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Case Study Presentation

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Case Study Presentation

  1. 1. Hey Sugar, Diabetes Got You Down? Kelly Knopf Dietetic Intern
  2. 2. Outline <ul><li>Social and Family History </li></ul><ul><li>Problem List </li></ul><ul><li>Current Nutritional Status </li></ul><ul><li>Pathophysiology </li></ul><ul><li>Outcomes </li></ul><ul><li>Barriers to Self-Care </li></ul><ul><li>Current Research </li></ul><ul><li>What’s on the Horizon? </li></ul>
  3. 3. Social & Family History <ul><li>40 years old </li></ul><ul><li>Male </li></ul><ul><li>Caucasian </li></ul><ul><li>Unmarried, lives at home with parents </li></ul><ul><li>Non-smoker </li></ul><ul><li>History of ETOH abuse </li></ul><ul><li>Unemployed </li></ul>
  4. 4. Problem List <ul><li>Past Problems </li></ul><ul><ul><li>Type 1 Diabetes Mellitus </li></ul></ul><ul><ul><li>Neuropathy </li></ul></ul><ul><ul><li>Kidney stones </li></ul></ul><ul><ul><li>ETOH abuse </li></ul></ul><ul><li>Current Problems </li></ul><ul><ul><li>DKA </li></ul></ul><ul><ul><li>Fever, chills, headache, abd pain, N/V, diarrhea x 5days </li></ul></ul>
  5. 5. Current Status <ul><li>HgbA1c 10.2% </li></ul><ul><li>Non-compliance, denial </li></ul><ul><li>Height 6’2” </li></ul><ul><li>Weight 168 lbs </li></ul><ul><li>BMI 21.6 </li></ul><ul><li>Normal weight </li></ul>
  6. 6. Overview DKA Diarrhea Possible depression ETOH abuse Neuropathy ↓ Urine output Kidney stones Nausea and vomiting Abdominal pain Polydipsia Weight loss Type 1 Diabetes Mellitus
  7. 7. Overview DKA Diarrhea Possible depression ETOH abuse Neuropathy ↓ Urine output Kidney stones Nausea and vomiting Abdominal pain Polydipsia Weight loss Type 1 Diabetes Mellitus Non-compliance
  8. 8. Outcomes <ul><li>Motivation </li></ul><ul><li>Goals </li></ul><ul><li>Compliance </li></ul><ul><li>Barriers </li></ul>
  9. 9. Barriers to Self-Care <ul><li>Dietary changes </li></ul><ul><li>Exercise </li></ul><ul><li>Self-monitoring </li></ul><ul><li>Self-medicating </li></ul><ul><li>Self-injecting </li></ul><ul><li>Frequent visits to clinic </li></ul>Harvey JN, Lawson VL. The importance of health belief models in determining self-care behaviour in diabetes. Diabetic Med. 2009;26(1):5-13.
  10. 10. Statistics <ul><li>14.8 million </li></ul><ul><li>23.5 million </li></ul><ul><li>20-25% </li></ul><ul><li>1.6-2.0 </li></ul><ul><li>1.76 </li></ul><ul><li>1.71 </li></ul><ul><li>3.11 </li></ul>Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive-Behavioral therapy for Adherence and Depression in Type 2 Diabetes. Jrnl of Cognitive Psychotherapy:An International Quarterly. 2010;24(4):329-343. Pan A, et al. Increased Mortality Risk in Women with Depression and Diabetes Mellitus. Archives of General Psychiatry. 2011;68(1):42-50.
  11. 11. Barriers – Emotional <ul><li>Health Belief Model (HBM) </li></ul><ul><ul><li>5 dimensions </li></ul></ul><ul><li>Theory of Planned Behavior (TPB) </li></ul><ul><ul><li>Intention </li></ul></ul><ul><ul><li>Perceived difficulty </li></ul></ul><ul><li>Blame and Anger </li></ul>DePalma MT, Rollison J, Comporese M. Psychosocial Predictors of Diabetes Management. Am J Health Behav. 2011;35(2):209-218. Harvey JN, Lawson VL. The importance of health belief models in determining self-care behavior in diabetes. Diabetic Med. 2009;26(1):5-13. Naranjo DM, Fisher L, Arean PA, Hessler D, Mullan J. Patients With Type 2 Diabetes at Risk for Major Depressive Disorder Over Time. Annals of Family Medicine. 2011;9(2):115-120. Shankar A, Conner M, Bodansky HJ. Can the theory of planned behaviour predict maintenance of a frequently repeated behaviour? Psychology, Health & Medicine . 2007;12(2):213-224.
  12. 12. Coping and Self-Care <ul><li>Healthy Coping </li></ul><ul><ul><li>Behaviors </li></ul></ul><ul><ul><li>Barriers </li></ul></ul><ul><li>Association of depression with treatment </li></ul><ul><ul><li>Compliance of varying self-care activities </li></ul></ul>AADE Guidelines for the Practice of Diabetes Self-Management Education and Training. AADE . Chicago, IL. Rev. November 2010. Kent D, Haas L, Randal D, et al. Healthy Coping: Issues and Implications in Diabetes Education and Care. Population Health Management. 2010;13(5):227-233. Zugen SI, Syed EU, Bhatti JA. Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: A cross-sectional study from Karachi, Pakistan. BMC Psychiatry. 2011;11(27):1-6.
  13. 13. Counseling and Accommodations <ul><li>Counseling </li></ul><ul><ul><li>screening </li></ul></ul><ul><li>Cognitive-Behavioral Therapy (CBT) </li></ul><ul><ul><li>Team approach </li></ul></ul><ul><li>Americans with Disabilities Act (ADA) </li></ul>Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive-Behavioral therapy for Adherence and Depression in Type 2 Diabetes. Jrnl of Cognitive Psychotherapy: An International Quarterly. 2010;24(4):329-343. Renosky RJ, Wray L, Hunt B, Ulbrecht JS, Hill-Briggs F. Counseling People Living with Diabetes. J Rehabil. 2008;74(4)31-40.
  14. 14. On the Horizon <ul><li>Study Protocol (2011): DiaMind </li></ul><ul><li>Study Protocol (2010): Telephone Linked Care (TLC) (2010) </li></ul>Van Son J, Nyklicek I, Pop V, Power F. Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial. BMC:Public Health. 2011; 11(131):1-11. Bird D, Oldenburg B, Cassimatis M, et al. Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked care Diabetes Project): study protocol. BMC Public Health. 2010;10:559-604.
  15. 15. References <ul><li>AADE Guidelines for the Practice of Diabetes Self-Management Education and Training. AADE . Chicago, IL. Rev. November 2010. </li></ul><ul><li>Bird D, Oldenburg B, Cassimatis M, et al. Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked care Diabetes Project): study protocol. BMC Public Health. 2010;10:559-604. </li></ul><ul><li>DePalma MT, Rollison J, Comporese M. Psychosocial Predictors of Diabetes Management. Am J Health Behav. 2011;35(2):209-218. </li></ul><ul><li>Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive-Behavioral therapy for Adherence and Depression in Type 2 Diabetes. Jrnl of Cognitive Psychotherapy: An International Quarterly. 2010;24(4):329-343. </li></ul><ul><li>Harvey JN, Lawson VL. The importance of health belief models in determining self-care behavior in diabetes. Diabetic Med. 2009;26(1):5-13. </li></ul><ul><li>Kent D, Haas L, Randal D, et al. Healthy Coping: Issues and Implications in Diabetes Education and Care. Population Health Management. 2010;13(5):227-233. </li></ul><ul><li>Naranjo DM, Fisher L, Arean PA, Hessler D, Mullan J. Patients With Type 2 Diabetes at Risk for Major Depressive Disorder Over Time. Annals of Family Medicine. 2011;9(2):115-120. </li></ul><ul><li>Pan A, et al. Increased Mortality Risk in Women with Depression and Diabetes Mellitus. Archives of General Psychiatry. 2011;68(1):42-50. </li></ul><ul><li>Renosky RJ, Wray L, Hunt B, Ulbrecht JS, Hill-Briggs F. Counseling People Living with Diabetes. J Rehabil. 2008;74(4)31-40. </li></ul><ul><li>Shankar A, Conner M, Bodansky HJ. Can the theory of planned behaviour predict maintenance of a frequently repeated behaviour? Psychology, Health & Medicine . 2007;12(2):213-224. </li></ul><ul><li>Van Son J, Nyklicek I, Pop V, Power F. Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial. BMC:Public Health. 2011; 11(131):1-11. </li></ul><ul><li>Zugen SI, Syed EU, Bhatti JA. Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: A cross-sectional study from Karachi, Pakistan. BMC Psychiatry. 2011;11(27):1-6. </li></ul>
  16. 16. Thank you for your time and attention!

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