Disease management aims to reduce costs and improve quality of life for chronic conditions like diabetes mellitus through integrated care. Diabetes is characterized by hyperglycemia due to impaired insulin production or resistance. The two most common types are type 1, caused by autoimmune destruction of insulin-producing cells, and type 2, caused by insulin resistance and relative insulin deficiency. Treatment involves lifestyle changes, oral medications, and insulin therapy to control blood glucose levels and minimize complications.
2. Disease management
Disease management is the concept of reducing health care
costs and improving quality of life for individuals with
chronic conditions by preventing or minimizing the effects of
the disease through integrated care.
Disease management is a proactive, multidisciplinary,
systematic approach to health care
• delivery that Includes all members with chronic disease.
• Supports the provider-patient relationship and plan of
care.
• Optimizes patient care through prevention and proactive
interventions based on evidence-based guidelines.
3. Diabetes Mellitus
Diabetes mellitus is the most common of the
endocrine disorders. It is a chronic metabolic
condition, characterized by hyperglycemia
due to impaired insulin production and
secretion with or without insulin resistance.
Diabetes mellitus may be classified according
to etiology, by far the most common types
being type 1 and type 2 diabetes.
4. Type 1 diabetes
Type 1 diabetes is a disease
characterized by the
destruction of the insulin-
producing pancreatic β-cells.
In more than 90% of cases, β-
cell destruction is associated
with autoimmune disease.
Type 2 diabetes
Type 2 diabetes is caused by a
relative insulin deficiency and
the body’s inability to effectively
use insulin. The pancreas is able
to produce some insulin;
however, as insulin resistance
increases, the effectiveness of
circulating insulin decreases, and
the amount produced is not
sufficient to meet the body’s
requirements.
6. Epidemiology
0.5M
children are living
with type 1 diabetes
worldwide
It’s the farType 2 diabetes is
much more common than
type 1, accounting for
approximately 90% of
people with diabetes.thest
planet from the sun
1 in 11 adults
have diabetes
Approximately 50–
60% of patients with
type 1 will present
before 20 years of age
• Type 2 diabetes is more common in people of African, African-
Caribbean, and South Asian family origin.
• Estimates in the UK suggest that type 2 diabetes currently affects
approximately 3.2 million adults with a conirmed diagnosis, and a
further 500,000 are thought to be undiagnosed (Diabetes UK, 2016)
1 in 10 by
2040
7. Pathogenesis
Pathogenesis of type I diabetes
An autoimmune disease-The
immune system mediates the
destruction of βcells.
• It develops in genetically
susceptible individuals who are
exposed to an environmental
factor that triggers the
autoimmune response; β-cell
destruction ensues.
• Overt Type1 DM does not
appear until about 90% of β-cells
are destroyed.
Pathogenesis of type II diabetes
• Risk factor Obesity (greatest risk
factor) Genetics Age (insulin
production decreases with age).
• Obesity is associated with increased
plasma levels of free fatty acids,
which make muscles more insulin
resistant, reducing glucose uptake.
• Lack of compensation in type II
diabetic patients in normal
individuals, the pancreas secretes
more insulin in response to free fatty
acids, thus neutralizing the excess
glucose.
9. Diabetes Diagnosis
5.8
• Screen all adults between ages 40 and 70 every 3 years.
• For those with risk factors for diabetes (obesity, family history, history
of gestational diabetes), start screening earlier. Some recommend early
screening for African Americans and Native Americans.
• Test anyone with signs or symptoms of diabetes
12. Pharmacotherapy of Diabetes
Avoid
Enjoy
• Diet and exercise are especially effective in
obese and sedentary patients (who constitute
most type II diabetic patients).
• Most patients, however, do not lose enough
weight to control glucose levels through diet
and exercise alone and will require
pharmacologic treatment.
• Glycemic control minimizes risks for
nephropathy, neuropathy, and retinopathy in
both Type 1 and 2 DM, and decreases risk
for cardiovascular disease for Type 1 DM.
15. • Intensive insulin therapy
• Insulin sliding
• scale Modifying insulin
Method of administration.
• Self-administered by sc
injection in abdomen,
buttocks, arm, and leg.
• Given intravenously for
emergency ketoacidosis.
Insulin based medication
16. Regimens
Most type I diabetic patients require 0.5 to 1.0 unit/kg per day to
achieve acceptable glycemic control.
Start with a conservative dose (0.2 units/kg) and adjust the regimen
according to the patient’s glucose levels.
Many different regimens exist, and every patient has unique needs.
Intensive insulin therapy
Long-acting insulin is given once daily in the evening.
These more aggressive therapies have been shown to significantly
decrease the incidence of diabetes complications such as retinopathy
and microalbuminuria when compared to prior regimens.
With intensive insulin therapy, the risk for hypoglycemia is a
serious concern.
17. Inpatient management of diabetic patients (sliding scale)
• An insulin sliding scale (SSI) of regular
insulin doses given according to bedside
finger-stick glucose determinations is
helpful in controlling blood glucose
levels in the hospital setting
• Once insulin therapy is started, a blood
glucose goal of 140 to 180 mg/dL should
be targeted for most patients.
18. Modifying insulin
• Physical activity—depending on the intensity of the activity, decrease
insulin dosage 1 to 2 units per 20 to 30 minutes of activity.
• During illness, administer all of the routine insulin. Many episodes of
DKA occur during episodes of illness.
• Stress and changes in diet require dosing adjustments.
• Patients undergoing surgery should get one-third to one-half of the
usual daily insulin requirement that day, with frequent monitoring and
adjustments, as necessary.
Surgical treatment
Surgical weight loss therapy (i.e., gastric bypass) is an effective
treatment for some patients, including adolescents. Additionally, islet
cell transplantation offers definitive treatment for selected qualified
patients.
