By Regan Hamilton

Can Occupational Therapy input improve diabetes management for individuals with Type 2 Diabetes?

What? Occupational Therapy input improving the management of diabetes

Who? People currently experiencing difficulty managing Type 2 Diabetes

Where? A local Type 2 Diabetes Support Group in Dundee, Scotland

How? - Identifying lifestyle factors - Enablement - Group skills - Education

The estimated diabetes prevalence worldwide for 2011 was 366 million and it is expected to affect 552 million people by 2030. (Diabetes UK, 2012)

There are 2.9 million people who have been diagnosed with diabetes in the UK (2011). (Diabetes UK, 2012)

By 2025, it is estimated that five million people will

have diabetes in the UK. (Diabetes UK, 2012)

That’s equivalent to: - more than 400 people every day - over 17 people every hour - around three people every ten minutes (Diabetes UK, 2012)

Statistics show that in Dundee, Tayside 6918 people have been diagnosed with Type 2 diabetes. This is higher than the average for Scotland. (Diabetes UK, 2013)

Figures show that 86.9% of those people diagnosed with type 2 are overweight or obese. (Diabetes UK, 2013)

There is a significant amount of secondary problems that have stemmed from type 2 diabetes. Renal failure, obesity, foot ulcers, stroke and high cholesterol levels are all significantly higher than the national average.

(Diabetes UK, 2013)

Dundee Healthy Living Initiative (2012).

Active Older Person’s Programme

(2005-2008).

Scottish Diabetes Framework: Diabetes Action Plan (2002) -A strategy to contain the growth of Diabetes.-Ensuring people diagnosed had access to quality care and treatment.-More people to receive regular health checks to prevent secondary effects from Diabetes.

NICE Guidelines: Type 2 diabetes: The management of type 2 diabetes (2009)

“Offer structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review.”

“Receive support from an appropriately trained and experienced healthcare professional.”

Social exclusion Disengagement from previous occupations Ability to work may be jeopardised

“As with any other chronic condition, the individual has to carry out many daily treatment-related tasks if adequate blood glucose control is to be achieved” (Diabetes Health Centre, 2008).

“Diabetes affects our blood vessels and nerves and therefore can affect any part of the body” (Global Diabetes Community, 2014).

Heart diseaseStrokeDiabetic retinopathy Kidney diseaseNerve Damage

http://www.youtube.com/watch?v=8pvlBvz5_js

Diabetes Specialist Nurses Diabetes Dietitians GP’s Other specialist health professionals involved

include a podiatrist and ophthalmologist.

A Diabetes Self-Management Article (2009) identified many barriers to self-management of the condition, these included…

Some people may find it very difficult to change their long-established behaviours in order to self-manageFinancial or logistical barriers include physical limitations of access to services and ongoing support once people have had initial self-management training or guidance.People can benefit from seeing their healthcare professionals on a more regular basis.Options are needed so that people can choose what is best in meeting their individual needs.

(Diabetes UK, 2009)

“Occupational therapists promote function,

quality of life and the realisation of potential

in people who are experiencing occupational

deprivation, imbalance or alienation”

(COT, 2011)

“Occupational therapy practitioners are experts at analysing

the performance skills and patterns necessary for people to

engage in their everyday activities (occupations). They can

effectively educate and train persons at risk for or who

currently have diabetes to modify current habits and

routines and develop new ones to promote a healthier

lifestyle and manage the condition” (American Occupational

Therapy Association, 2011)

“Occupational therapy interventions can integrate diabetes management into patients’ lifestyles, while including context and culture in treatment planning and design” (Rodriguez, 2009)

Secondary problems may result in service users being unable to complete ADL’s (Estes, 2012)

Social participation may impacted by decreased mobility and fatigue (Schmader, 2002).

The Model of Human Occupation (MOHO)

(Kielhofner, 2008)

Educative Approach: (Hoffmann, 2009)

Educating individuals in terms of diabetes management within their individual lifestyleProviding educative information for friends/families to aid with the management Group work

Cognitive Behavioural Approach:ThoughtsBehavioursEmotion/moodPhysiological responsesThe environment (Duncan, 2011)

ReferralSelfGPOther Health Professionals involved with the group

AssessmentInitial AssessmentMOHOST (Parkinson, Forsyth & Kielhofner,2006)

Allows the therapist to assess the individual’s:MotivationPatternsCommunication & Interaction skillsProcess SkillsMotor SkillsEnvironment

…And identify how these are impacting the individual! (Parkinson, Forsyth & Kielhofner,2006)

Group sessions – including exercise or cooking classes (ADA, 2010)

Provide techniques to organise and track medications (American Occupational Therapy Association, 2011)

Grading and Adapting dietary changes, exercise programmes etc. into manageable steps and incorporating them into present daily routines (American Occupational Therapy Association, 2011)

Lack of referrals:-individuals may not fully understand service

-individuals may be in denial about their management of the condition

-individuals may lack confidence in asking for further help due to anxiety (Goldstein & Mueller-Wieland, 2013)

Other Health Professionals may not see the benefits of having an OT within the service

Possible reductions in the number of people not managing the condition

Possible reductions in the number of people with type 2 diabetes experiencing secondary problems

“Type 2 diabetes can result in a wide range of complications with repercussions for the NHS. The economic impact of this disease

includes: direct cost to the NHS and associated healthcare support services indirect cost to the economy, including the effects of early

mortality and lost productivity” (The National Collaborating Centre for Chronic Conditions, 2002).

Questionnaires for service users

Evaluation of blood glucose levels from before OT input and afterwards

MOHOST Goal Attainment Scaling

(GAS)

Document risks for each service user and monitor these

Individuals may require referral to other services Time Constraints within the setting

Confidentiality within

group-led interventions

More people not able to manage type 2 diabetes

More people experiencing secondary problems from the condition

Higher mortality rates

More cost for the NHS (2.8 billion estimate in 2007) (The National Collaborating Centre for Chronic Conditions, 2002).

American Diabetes Association (ADA). (2012). Type 2. In: Atchison, B.J. and Dirette, D.K. Conditions in Occupational Therapy. 4th ed. Baltimore: Lippincott Williams & Wilkins. pp. 172.

American Occupational Therapy Association. (2011). Occupational Therapy’s Role in Diabetes Self-management. Available: http://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/HW/Facts/Diabetes%20fact%20sheet.pdf. Last accessed 24.05.2014

Castandea, C., Layne, J.E., Munoz-Orians, L., Gordon, P.L., Walsmith, J., Foldvari, M., et al. (2002). A randomised control trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care, 25(12), 2335-2341.

College of Occupational Therapists. (2010). Code of Ethics and Professional Conduct. Available: http://www.cot.co.uk/sites/default/files/publications/public/Code-of-Ethics2010.pdf. Last accessed 24.05.2014.

College of Occupational Therapists. (2011). Professional Standards for Practice. Available: http://www.cot.co.uk/standards-ethics/professional-standards-occupational-therapy-practice. Last accessed 22.05.2014.

Diabetes Health Centre. (2008). The Psychological and Social effects of Type 2 Diabetes. Available: http://www.health.am/db/more/the-psychological-and-social-impact-of-type-2-diabetes. Last accessed 18.05.2014.

Diabetes UK. (2009). Improving supported self-management for people with diabetes. Available: http://www.diabetes.org.uk/Documents/Reports/Supported_self-management.pdf. Last accessed 20.05.2014.

Diabetes UK. (2012). Diabetes in the UK 2012. Available: http://www.diabetes.org.uk/Documents/Reports/Diabetes-in-the-UK-2012.pdf. Last accessed 14.05.2014.

Diabetes UK. (2013). Tayside- Diabetes UK. Available: http://www.diabetes.org.uk/In_Your_Area/Scotland/Diabetes_in_your_area_Scotland/Tayside/?print=1. Last accessed 14.05.2014.

Duncan, E. A. S (2011) Foundations for Practice in Occupational Therapy. 5th edn. London: Elsevier.

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