Hey Sugar, Diabetes Got You Down?

Kelly Knopf

Dietetic Intern

Outline

Social and Family History Problem List Current Nutritional Status Pathophysiology Outcomes Barriers to Self-Care Current Research What’s on the Horizon?

Social & Family History

40 years old Male Caucasian Unmarried, lives at home with parents Non-smoker History of ETOH abuse Unemployed

Problem List

Past Problems Type 1 Diabetes Mellitus Neuropathy Kidney stones ETOH abuse

Current Problems DKA Fever, chills, headache, abd pain, N/V,

diarrhea x 5days

Current Status

HgbA1c 10.2% Non-compliance, denial Height 6’2” Weight 168 lbs BMI 21.6 Normal weight

Overview

DKA

Diarrhea

Possible depression

ETOH abuse

Neuropathy

↓ Urine output

Kidney stones

Nausea and vomiting

Abdominal pain

Polydipsia

Weight loss

Type 1 Diabetes Mellitus

Overview

DKA

Diarrhea

Possible depression

ETOH abuse

Neuropathy

↓ Urine output

Kidney stones

Nausea and vomiting

Abdominal pain

Polydipsia

Weight loss

Type 1 Diabetes Mellitus

Non-compliance

Outcomes

Motivation Goals Compliance Barriers

Barriers to Self-Care

Dietary changes Exercise Self-monitoring Self-medicating Self-injecting Frequent visits to

clinic

Harvey JN, Lawson VL. The importance of health belief models in determining self-care behaviour in diabetes. Diabetic Med. 2009;26(1):5-13.

Statistics

14.8 million 23.5 million 20-25% 1.6-2.0 1.76 1.71 3.11

Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive-Behavioral therapy for Adherence and Depression in Type 2 Diabetes. Jrnl of Cognitive Psychotherapy:An International Quarterly. 2010;24(4):329-343.Pan A, et al. Increased Mortality Risk in Women with Depression and Diabetes Mellitus. Archives of General Psychiatry. 2011;68(1):42-50.

Barriers – Emotional

Health Belief Model (HBM) 5 dimensions

Theory of Planned Behavior (TPB) Intention Perceived difficulty

Blame and Anger

DePalma MT, Rollison J, Comporese M. Psychosocial Predictors of Diabetes Management. Am J Health Behav. 2011;35(2):209-218.Harvey JN, Lawson VL. The importance of health belief models in determining self-care behavior in diabetes. Diabetic Med. 2009;26(1):5-13.Naranjo DM, Fisher L, Arean PA, Hessler D, Mullan J. Patients With Type 2 Diabetes at Risk for Major Depressive Disorder Over Time. Annals of Family Medicine. 2011;9(2):115-120.Shankar A, Conner M, Bodansky HJ. Can the theory of planned behaviour predict maintenance of a frequently repeated behaviour? Psychology, Health & Medicine. 2007;12(2):213-224.

Coping and Self-Care

Healthy Coping Behaviors Barriers

Association of depression with treatment Compliance of varying

self-care activities

AADE Guidelines for the Practice of Diabetes Self-Management Education and Training. AADE. Chicago, IL. Rev. November 2010.Kent D, Haas L, Randal D, et al. Healthy Coping: Issues and Implications in Diabetes Education and Care. Population Health Management. 2010;13(5):227-233.Zugen SI, Syed EU, Bhatti JA. Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: A cross-sectional study from Karachi, Pakistan. BMC Psychiatry. 2011;11(27):1-6.

Counseling and Accommodations

Counseling screening

Cognitive-Behavioral Therapy (CBT) Team approach

Americans with Disabilities Act (ADA)

Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive-Behavioral therapy for Adherence and Depression in Type 2 Diabetes. Jrnl of Cognitive Psychotherapy: An International Quarterly. 2010;24(4):329-343.Renosky RJ, Wray L, Hunt B, Ulbrecht JS, Hill-Briggs F. Counseling People Living with Diabetes. J Rehabil. 2008;74(4)31-40.

On the Horizon

Study Protocol (2011): DiaMind

Study Protocol (2010): Telephone Linked Care (TLC) (2010)

Van Son J, Nyklicek I, Pop V, Power F. Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial. BMC:Public Health. 2011; 11(131):1-11.Bird D, Oldenburg B, Cassimatis M, et al. Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked care Diabetes Project): study protocol. BMC Public Health.2010;10:559-604.

References• AADE Guidelines for the Practice of Diabetes Self-Management Education and Training. AADE. Chicago,

IL. Rev. November 2010.• Bird D, Oldenburg B, Cassimatis M, et al. Randomised controlled trial of an automated, interactive

telephone intervention to improve type 2 diabetes self-management (Telephone-Linked care Diabetes Project): study protocol. BMC Public Health.2010;10:559-604.

• DePalma MT, Rollison J, Comporese M. Psychosocial Predictors of Diabetes Management. Am J Health Behav. 2011;35(2):209-218.

• Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive-Behavioral therapy for Adherence and Depression in Type 2 Diabetes. Jrnl of Cognitive Psychotherapy: An International Quarterly. 2010;24(4):329-343.

• Harvey JN, Lawson VL. The importance of health belief models in determining self-care behavior in diabetes. Diabetic Med. 2009;26(1):5-13.

• Kent D, Haas L, Randal D, et al. Healthy Coping: Issues and Implications in Diabetes Education and Care. Population Health Management. 2010;13(5):227-233.

• Naranjo DM, Fisher L, Arean PA, Hessler D, Mullan J. Patients With Type 2 Diabetes at Risk for Major Depressive Disorder Over Time. Annals of Family Medicine. 2011;9(2):115-120.

• Pan A, et al. Increased Mortality Risk in Women with Depression and Diabetes Mellitus. Archives of General Psychiatry. 2011;68(1):42-50.

• Renosky RJ, Wray L, Hunt B, Ulbrecht JS, Hill-Briggs F. Counseling People Living with Diabetes. J Rehabil. 2008;74(4)31-40.

• Shankar A, Conner M, Bodansky HJ. Can the theory of planned behaviour predict maintenance of a frequently repeated behaviour? Psychology, Health & Medicine. 2007;12(2):213-224.

• Van Son J, Nyklicek I, Pop V, Power F. Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial. BMC:Public Health. 2011; 11(131):1-11.

• Zugen SI, Syed EU, Bhatti JA. Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: A cross-sectional study from Karachi, Pakistan. BMC Psychiatry. 2011;11(27):1-6.

Thank you for your time and

attention!