do Rio de Janeiro, Rio de Janeiro, R J, Brazil We created serial comics formatted like a journal in order to instruct patients and the general population about diabetes. The main goal is to help them identify the correct treatment avoiding the common errors and how to handle with this long-term chronic disease. The main comic's
$31
character is a bus driver that has the typical Insulin Resistence Syndrome called "Uncle Juli,~o". We set up a teaching process where the patients could learn easily using a simple and common language. The process should be light and funny. At the moment the serial comic has 7 editions: the 1st and 2nd - "Insulin Resistance"; the 3rd and 4th - "The Heart" (and their complications); the 5th, 6th and 7th - "The Diet Day". Each one was published on a 4 collored pages and free distributed to Diabetic Associations, general hospitals, private offices and schools. More than 30.000 journals are published per each edition and was supported by Merck Quimical Industry. We applied a questionary with 15 questions to 88 diabetic patients, with ages between 45 and 77, to evaluate the process of acquaintance and how this kind of language was accepted. Conclusion: It's necessary that we employ new motivation techniques to diabetic education. Different approaches can be developed defining simple objectives to be achieved by patients in their commom lives. We realize that 100% of the patients that answered the questionary understood very well the message as they had a score of 95% of correct answers.
P199 An Educational Approach to Diabetes Mellitus in Argentina (CADIEQ) THE CADIEQ COMMITTEE. Argentine Diabetes Society (SAD), Buenos Aires, BA, Argentina; Medicine and Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States of America In order to achieve the level of care necessary to minimize diabetes complications there needs to be in place knowledgeable physicians and health professional teams to provide necessary education and support. We report separately the efforts of the SAD to education generalist physicians (PROCAMEG). CADIEQ (Programa de Capacitici6n en Diabetes Tipo 2 del Equipo de Salud No Medico) is the Society's corresponding program for six health professions that participate in diabetes care: Nurses, nutritionists, health educators, podiatrists, physical therapists and social workers. Core educational programs were developed by these health professionals and SAD that include basic diabetes information, instruction in the education process and professional specific information. These programs are held in central sites with small groups (8-12) attending. The process of student selection included written commitment of service chiefs to initiate a diabetes education team upon completion, to provide the necessary financial and administrative support and the patient information to evaluate the program. Students were selected from a variety of clinical and geographic locations. Evaluation includes pre and post knowledge testing, course evaluation by peers, team formation and functioning and patient outcomes over twelve months. Patient measures include the absence or present of basic treatment modalities (eg, diet, exercise), complications screening (eg, eye and foot examinations, albuminuria, blood pressure) and intermediate patient outcomes (eg, HbAlc, blood pressure and lipid control). The program can serve as a model for developing countries. Materials available will include course content for the six professions and evaluation materials.
P200 Role of The Diabetes Educator in a Mexican Private Center FELIPE VAZQUEZ-ESTUPEqAN, Ma. Carranza. Education, Diabetes Care Center, Mexico, DE Mexico Objective: To describe the first year of experience of diabetes education in a private program. Methods: We evaluated patients with diabetes mellitus type 2 a subsample of 100 members of Diabetes Care Center, with a knowledge test, a training satisfaction questionnaire and HbAlc. The program consist of 8 weekly sessions applying meal planning, hypoglicemia, sick days management, emotional management, self monitoring, drug and insulin use applying empowerment approach to diabetes education. Reinforcement sessions
$32
Poster Session 1
were provided each month. The patients were screened for psychosoeial problems and refered to psychological or psychiatric atention when needed. The patients also received support from an excercise expert. Results: The knowledge increased from an average of 6/10 to 9/10 points (p < 0.05). The HbA lc decreased from 11.1 4- 3% to 7.9 4- 2% (p< 0.05), 80% of the patients completed the program. The patients were mainly derived by recommendation of general practitioners and family members, 95 of the patients evaluatated the program as very satisfactory. Condusions: The role of diabetes educator in the private practice is expanding in Mexico. It effectively can increase the knowledge and skills of the patients improving metabolic control and the detection of psychosocial problems. The diabetes educator can integrate the colaboration of professionals in an interdisciplinary team.
P201 Diabetes Health Education for Non-Readers ARACELY ROSALES. Taking Control, HPC, Philadelphia, PA, United States of America Purpose: To teach and demonstrate effective techniques for diabetes education and materials development targeting diverse cultural groups of people diagnosed with diabetes who in addition have limited reading skills. Method: The U.S. is a country with an increasing number of people of diverse cultural and ethnic backgrounds. In addition an estimated 47% of adults read at or below 6th grade reading level. However, most diabetes educational materials continue to be developed for persons reading above 10th grade reading level with little attention or sensitivity given to different cultural values. The Taking Control/"Controlando Nuestra Diabetes" Program of the Health Promotion Council in Pennsylvania has been teaching diabetes and developing diabetes educational curriculums, diabetes nutritional guides, participants diabetes handouts and visual aids/posters in both Spanish and English for Latinos and African Americans who have limited reading skills. Materials and teaching techniques are designed to give diabetes information and to ensure participants' understanding and participation. Results: Participants baseline measurements are taken before and after the (one day a week for seven weeks) program: height, weigh, blood pressure, medication history and glicosylated hemoglobin A1C. A computerized information system is used to describe and monitor participants, e.g. over one year of follow-up many of the program participants were at very high risk of developing complications from diabetes, 20% were smokers, 33% were >20% above ideal weight. Only 23% reported using glucose monitors. Improvements have been shown in every indicator of health status one year after classes end. Conclusion: The Taking Control/Controlando Nuestra Diabetes Program's teaching techniques and developed easy-to-read diabetes educational materials have proven to be effective. This workshop shares results of program outcomes, strategies we have learned from adult and diabetes educators. Participants in this workshop will gain a sense of what is like to have diabetes and not to be able to read and understand through experimental exercises. They learn effective methods of teaching diabetes to nonreaders and techniques to developing diabetes educational material that are easy-to-read and culturally sensitive. They learn about methods of assessment, testing and materials revision. Free diabetes nutrition guides masters in Spanish will be distributed.
P202 Telematic Aid in Intensifying Insulin Therapy: A Randomized Evaluation of the Glycotel System M.C. CHAUCHARD, M.C. Turnin, J. Martini, H. Sackmann, C. Bolzonella, D. Fabre, J.E Tauber, H. Hanaire-Broutin. Department of Diabetes, University Hospitals, Toulouse, France Glycotel, which is accessible by Minitel from the patient's home, is a
telematic system which assists in adjustment of insulin doses. Every day, diabetes patients enter their glucose levels and insulin doses for analysis by a diabetologist who then gives advice on treatment. We evaluated the system with 40 type I diabetic patients (age 43 + 2 yr, duration of diabetes 17 + 2 yr) with poor metabolic control (HbA1C _> 8.5%) and who required optimized treatment (transition to 3 or 4 injections, use of analogs or a portable pump). The patients were randomly divided into two groups: a control group (C = 19 patients) who were seen by a diabetologist at 2 months (T2) and 4 months (T4) and a Glycotel group (G = 21 patients) who in addition had daily access to assistance via the telematic system for renewable two-week periods. HbA 1C improved in the Glycotel group, decreasing from 10.2 4- 0.4% to 8.7 4- 0.2% at 2 months and to 8.7 4- 0.3% at 4 months vs 9.4 4- 0.3%, 9.2 4- 0.2% and lastly 9.2 4- 0.2% in the control group. After adjustment for baseline HbA1C levels, only the Glycotel group showed a significant improvement (p<0.0001). The 1.5% decrease of HbA1C in group G vs 0.2% in group C (p<0.01) was associated with a tendency to less frequent hypoglycemia. The percentage of hypoglycemias (glycemia<0.6 g/I) in the final month was 3.54-0.6% in group G and 5.8 4- 0.9% in group C (p = 0.058). In these patients whose management had been unsuccessful, compliance with the system was excellent as Glycotel fulfilled their expectations and improved their glyeemic balance.
P203 Evaluation of the Effects of the Zahke Education for Type 2 Patients N. MASIKE, G. Luthuli, M. Ndvngwane, E Bonnici. Roche Diagnostics
South Africa Object of Study: • To determine the level of patient knowledge regarding the mechanisms of the disease progress and to assess the level of self-care of the patients • To determine the frequency of hospitalisation before and after exposure to the program • To evaluate the changes in behaviour and life style after participation in the 4 modules of the Zakhe program • To evaluation relevant physiological parameters before and after the 4 modules Study Design: Individual controlled study in which diabetes related parameters were assessed 6 months prior to the training sessions and again nine months after completion of the program Method: • 2000 patients from 7 participating centers were selected • An evaluation sheet was completed by the health care workers Results: • 60% reduction in hospitalisation • 60% reported increase in motivation of self-care • 50% of patients had a significant reduction in blood pressure • Knowledge related to hypo- and hyperglycaemia improved overall by 75% • 40% of patients had a significant reduction in weight Conclusion: Participants in the study showed an overall improvement in physiological Parameters as well as attitude and knowledge after undergoing training with The Zakhe program.
P204 Use of P.I.E.P. Program To Detect Diabetic People with Foot at Risk ESTHERL GIL, Alfonso L. Calle-Pascual. El Club del Pie; Servicio de Endocrinologia y Nutrician, Hospital Clinico San Carlos, Madrid, Spain Foot Club is formed by healthcare teams which use software EI.E.E as a tool to identify real feet risk factors. This software is based on a routine exploration patterns to diagnose polyneuropathy, peripheral vascular pathology and morphologic alterations. It evaluates feet care habits, too. Club's objective is achieved injuries prevention through software guide-
P197 Viviendo la Vida Dnlce: Community Organizing in a Latino Dominant Environment DIANA N. DE LEON, Franco Reyna, Maria Hayes Bautista, Martha Herrera, Sherry Foldvary, Armida Duran. A case Study of a situation that will shortly occur in most large cities of the USA: the Latino community reaction to a community's nonresponse in addressing diabetes as it impacts the need of the Latino community. The Latino Community Diabetes Council (LCDC) was formed in 1996 by Latino professionals and individuals from local community organizations working on diabetes issues in one form or another. These individuals recognized the need to dialogue regarding the lack of organized efforts in the Latino community to adequately address the diabetes epidemic impacting the Latino community. Organizations such as the Multicultural Area Health Education Center (MAHEC), White Memorial Medical Center, University of California at Los Angeles (UCLA)-Center for the Study of Latino Health and Culture and the Los Angeles County Department of Health Services came together for the formation of a Latino based organization dedicated to diabetes. These public health strategies called for "Culturally Competent Community Organizing". Therefore, the standard areas of community participation, issue selection, community competence, commmunity empowerment and the development of critical consciousness were developed in the Latino community setting by Latino professionals. While North American philanthropy has often viewed Latinos as non-participants in community activity, LCDC provides an illustration of the unique ways in which Latinos participate in community activities by building on the natural cultural linkages between Latino providers, the new population of Latino professionals, Latino organizations and their community to harness the natural energy in these communities, and to provide a voice to those who have not yet been heard. LCDC grew structurally by securing in kind services, private and public funds for activities, establishing a corporate structure, and building upon linkages with a broader Latino constituency.
P198 Comic as an Education Method for Diabetic Patients and General Population CLAUDIA PIEPER, Antonino Homobono. Diabetes, Santa Casa da Misericordia do Rio de Janeiro, Rio de Janeiro, R J, Brazil We created serial comics formatted like a journal in order to instruct patients and the general population about diabetes. The main goal is to help them identify the correct treatment avoiding the common errors and how to handle with this long-term chronic disease. The main comic's
$31
character is a bus driver that has the typical Insulin Resistence Syndrome called "Uncle Juli,~o". We set up a teaching process where the patients could learn easily using a simple and common language. The process should be light and funny. At the moment the serial comic has 7 editions: the 1st and 2nd - "Insulin Resistance"; the 3rd and 4th - "The Heart" (and their complications); the 5th, 6th and 7th - "The Diet Day". Each one was published on a 4 collored pages and free distributed to Diabetic Associations, general hospitals, private offices and schools. More than 30.000 journals are published per each edition and was supported by Merck Quimical Industry. We applied a questionary with 15 questions to 88 diabetic patients, with ages between 45 and 77, to evaluate the process of acquaintance and how this kind of language was accepted. Conclusion: It's necessary that we employ new motivation techniques to diabetic education. Different approaches can be developed defining simple objectives to be achieved by patients in their commom lives. We realize that 100% of the patients that answered the questionary understood very well the message as they had a score of 95% of correct answers.
P199 An Educational Approach to Diabetes Mellitus in Argentina (CADIEQ) THE CADIEQ COMMITTEE. Argentine Diabetes Society (SAD), Buenos Aires, BA, Argentina; Medicine and Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States of America In order to achieve the level of care necessary to minimize diabetes complications there needs to be in place knowledgeable physicians and health professional teams to provide necessary education and support. We report separately the efforts of the SAD to education generalist physicians (PROCAMEG). CADIEQ (Programa de Capacitici6n en Diabetes Tipo 2 del Equipo de Salud No Medico) is the Society's corresponding program for six health professions that participate in diabetes care: Nurses, nutritionists, health educators, podiatrists, physical therapists and social workers. Core educational programs were developed by these health professionals and SAD that include basic diabetes information, instruction in the education process and professional specific information. These programs are held in central sites with small groups (8-12) attending. The process of student selection included written commitment of service chiefs to initiate a diabetes education team upon completion, to provide the necessary financial and administrative support and the patient information to evaluate the program. Students were selected from a variety of clinical and geographic locations. Evaluation includes pre and post knowledge testing, course evaluation by peers, team formation and functioning and patient outcomes over twelve months. Patient measures include the absence or present of basic treatment modalities (eg, diet, exercise), complications screening (eg, eye and foot examinations, albuminuria, blood pressure) and intermediate patient outcomes (eg, HbAlc, blood pressure and lipid control). The program can serve as a model for developing countries. Materials available will include course content for the six professions and evaluation materials.
P200 Role of The Diabetes Educator in a Mexican Private Center FELIPE VAZQUEZ-ESTUPEqAN, Ma. Carranza. Education, Diabetes Care Center, Mexico, DE Mexico Objective: To describe the first year of experience of diabetes education in a private program. Methods: We evaluated patients with diabetes mellitus type 2 a subsample of 100 members of Diabetes Care Center, with a knowledge test, a training satisfaction questionnaire and HbAlc. The program consist of 8 weekly sessions applying meal planning, hypoglicemia, sick days management, emotional management, self monitoring, drug and insulin use applying empowerment approach to diabetes education. Reinforcement sessions
$32
Poster Session 1
were provided each month. The patients were screened for psychosoeial problems and refered to psychological or psychiatric atention when needed. The patients also received support from an excercise expert. Results: The knowledge increased from an average of 6/10 to 9/10 points (p < 0.05). The HbA lc decreased from 11.1 4- 3% to 7.9 4- 2% (p< 0.05), 80% of the patients completed the program. The patients were mainly derived by recommendation of general practitioners and family members, 95 of the patients evaluatated the program as very satisfactory. Condusions: The role of diabetes educator in the private practice is expanding in Mexico. It effectively can increase the knowledge and skills of the patients improving metabolic control and the detection of psychosocial problems. The diabetes educator can integrate the colaboration of professionals in an interdisciplinary team.
P201 Diabetes Health Education for Non-Readers ARACELY ROSALES. Taking Control, HPC, Philadelphia, PA, United States of America Purpose: To teach and demonstrate effective techniques for diabetes education and materials development targeting diverse cultural groups of people diagnosed with diabetes who in addition have limited reading skills. Method: The U.S. is a country with an increasing number of people of diverse cultural and ethnic backgrounds. In addition an estimated 47% of adults read at or below 6th grade reading level. However, most diabetes educational materials continue to be developed for persons reading above 10th grade reading level with little attention or sensitivity given to different cultural values. The Taking Control/"Controlando Nuestra Diabetes" Program of the Health Promotion Council in Pennsylvania has been teaching diabetes and developing diabetes educational curriculums, diabetes nutritional guides, participants diabetes handouts and visual aids/posters in both Spanish and English for Latinos and African Americans who have limited reading skills. Materials and teaching techniques are designed to give diabetes information and to ensure participants' understanding and participation. Results: Participants baseline measurements are taken before and after the (one day a week for seven weeks) program: height, weigh, blood pressure, medication history and glicosylated hemoglobin A1C. A computerized information system is used to describe and monitor participants, e.g. over one year of follow-up many of the program participants were at very high risk of developing complications from diabetes, 20% were smokers, 33% were >20% above ideal weight. Only 23% reported using glucose monitors. Improvements have been shown in every indicator of health status one year after classes end. Conclusion: The Taking Control/Controlando Nuestra Diabetes Program's teaching techniques and developed easy-to-read diabetes educational materials have proven to be effective. This workshop shares results of program outcomes, strategies we have learned from adult and diabetes educators. Participants in this workshop will gain a sense of what is like to have diabetes and not to be able to read and understand through experimental exercises. They learn effective methods of teaching diabetes to nonreaders and techniques to developing diabetes educational material that are easy-to-read and culturally sensitive. They learn about methods of assessment, testing and materials revision. Free diabetes nutrition guides masters in Spanish will be distributed.
P202 Telematic Aid in Intensifying Insulin Therapy: A Randomized Evaluation of the Glycotel System M.C. CHAUCHARD, M.C. Turnin, J. Martini, H. Sackmann, C. Bolzonella, D. Fabre, J.E Tauber, H. Hanaire-Broutin. Department of Diabetes, University Hospitals, Toulouse, France Glycotel, which is accessible by Minitel from the patient's home, is a
telematic system which assists in adjustment of insulin doses. Every day, diabetes patients enter their glucose levels and insulin doses for analysis by a diabetologist who then gives advice on treatment. We evaluated the system with 40 type I diabetic patients (age 43 + 2 yr, duration of diabetes 17 + 2 yr) with poor metabolic control (HbA1C _> 8.5%) and who required optimized treatment (transition to 3 or 4 injections, use of analogs or a portable pump). The patients were randomly divided into two groups: a control group (C = 19 patients) who were seen by a diabetologist at 2 months (T2) and 4 months (T4) and a Glycotel group (G = 21 patients) who in addition had daily access to assistance via the telematic system for renewable two-week periods. HbA 1C improved in the Glycotel group, decreasing from 10.2 4- 0.4% to 8.7 4- 0.2% at 2 months and to 8.7 4- 0.3% at 4 months vs 9.4 4- 0.3%, 9.2 4- 0.2% and lastly 9.2 4- 0.2% in the control group. After adjustment for baseline HbA1C levels, only the Glycotel group showed a significant improvement (p<0.0001). The 1.5% decrease of HbA1C in group G vs 0.2% in group C (p<0.01) was associated with a tendency to less frequent hypoglycemia. The percentage of hypoglycemias (glycemia<0.6 g/I) in the final month was 3.54-0.6% in group G and 5.8 4- 0.9% in group C (p = 0.058). In these patients whose management had been unsuccessful, compliance with the system was excellent as Glycotel fulfilled their expectations and improved their glyeemic balance.
P203 Evaluation of the Effects of the Zahke Education for Type 2 Patients N. MASIKE, G. Luthuli, M. Ndvngwane, E Bonnici. Roche Diagnostics
South Africa Object of Study: • To determine the level of patient knowledge regarding the mechanisms of the disease progress and to assess the level of self-care of the patients • To determine the frequency of hospitalisation before and after exposure to the program • To evaluate the changes in behaviour and life style after participation in the 4 modules of the Zakhe program • To evaluation relevant physiological parameters before and after the 4 modules Study Design: Individual controlled study in which diabetes related parameters were assessed 6 months prior to the training sessions and again nine months after completion of the program Method: • 2000 patients from 7 participating centers were selected • An evaluation sheet was completed by the health care workers Results: • 60% reduction in hospitalisation • 60% reported increase in motivation of self-care • 50% of patients had a significant reduction in blood pressure • Knowledge related to hypo- and hyperglycaemia improved overall by 75% • 40% of patients had a significant reduction in weight Conclusion: Participants in the study showed an overall improvement in physiological Parameters as well as attitude and knowledge after undergoing training with The Zakhe program.
P204 Use of P.I.E.P. Program To Detect Diabetic People with Foot at Risk ESTHERL GIL, Alfonso L. Calle-Pascual. El Club del Pie; Servicio de Endocrinologia y Nutrician, Hospital Clinico San Carlos, Madrid, Spain Foot Club is formed by healthcare teams which use software EI.E.E as a tool to identify real feet risk factors. This software is based on a routine exploration patterns to diagnose polyneuropathy, peripheral vascular pathology and morphologic alterations. It evaluates feet care habits, too. Club's objective is achieved injuries prevention through software guide-