My name is Eva Grenberg. I'm a specialist diabetes nurse with a master in medical anthropology. I'm the nurse manager of the Day Hospital Department at Steno Diabetes Center, Gentofte, Denmark. The aim of this lecture is to introduce you to some of the challenges people with type 2 diabetes faces in their daily lives, especially when it comes to healthy eating. It's also to introduce you to some simple tools to help people self-manage their type 2 diabetes better by choosing healthy meal plans. I shall also be presenting the idea of designing an app that might help making better meal plans. In their daily lives, people with type 2 diabetes face many challenges. Among which, diet and exercise play a significant role as these are issues that they face everyday. Studies indicate that the prevalence of diabetes is going to rise globally to 642 million by 2040. As the epidemic of diabetes rises worldwide, the treatment options become more complex and varied. However, diet, exercise, education, and self-management continues to remain the cornerstones of diabetes management. A number of studies have shown that diabetes self-management education and diabetes self-management support improve clinical outcomes and enhance the quality of life. The diabetes attitudes, wishes, and need study called DAWN 2, conducted in 17 countries worldwide, surveyed more than 5,000 diabetes patients, healthcare professionals, and families to patients. The study findings provide a perspective on the present status of diabetes care. Result from the DAWN 2 studies show that living with diabetes is still a challenge for those with diabetes, and most of them need to make significant changes to their diet. And to eat healthily, to enable them to self-manage their diabetes better. The DAWN 2 study further shows that many areas of diabetes self-management need substantial improvement. And close collaboration among healthcare professionals, family members, and people with diabetes, to improve self-management skills and diabetes outcome. It is important for everyone with diabetes to have access to active self-management training in diabetes. In the following video, I would like to introduce you to Eva, a type 2 diabetes patient. >> I'm definitely not the perfect patient. I'm not any doctor's dream. In fact, maybe the opposite. But what I like when I go to the doctor is that they know who I am and they can see my figures from last time I was there. And they can see my new blood sugars. And they definitely could have been better. I always know that. Of course sometimes I do improve. For me, it's very difficult to change my lifestyle. I would like to have a pill that actually could fix it. My diabetes is not a friend of my choice. It's just a person who's there. It's a thing there actually being at my side all the time. But I don't like it. I didn't invite it in. So acceptance from my part is very difficult. When I discuss things with my doctor, they try to explain every complicated thing for me in very detail but I don't need further detail. I know all the calories in the world, I can tell you what's any apple or any cake that I shouldn't be eating, but I still eat it and I don't know why. I don't want to recognize this illness as it is, as my companion. I'm actually on a very good medicine at the moment. But, I also know that with my diabetes, and with my complications, presently, I might be tainting to insulin at some point. And, for me, that's really a wall, I see it as a very huge, large wall, very difficult to pass, and I don't want to pass it. I know from my husband how low blood sugars work, and I don't want to go there if possibly I can't. I know it's also just for me, a matter of attitude. It might be the solution to all my problems, but I don't know that yet. That's part of my story. What I also like when I go to the doctor is the fact that I'm actually allowed to, maybe sometimes, maybe until the next time we see each other, be allowed, as long as I don't gain weight, that will be a success story as well. It's not always about losing the next three kilos, it's also sometimes accepting that I'm busy and next time we'll just have to make sure that the blood sugar hasn't risen or my weight is still the same. That's a wonderful day then. >> In the video, you'll learn that she sees diabetes as a friend I did not invite into my life. It is hard for her to accept her diabetes. She has challenges in following her treatment. She knows what she should do and doesn't know why she doesn't do so. Her talk helps us understand the dilemmas facing patient and the video focus on the emotional, behavioral, and social aspects of the living with the diabetes. In between visits to the doctor, individuals with diabetes have to make innumerable daily decisions that affect their diabetes management. As you can see in the figure, most of the time individuals with diabetes end up having to make their own decisions. These decisions could relate to diet, exercise, medication, or monitoring. To ensure better clinical outcome, it is vital that day-to-day decisions are based on a clear understanding and knowledge of the disease, and that those with diabetes are educated, trained, empowered, and have the skills to make the best choice. Self-management means that people with diabetes take the responsibility for managing their diabetes and have the confidence to solve problems. Active self-management leads to better metabolic control, reduction of symptoms, and improved quality of life. Self management is actually a part of daily life and can be individualized. But to get there, patients need to truly reflect and understand their daily lives. It is only my actual understanding what they are doing that they can consider which changes to make. The two tools, my day and plate model, are some of the tools now used in the period between appointment to the diabetic clinic. Reflecting on this might reveal crucial new information on what it is like to live with diabetes and what to prioritize when working together with patients with diabetes. The aim of the My Day tool is for health care professionals to develop a close bond with diabetes patients while gathering crucial information about their diet and exercise plans and understanding things from their point of view. The My Day tool helps healthcare professionals discuss and review daily life in order to make individuals better qualified in decision-making. When filling in the form, tell the patient to write about a routine day in their life, and what they did from morning to night. An easy way to do would be write about what happened yesterday, what they ate, if they took any medicine, what kind of exercise they did, and what kind of work they did. The details must be filled in according to the different time schedules. After completing the form, the patient and the healthcare professional get an opportunity to discuss my day plan. The ensuring dialogue with the healthcare professional gives the diabetes patient the opportunity to better understand and learn relevant details about their own daily life. Such as their normal meal times, what is normal eating, and other information that the healthcare professional can also use to phone the basic for giving individualized advice suitable for their needs. The latest nutrition guidelines focus more on eating patterns and individual preferences instead of diet prescription. To understand eating patterns and individual preferences, different tools can be used to make healthy food choices. One way of organizing food to address different choices is by using the plate model, a practical tool to help put together a healthy meal. The plate model helps in meal planning by controlling the amount of carbohydrate in the portion. The healthy plate model is simple, everyone can use it, and it helps increase the consumption of fruit and vegetables. At Steno Diabetes Center, we use both the T and Y shape plate models to teach patients what diabetes to make choices. The T shaped plate is for those wishing to lose weight, while the Y shape plate is for those wishing to maintain their weight. The plates can help to know what kind of food and how much to have for a meal. Specially calibrated portion control plates and bowls were used in a randomized trial in Canada to study the effect on weight loss in overweight persons with Type 2 diabetes. Results showed significant weight loss and reduced need for anti-hyperglycemic medication after six month use of the model compared to the control group. To improve health outcomes and healthy eating habits in elderly diabetes patients, it is important not only to understand the challenges they're facing, but also to empower them to make informed self-management choices. The way forward could be by giving them skills on how to make healthy food choices and to use the plate model in the form of an easy to use app. Thank you for listening.
