Diabetes Care & Management: A Review

This document reviews various aspects of diabetes care and management. It examines the role of psychological support programs, technological advancements like mHealth apps, and the effectiveness of multidisciplinary team care in managing diabetes. The review also considers national strategies and initiatives aimed at improving diabetes care in Australia.

Running head: OPTIMISING CARE IN CHRONIC CONDITION
Optimising care in chronic condition
Name of the student:
Name of the University:
Author’s note

1OPTIMISING CARE IN CHRONIC CONDITION
Part A: Executive summary of policy and evidence supporting optimal care delivery for
people with diabetes:
Diabetes is a chronic disease condition resulting in uncontrolled blood sugar and serious
damage to other body system with time. The burden of the disease is understood from the fact
that diabetes has been the direct cause of 1.6 million deaths worldwide in 2015 (World Health
Organization. 2017). In Australia, about 1.2 million people have been diagnosed with diabetes
and the rate increased from 4.4% to 5.1% in 2014-2015 (Health.gov.au. 2016). The Australian
government implemented many policies to provide optimal care for people with diabetes and
meet complex health care needs of affected people. Some example of diabetes related policies
include the Diabetes Australia National Policy Priorities 2010 and the Australian National
Diabetes Strategy 2016-2020.
The Australian National Diabetes Strategy 2016-2020 is an example of national response
to diabetes across all levels of government and it was endorses by the Australian Health
Minister’s Advisory Council (AHMAC) on 2nd October 2015 (Health.gov.au. 2018). The main
vision of the National Diabetes Strategy is to strengthen all sectors in implementing coordinated
approach to reduce social, human and economic impact of diabetes in Australia. It aimed to
reduce the social and economic burden of diabetes by preventing and managing diabetes,
improving diabetes service and use of primary care service, recognition of patient needs and
coordination of health care resource at all levels. The guiding principles for this goal included
collaboration and cooperation, coordination and integration, facilitation of person-centered care,
measurement of health behavior and minimization of health inequalities. To reduce the quality of
life of people living with diabetes, the Australian government planned developing agreed clinical
guideline, local care pathways and preventive programmes to support people with diabetes. The

2OPTIMISING CARE IN CHRONIC CONDITION
national strategy also focused on improving access to self-management education programme
and peer support programme (Department of Health 2018). Evidence suggest that diabetes self-
management education significantly improves the glycated hemoglobin (A1C) level in diabetes
patient (Chrvala, Sherr and Lipman 2016). In addition, the focus on implementing integrated care
service is effective as Doherty et al. (2016) showed that integrated medical, psychological and
social care in diabetes can reduce psychological and social co-morbidities of diabetes and
improve patient’s satisfaction level.
Another evidence of policy aiming to fulfill complex health care needs of people with
diabetes includes the National Policy priorities 2010 that focused on better management and
prevention of diabetes for all Australians. It priorities care of people with diabetes by several
strategies like better accessibility to insulin pump, management of diabetes in aged care services,
health literacy for people with diabetes and controlling junk food and sugar beverage advertising
and marketing. It was a comprehensive policy that addressed all types of risk factors and issues
that increases challenges for people with diabetes (Diabetes Australia 2012). Hence, diverse
range of intervention targeting lifestyle, physical activity, diet and other areas are effective in
supporting people with diabetes and prevent diabetes. The above review of policy steps and
evidence for providing optimal care are all patient centered care strategy, that hold promotes in
reaching desired glycemic targets and improving patient’s quality of life (W Powell et al. 2015).
Part B: Recommendation for patient and family’s care within one particular local health
district within Sydney:
The main purpose of this section is to provide recommendation for care of patient and
family with diabetes in one particular health district within Sydney. The recommendations for

3OPTIMISING CARE IN CHRONIC CONDITION
care is based on analysis of case scenario of Joel, a 13 years old teenager, who has been
diagnosed with type 1 diabetes recently and informed by the executive summary presented in
part A. Joel lives with his mother Kate and 16-year old sister in Western Sydney Local Health
District. After the diagnosis of Type 1 diabetes, Joel’s mother is focused on supporting Joel’s
health holistically. This can be done by the implementation of patient-centered care plan for Joel.
Patient centered care plan is the main determinant of high quality care and it improves the
likelihood of equal access to services and achieving good patient outcome. It is necessary for
supporting people with chronic illness to enhance satisfaction care, empower patient and
holistically address health needs of patient (Berghout et al. 2015). Constant monitoring and care
of patient and providing access to appropriate resource to influence health behavior are essential
to provide holistic care to patient. Patient-centered care is favored by all patient group (de Boer,
Delnoij and Rademakers 2013). To recommend appropriate local health services to provide
optimal care to Joel, it will be necessary to identify social, health and psychological issues for
Joel and suggest services to patient accordingly.
The main health issue for Joel is the diagnosis of Type 1 diabetes and lack of knowledge
about managing the condition effectively. He dislikes taking medications and wants to cease
treatment so that he can live like a normal teen. Based on this information, Joel is in need of
support from local health care services for controlling his blood sugar level. Western Sydney is a
diabetes hotspot and after the establishment of Western Sydney Diabetes (WSD) initiative,
various private and non-government sector have come up to work with people with diabetes. As
Joel is a newly diagnosed diabetes patient, providing him the right treatment is important. Hence
to control blood sugar level of Joel, it is recommended that he and his mother Kate should be
referred to general practice services or out-patient clinic to get relevant medication to manage

4OPTIMISING CARE IN CHRONIC CONDITION
his condition. Joel can be referred to Westmead hospital diabetes clinic which can provide
specialist medical care to people with diabetes. The usefulness of this clinic is that it focuses on
optimizing diabetes care and treating all form of complication associated with the disease.
Hence, clinicians in the clinic can provide the right treatment to Joel and they can also refer them
to other allied health services as they work closely with diabetes educators, dieticians and
podiatrist (Diabetes Clinics - WSLHD 2018). The advantage of diabetes outpatient clinic in
Western Sydney is that it has been developed in a manner to become rapid access and
stabilization clinic that fulfills the principle of integrated care for disease management (Western
Sydney Diabetes 2018). This recommendation is in relevance with the National Health Strategy
Goal of 2016-2020 of improving the quality of life of people with diabetes as the national policy
proposed that increasing access to specialist support through local regional networks of care is
essential for management of diabetes (Department of Health 2018). Hence, by referreing Joel
and Kate to outpatient clinic, it will create the pathway for identifying specialist care and other
support services for patient.
In addition, it has been evident from the case scenario of Joel that both Joel and his
mother Kate finds the type 1 diabetes as a burden and they lack the understanding that they can
engage in physical activity and other normal life activity like other normal children. Kate also
want to change dietary choice of Joel to provide holistic care. Hence, from this information, it is
recommended that Joel and his mother be referred to diabetes education service and community
health services in Western Sydney so they get adequate health education to effective manage type
1 diabetes and live a high quality life. By participating in diabetes education program, Joal can
be encouraged to increase level of physical activity and eat healthy food which is in relevance
with the optimal care approach provided by National Diabetes Health Strategy 2016-2020.

5OPTIMISING CARE IN CHRONIC CONDITION
Diabetes education services at Western service have experienced diabetes educator and the
general practitioner refer patients to diabetes educators. They provide education to patient as per
the patient’s needs by considering health literacy level of patient, stage of disease and type of
diabetes. Partnering with diabetes educator is essential for providing optimal care to patients like
Joel because they promote behavioral change in patient and empower patients to manage the
disease successfully. Diabetes educator act as the main facilitator of behavioral change in newly
diagnosed patient and their knowledge helps in providing individualized care plan to patient
(Burke, Sherr and Lipman 2014).
Secondly, it is recommended that Joel and Kate visit diabetes clinic in Western Sydney
where team of nurse educators, podiatrist, dietician and psychological work with each other to
help patient achieve best clinical outcome. This would enhance the likelihood of receiving
multidisciplinary diabetes team care. Type 1 diabetes is a condition that requires life-long
intensive treatment and self-management approach to lead a good quality life. However, the
issue for young patient with Type 1 diabetes is that due to complexity of treatment, they fail to
achieve glycemic control and constantly suffer from poor health outcome. To prevent
concomitant poor health outcomes for Joel, it is necessary that he engages in multi-disciplinary
clinician consultation to gain knowledge about ways to self-manage the condition. This would
also enhance skill of Joel and his family related to day-to-day self-management of Type 1
diabetes (Wiley et al. 2015). Hence, apart from receiving ancillary care from general practitioner,
Joel must also collaborate with clinicians as outpatient clinic so that other multi-professional
team such as specialist physicians, diabetes educator, dietician and psychologist can also work
him. The advantage of diabetes specialist service and integrated in Western Sydney is that they
intervene promptly to reduce the need for hospitalization and provide patient with the right

6OPTIMISING CARE IN CHRONIC CONDITION
health resource in the right setting (Western Sydney Diabetes 2018). Integrated service fulfills
the elements of patient-centred care by ensuring that young patient like Joel do not feel that
mode of delivery disrupts their lifestyle preferences. They use appropriate health apps and
technology to integrate care. This is also relevant with the guiding principles of the Australian
National Diabetes Strategy 2016-2020 as it mentioned that integration of diabetes care needs to
be done by coordination across services, setting and technology (Department of Health 2018). It
gave the directive of meaningful use of mHealth apps among consumers and as Joel is a
teenager, developing a patient centered mHealth app is necessary so that Joel can effective
transition to self-management of diabetes instead of relying on her mother Kate for self-
management (Holtz et al. 2017).
The above three recommendations related to outpatient visits, specialist care,
multidisciplinary and diabetes education services can fulfill the needs for controlling gylcemic
control, managing specific disease related complication, diet and physical activity changes and
self-management education for Joel. However, another complex issue for Joel was that he was
psychologically disturbed after being diagnosed with Type 1 diabetes. He was anxious regarding
what would happen if other students comes to know about his condition. He had the belief that
he will be discriminated and he would not be able to take part in activities like camps and sports.
Hence, considering this issue, it is evident that diagnosis of diabetes also results in poor
psychological outcome in patient. They are often depressed and anxious regarding their future
life. Therefore, in view of this problem, it is recommended that Joel and Kate are referred to
psychological support services in Western Sydney. This care recommendation is also in
relevance with Australian National Diabetes Strategy 2016-2020 as it gave the directive that to

7OPTIMISING CARE IN CHRONIC CONDITION
assist young people to engage in self-management of diabetes, psychological support services are
necessary for them (Department of Health 2018).
Outpatient clinic at Westmead hospital can also provide the service of psychologist to
Joel and Kate so that they could learn to cope up with Type 1 diabetes (Western Sydney Diabetes
2018). Psychological support program can reduce symptom of psychological distress, improve
mood and improve the quality of life of patient with Type 1 diabetes. A research done to evaluate
the efficacy of psychological support program on outcome of Type 1 diabetes patient revealed
that psychological support is necessary to improve patient’s skill to improve living with diabetes
(Forlani et al. 2010). Such psychological support programs covers different aspect of living with
the condition and clarifies several misconception related to the disease too. Hence, by the use of
integrated care and work with multi-professional team, social, health and psychological needs of
Joel in optimally managing Type 1 Diabetes can be fulfilled.

8OPTIMISING CARE IN CHRONIC CONDITION
References:
Berghout, M., van Exel, J., Leensvaart, L. and Cramm, J.M., 2015. Healthcare professionals’
views on patient-centered care in hospitals. BMC health services research, 15(1), p.385.
Burke, S.D., Sherr, D. and Lipman, R.D., 2014. Partnering with diabetes educators to improve
patient outcomes. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, p.45.
Chrvala, C.A., Sherr, D. and Lipman, R.D., 2016. Diabetes self-management education for adults
with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient
education and counseling, 99(6), pp.926-943.
de Boer, D., Delnoij, D. and Rademakers, J., 2013. The importance of patient-centered care for
various patient groups. Patient education and counseling, 90(3), pp.405-410.
Department of Health 2018. Australian National Diabetes Strategy 2016–2020. . Retrieved 23
April 2018, from
http://www.health.gov.au/internet/main/publishing.nsf/content/3AF935DA210DA043CA257EF
B000D0C03/$File/Australian%20National%20Diabetes%20Strategy%202016-2020.pdf
Diabetes Australia 2012. NATIONAL POLICY PRIORITIES 2010.
Static.diabetesaustralia.com.au. Retrieved 23 April 2018, from
https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/283db11a-ec5c-479a-adc3-
59dd66935d5d.pdf
Diabetes Clinics - WSLHD. 2018. Wslhd.health.nsw.gov.au. Retrieved 23 April 2018, from
http://www.wslhd.health.nsw.gov.au/Department-of-Diabetes-and-Endocrinology--Westmead-
Hospital-/Outpatient-Services/Diabetes-Clinics

9OPTIMISING CARE IN CHRONIC CONDITION
Doherty, A.M., Gayle, C., Morgan-Jones, R., Archer, N., Laura-Lee, Ismail, K. and Werner, A.,
2016. Improving quality of diabetes care by integrating psychological and social care for poorly
controlled diabetes: 3 Dimensions of Care for Diabetes. The International Journal of Psychiatry
in Medicine, 51(1), pp.3-15.
Forlani, G., Nuccitelli, C., Caselli, C., Moscatiello, S., Mazzotti, A., Centis, E. and Marchesini,
G., 2013. A psychological support program for individuals with Type 1 diabetes. Acta
diabetologica, 50(2), pp.209-216.
Health.gov.au. 2016. Department of Health | Diabetes. Retrieved 23 April 2018, from
http://www.health.gov.au/internet/main/publishing.nsf/content/chronic-diabetes
Health.gov.au. 2018. Department of Health | Australian National Diabetes Strategy 2016-2020.
Retrieved 23 April 2018, from
http://www.health.gov.au/internet/main/publishing.nsf/content/nds-2016-2020
Holtz, B.E., Murray, K.M., Hershey, D.D., Dunneback, J.K., Cotten, S.R., Holmstrom, A.J.,
Vyas, A., Kaiser, M.K. and Wood, M.A., 2017. Developing a Patient-Centered mHealth App: A
Tool for Adolescents With Type 1 Diabetes and Their Parents. JMIR mHealth and uHealth, 5(4).
W Powell, P., D Corathers, S., Raymond, J. and Streisand, R., 2015. New approaches to
providing individualized diabetes care in the 21st century. Current diabetes reviews, 11(4),
pp.222-230.
Western Sydney Diabetes 2018. Westernsydneydiabetes.com.au. Retrieved 23 April 2018, from
https://www.westernsydneydiabetes.com.au/framework-for-change/specialised-consultation/out-
patient-clinics

10OPTIMISING CARE IN CHRONIC CONDITION
Wiley, J., Westbrook, M., Long, J., Greenfield, J.R., Day, R.O. and Braithwaite, J., 2015.
Multidisciplinary diabetes team care: the experiences of young adults with type 1
diabetes. Health Expectations, 18(5), pp.1783-1796.
World Health Organization. 2017. Diabetes. Retrieved 23 April 2018, from
http://www.who.int/mediacentre/factsheets/fs312/en/