Critical Decision Making: The role of the APN in the care of patients with Diabetes Mellitus. Morag Henry

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1 Critical Decision Making: The role of the APN in the care of patients with Diabetes Mellitus Morag Henry

2 International Diabetes Federation 2014

3 Diabetes Facts and Figures in Switzerland (International Diabetes Federation 2014) 2005 : 250,000 Diabetiker (4.0 % der Bevölkerung) 2014 : 629,900 Diabetiker (11.3 % der Bevölkerung) 339,200 Prediabetes (6.1 % der Bevölkerung) : 726,500 Diabetiker 90% Type 2 diabetes

4 3,350 Swiss citizens die from diabetes every year. 9 deaths every day. (International Diabetes Federation 2014)

5 All members of the inter-professional healthcare team will increasing encounter patients with diabetes Duty of care for diabetic patients is NOT confined to the Specialist Diabetes Team

6 Advanced Practice Nurse Duty of Care Diagnosed Undiagnosed At risk

7 At Risk ,200 Prediabetes (6.1 % der Bevölkerung)

8 Prediabetes (American Diabetes Association. Standards of medical care in diabetes Diabetes Care.2015;38(suppl 1):S1-S93) The progression into diabetes mellitus from prediabetes is 25% over three to five years.. Nathan et al. (2007) 5-10% of people per year with prediabetes will progress to diabetes. Tabak et al (2012)

9 Preventing or Delaying Progression - APN role For prediabetic individuals, lifestyle modification is the cornerstone of diabetes prevention, with evidence of a 40 70% relative-risk reduction Tabak et al (2012) Weight loss (7% of body weight) Awareness Education Change management Ongoing support Appropriate referral 150 min/week moderate activity Annual monitoring of individuals with prediabetes ADA Guidelines (2015)

10 Undiagnosed Diabetes - APN role History taking Family History Cardiovascular disease Sexual health issues Depression Physical examination

11 Patients with known Diabetes - APN role Individualised holistic patient centred care. Supporting patient self management to reduce complications. Reinforcing and supplementing medical and DSN roles

12

13 Patients with known Diabetes - APN role Hypoglycaemic medication Medication adherence Side effects Integration into individual s life

14

15

16 Sensible Neuropathie Fehlendes Schmerz- und Temperaturempfinden zu heisse Fussbäder Fundgegenstände bei Schuhuntersuchung Mehrstündige Wanderung in neuen Bergschuhen mit Wollsocken Zwei Stunden in neuen Schuhen

17 Patients with known Diabetes - APN role Hypotensive/ lipid lowering/ anti platelet medication Medication adherence Side effects Integration into individual s life Lifestyle change

18 Motivational Interviewing Ongoing support Appropriate referral

19 Patients with known Diabetes - APN role Prevalence of depression in the diabetic population 24% compared with 17% in the non-diabetic population. Goldney et al (2004) Patients suffering from Type 2 diabetes and depression had 82% increased risk for MI compare with those with single disease. Scherrer et al (2011) I UK GPs failed to identify over 50% of patients who later screened positive for depression. Arroll et al (2005)

20 Men "50-75% diabetic men have erectile dysfunction Awareness 3x higher than in non-diabetic History taking men. Appropriate referral Women 18 % Type 1 and 42 % Type 2 experienced sexual dysfunction (Musicki 2010)

21

22 The role of the APN in the care of patients with Diabetes Mellitus Individualised holistic patient centred care. Supporting self management within patients individual life environments. Working as a member of the inter-disciplinary healthcare team.

23 Vielen Dank für Ihre Aufmerksamkeit.

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