Internal Medicine & Hospital Medicine

Biography

Biography: Aldimachki g

Abstract

Therapeutic Patient Education is the patient’s/ family’s capacity building process on the basis of integrated actions to care project. It is also the set of practices to allow the patient skills, to support actively the illness, care and monitoring, in partnership with the healthcare team. This is a co-construction between the treated and the caregiver, a comprehensive care most optimal in a cognitive behavioural perspective and psycho-emotional through which the evaluation of quality patient's life is paramount.

Introduction: The study DAWN2 France showed that people with diabetes have an impaired quality of life. A alteration efficiency of the management of this pathology. This study also showed that French patients seem more anxious than in most other countries, the fear of hypoglycemia is a very important point, as the fear of injections and that the transition to insulin is seen as a penalty. By giving patients educational sessions, group and individual, medically, dietary, physical, psychological and social, the ETP has significantly improved the management of patients.

Methods: An observational study is to evaluate the evolution of the quality of life and the metabolic balance of a cohort of 100 patients who completed a personal ETP program, developed about 18 educational workshops, full hospitalization. A day hospital monitoring is proposed at 3, 6 and 9 months. The desired main criterion is the quality of life. The questionnaire used to assess the quality of life is the SF-36. The biological and anthropometric parameters also measured.

The main characteristics of the patients included in this study were:

• Age between 18 and 70 years;
• Type 2 diabetes diagnosed for at least 6 months;
• HbA1c> 7%;
• BMI> 30;
• Patient treated by at least two oral antidiabetics;
• No severe proliferative diabetic retinopathy;
• Associated metabolic syndrome;
• Lack of thyroid dysfunction;
• No modification therapy (treatment) for at least 2 months

Results: 
Quality of Life: The study demonstrates a significant improvement in the quality of life of patients who have taken the ETP program between 0 and nine months, clarified by the same patients, by improving their knowledge, improved self-assessment (knowledge, skills). An improvement in all dimensions but also we see a profile change: patients experience fewer limitations on the mental plane (Δ = 65.8) and physical (Δ = 82). In addition, there is an increase important in the relational aspect (Δ = 38, 2). Changes in physical activity are also important (Δ = 48,6)

Improving Balance Glycaemic: The change in glycated hemoglobin percentage was statistically significant, explained, firstly through regular physical activity can reduces HbA1C by 0.6%, by increasing muscle glucose uptake independently of insulin metabolism, affirmed via several randomized studies. And on the other hand, weight loss and decrease in insulin resistance, as demonstrated by the meta-analysis of various clinical studies. A significant decrease in mean HbA1C (- 3.2 point). The initial average HbA1C is 10.10% (± 2.5).

Improvement of other Metabolic Parameters: A significant decrease in triglycerides (- 2 g / l), also a decrease in LDL-cholesterol (1.4g / l), an increase of HDL-cholesterol (0.22 g / l), a decrease of GGT were demonstrated, meaning a significant reduction in the potential cardiovascular risk already well demonstrated by the study Look AHEAD Research Group.

Concerning the Physical Activity: Physical testing performed at each check-up showed an improvement in muscle strength, adaptability to physical exertion, balance and flexibility. The interview with patients noted a steady and sustainable physical activity, respects the duration and recommended frequency that helped to improve both glycemic control and also the metabolic parameters including lipid profile correlation with the meta-analysis of several studies.

Behaviour and Comfort food: The study showed over time, following the assessment at each visit, improvements in the comfort, feeding behaviour and reproduction of food, which is the first line of the management of type 2 diabetes.

Body Weight: decreases significantly over 10%.

Therapeutic Change:
Conclusion:

• ETP personalized, adapted to the educational diagnosis, has a positive and significant impact on the quality of life of the patient.
• Improved self-esteem and self-confidence is up a total change patient profile.
• The importance of structured outpatient follow in patient care (HDJ, network care ... etc ..).
• It is also an effective method for improving glycemic control, the prevention of diabetes
• Complications as well as in reduction of cardiovascular risk factors.
• Improved biological and anthropometric parameters and changes treatment during followup,
• potentially have an impact on reducing the total cost of management of this chronic disease.