This document outlines the key components of non-pharmacological diabetes management, including diabetes self-management education, medical nutrition therapy, physical activity, smoking cessation, immunization, psychological issues, exercise, stress management, foot care, education, self-monitoring of blood glucose, diet, and lifestyle management. It provides details on recommendations and guidelines for each component from organizations like the International Diabetes Federation, emphasizing that non-pharmacological approaches are effective, safe and can be affordable forms of diabetes care when implemented properly through education and lifestyle changes.

1. Non Pharmacological Diabetes
Management
UEDA Diabetes Mini-Course
Aswan Feb. 2016

2. Foundations of Care
Agenda
1. Diabetes Self-management Education
2. Medical Nutrition Therapy
3. Physical Activity
4. Smoking Cessation
5. Immunization
6. Psychological Issues

3. Diabetic Patient Care
Non-Pharmacological
Exercise
Stress
Management
Foot Care
Education
SMBG
Smoking
Cessation
Diet
Pharmacological
Oral Hypoglycemic Drugs
Insulins
Insulin Analogs
Interventional Foot Care
Interventional Cardiology
Etc….
Education

5. LS11 Encourage increased duration and frequency of physical
activity (where needed), up to 30-45 minutes on 3-5 days per
week, or an accumulation of 150 minutes per week of moderate
intensity aerobic activity
Adults with diabetes should be advised to perform at least 150
min/ week of moderate-intensity aerobic physical activity (50–
70% of maximum heart rate), spread over at least 3 days/week
with no more than 2 consecutive days without exercise. A
Both aerobic and resistance exercise are beneficial for patients
with diabetes, and it is optimal to do both types of exercise. At
least 150 minutes per week of aerobic exercise, plus at least two
sessions per week of resistance exercise, is recommended.
Adults and older people: 150 minutes (two and half hours)
each week of moderate- to vigorous-intensity physical
activity. Muscle-strengthening activity should also be
included twice a week.
Exercise

6. Stress in Diabetics
Stress within the Family
Stress in the work
Other stresses
Stress due to Diabetes

7. Explore the social situation, attitudes, beliefs and worries
related to diabetes and self-care issues. Assess well-being
(including mood and diabetes distress), periodically, by
questioning or validated measures
Psychosocial screening and follow up may include, but are
not limited to, attitudes about the illness, expectations for
medical management and outcomes, affect/ mood,
general and diabetes related quality of life, . E
In both type 1 and 2 diabetes, interventions that target
families’ ability to cope with stress or diabetes-related
conflict should be included in educational interventions
when indicated (Grade B, Level 2)
Stress, whether physical stress or mental stress, has been
proven to instigate changes in blood sugar levels, which
for people with diabetes can be problematic.*
Stress Management

8. Reference
1. Surwit RS, van Tilburg MAL, Zucker N, McCaskill CM, Parekh P, Feinglos MN, Edwards CL,
Williams P, and Lane JD. Stress management improves long-term glycemic control in Type 2
diabetes. Diabetes Care, 2002; 25: 30-34.
Stress Management improves long-term
glycemic control in Type 2 diabetes

9. Effectiveness of foot care education among
people with type 2 diabetes in rural areas in India
We found that even 5-6 min of time devoted to
individual patient education improved their foot care
practice. When consistently reinforced, this education is
likely to result in healthy habit formation, which may
prevent disability and reduce medical expenditure in the
long run.
Reference
Suman Saurabh, Sonali Sarkar, Kalaiselvi Selvaraj, Sitanshu Sekhar Kar, S. Ganesh Kumar, andGautam
Roy. Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry,
India. Indian J Endocrinol Metab. 2014 Jan-Feb; 18(1): 106–110.

10. Foot care education in patients with diabetes at
low risk of complications: a consensus statement
The key educational elements for diabetes patients at low risk of
complications are captured with the mnemonic CARE:
Control: control blood glucose levels (in accordance with recommendations
from your healthcare professional).
Annual: attend your annual foot screening examination with your healthcare
professional.
Report: report any changes in your feet immediately to your healthcare
professional.
Engage: engage in a simple daily foot care routine by washing and drying
between your toes, moisturizing and checking for abnormalities.

11. Effectiveness of smoking cessation
counseling
Smoking cessation is one of the few interventions that
can safely and cost-effectively be recommended for all patients,
and it has been identified as a gold standard against which other
preventive behaviors should be evaluated. A number of large
randomized clinical trials have demonstrated the efficacy and
cost-effectiveness of certain forms of provider and behavioral
counseling in changing smoking behavior of primary care and
hospitalized patients.

13. Strategies for improving glycemic control:
effective use of glucose monitoring “SMBG”
Self-monitoring of blood glucose (SMBG) is one strategy for
improving glycemic control; however, patient adherence is
suboptimal and proper education and follow-up are crucial.
Patients need to understand:-
 why they are being asked to self-test
 what their glycemic targets are
 what they should do based on the results of self-monitoring
Patients also must be taught proper technique and must
be given specific recommendations regarding frequency and
timing for self-monitoring.

14. ED1 Make patient-centered, structured self-management
education an integral part of the care of all people with type 2
diabetes.
ED4 Ensure that education is accessible to all people with diabetes,
taking account of culture, ethnicity, psychosocial, and disability
issues.
People with diabetes should receive diabetes self-management
education (DSME) and diabetes self-management support (DSMS)
when their diabetes is diagnosed and as needed thereafter. B
People with diabetes should be offered timely diabetes education
that is tailored to enhance self-care practices and behaviors
(Grade A, Level 1A).
Managing diabetes can be exceedingly demanding, often requiring
you to make lifestyle changes – stopping smoking, changing your
diet and physical activity levels, taking medication and monitoring
your blood glucose levels.
Education

15. Development of a Therapy
“Drug Mesh”
Effectiveness
Safety
Affordability

16. Exercise
Stress
Management
Foot Care
Education
SMBG
Smoking
Cessation
Diet
Education

17. IDF Recommendations
UEDA Diabetes Mini-Course
Aswan Feb. 2016

18. Education
ED1 Make patient-centered, structured self-
management education an integral part of the care
of all people with type 2 diabetes:
 From around the time of diagnosis.
 On an ongoing basis, based on routine
assessment of need.
 On request.
ED2 Use an appropriately trained multidisciplinary team
to provide education to groups of people with
diabetes, or individually if group work is considered
unsuitable. Where desired, include a family
member or friend.

19. ED3 Include in education teams a health-care
professional with specialist training in diabetes
and delivery of education for people with diabetes.
ED4 Ensure that education is accessible to all people
with diabetes, taking account of culture, ethnicity,
psychosocial, and disability issues. Consider
delivering education in the community or at a local
diabetes center, through technology and in
different languages. Include education about the
potential risk of alternative medicine.
Education

20. ED5 Use techniques of active learning (engagement in
the process of learning and with content related
to personal experience), adapted to personal
choices and learning styles.
ED6 Use modern communications technologies to
advance the methods of delivery of diabetes
education.
ED7 Provide ongoing self-management support.
Education

21. Psychological Care
PS1 In communicating with a person with diabetes,
adopt a whole-person approach and respect that
person’s central role in their care. Communicate
non-judgmentally and independently of attitudes
and beliefs.
PS2 Explore the social situation, attitudes, beliefs and
worries related to diabetes and self-care issues.
Assess well-being (including mood and diabetes
distress), periodically.

22. PS3 Counsel the person with diabetes in the context
of ongoing diabetes education and care.
PS4 Refer to a mental health-care professional with a
knowledge of diabetes when indicated.
Indications may include: severe coping
problems, signs of major depression, anxiety
disorder, personality disorder, addiction and
cognitive decline.
Psychological Care

23. Lifestyle Management
LS1 Offer lifestyle advice to all people with type 2 diabetes
around the time of diagnosis.
LS2 Review and reinforce lifestyle modification yearly and
at the time of any treatment change or more frequently
as indicated.
LS3 Review and provide ongoing counselling and
assessment yearly as a routine, or more often as
required or requested, and when changes in medication
are made.

24. LS4 Advise people with type 2 diabetes that lifestyle
modification, by changing patterns of eating and
physical activity, can be effective in controlling many
of the adverse risk factors found in the condition.
LS5 Provide access to a dietitian (nutritionist) or other
health-care professional trained in the principles of
nutrition, at or around the time of diagnosis, offering
an initial consultation with follow-up sessions as
required, individually or in groups.
LS6 Individualize advice on food/meals to match needs,
preferences, and culture.
Lifestyle Management

25. LS7 Advise on reducing energy intake and control of
foods with high amounts of added sugars, fats or
alcohol.
LS8 Match the timing of medication (including
insulin) and meals.
LS9 Provide advice on the use of foods in the
prevention and management of hypoglycemia
where appropriate.
LS10 Introduce physical activity gradually, based on
the individual’s willingness and ability, and
setting individualized and specific goals
Lifestyle Management

26. LS11 Encourage increased duration and frequency of
physical activity (where needed), up to 30-45 minutes
on 3-5 days per week, or an accumulation of 150
minutes per week of moderate-intensity aerobic activity
(50-70% of maximum heart rate).
LS12 In the absence of contraindications, encourage
resistance training three times per week.
LS13 Provide guidance for adjusting medications (insulin)
and/or adding carbohydrate for physical activity.
Lifestyle Management

27. In Conclusion
All mentioned
“Non-Pharmacological/Non-Interventional”
modalities of Diabetes Care are
Effective, Safe And Can Be Affordable.

28. In Conclusion
If we can offer People with Diabetes such care
This is excellent
If we don’t have the time or the “Know How”
We have to develop a system to deliver such care
This is their RIGHT
& Our Mission

29. Lastly we hope that course will achieve
its goals and help you all in getting the
best of the forthcoming conference
UEDA Board
UEDA Diabetes Mini-Course
Aswan Feb. 2016