My dear classmates

The 1st part of our proposal is  now available for your convenience

Yours,

Elham-Mir

Understanding the psychosocial barriers to effective diabetes therapy>>

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The scale of the problem that diabetes poses to world health is still widely under recognized. It is estimated that if the current trends continue the numbers of people with diabetes will almost double from 194 million people in 2003 to 333 million by the year 2025. Diabetes is already the most costly health care problem all over the world. Epidemiologic studies in Iran indicated the number of people suffering from Diabetes type 2 is about 2 million, it is estimated this number will be 3,200,000 by the year 2020.This number do not consist the number of people who are not aware of the underlying condition .>>

Beyond the routine advancements for coping with a variety of recognized diabetes complications including retinopathy, nephropathy, neuropathy and cardiovascular manifestations, recent studies highlight the importance of psycho-social factors in diabetes management. Research shows that psychological co-morbidity is prevalent in people with diabetes. As a result well being, self care and glycaemic control are adversely affected. Depression is common in people with diabetes and unfortunately under diagnosed in many cases. A person with a major depressive disorder suffers from a depressed mood and or a loss of interest or pleasure in daily activities for a prolonged period of time. This disorder is characterized by the presence of a number of symptoms including significant weight loss or weight gain, insomnia or hypersomnia, feeling of worthlessness or excessive or inappropriate guilt and recurrent thoughts of suicide. Recent studies including the Diabetes Attitudes, Wishes and Needs (DAWN) in US and many European countries indicate that in general psychosocial support is under-resourced and inadequate in both adults and children with diabetes. In order to minimize the risk of diabetes complications we need to initiate:>>

• Qualified communication for improving quality of life in diabetic patients. Quality of life is increasingly used as a factor in the evaluation of the quality of care. In diabetes care self report questionnaires are employed in large scale inventory research into the human experience of people living and condition. While this approach is both logical and positive it can not replace effective communication between people as a means of understanding the individual needs for each person. Health carers who are committed to providing quality diabetes care must be prepared to spend more time mediating intense emotional interactions with people who have the condition. To achieve this health carers require improved communication skills and adequate psychological knowledge.>>
• Diabetes education >>

To improve health outcomes and ensure the total well-being of people with the condition it is important to reach the person beyond the laboratory results and blood glucose reports. Diabetes education can make an important and positive impact in a number of people with Type 2 diabetes. At the beginning of Insulin therapy an exaggerated fear of injections, a lack of information and understanding about insulin and some widely held misconceptions about the functioning of the hormone often lead to psychological insulin resistance. The anxieties and resistance to medication which often accompany Insulin therapy can be conquered with the support of a diabetes education program which reassures people that the need for injection of insulin dose not represent a personal failure, helps them to learn about how to prevent and manage hypoglycaemia accompanies them through the injection process. As a whole diabetes education is effective in improving both metabolic outcomes and quality of life.>>

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• Integrate psychosocial issues into national diabetes program>>

People with diabetes or those who have a close personal relationship with a person with diabetes know how strongly the condition impacts on every-day life. Studies demonstrate that diabetics have significantly more psychological problems than the background population. Rates of depression have been seen in people with diabetes which are 2-4 times higher than those in the general population. The psychiatric problems may complicate and impact negatively on diabetes management and outcomes. These will require medical and behavioral assessment and treatment .A team consisting of a general practitioner, a diabetes nurse or a specialist diabetes doctor is needed to help people adjusting to life with diabetes.>>

• Keep people at the center of care>>

The establishment of a practice which puts the person at the center of care will require a change in the attitudes and beliefs of health professionals and people with diabetes. A service which places the person with diabetes at the center of care will undoubtedly demand the adoption of this philosophy by the organizations responsible for the delivery of diabetes care. A recently diagnosed person with diabetes needs a level of confidence in order to take a series of decisions regarding the management of his or her condition. In order to this reassurance should be offered by the health carers.>>

The expert people with diabetes could also be considered an important resource for the health service as effective health campaigners and members of health care bodies.>>

In a world in which health care system are failing people with chronic health conditions we need a new paradigm in which people with diabetes become their own health care providers with health care professionals playing a supporting role. In diabetes care the principal objective is effective therapy for people with type 2 diabetes involves lifestyle changes and poly-pharmacy targeting levels of blood glucose, blood pressure and blood fat. Barriers to effective diabetes therapy have been identified within the organization of health care and in the interaction between health care providers and people with diabetes. >>

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