Diabetes is a serious, common and costly disease that affects 4 percent of the Philippine population. Some 800,000 new cases are diagnosed annually. The complications of diabetes include cardiovascular disease, blindness, kidney failure, nerve damage, and lower extremity amputations. These complications subsequently result in higher rates of disability, increases in use of health care services, lost days from work, and unemployment, and decreased quality of life.

Despite its multi-system effects, diabetes is a controllable disease, and there is unequivocal evidence that its enormous human and economic toll can be significantly reduced by education.

History
Dr. Elliot Joslin is credited with developing the concept of the “diabetes team”. Even in the pre-insulin era, he realized the importance of having nurses and other health care professionals assist in diabetes treatment. After the discovery of insulin, Dr. Joslin had nurses assist patients with insulin use after discharge from the hospital. His attitude was “the diabetic who knows the most lives the longest”, a concept obviously well ahead of his time.

In the late 1970s and early ’80s, more physicians were learning about the usefulness of the diabetes team. Several physicians acknowledged that diabetes care was becoming so complex that other health care professionals would be required to help provide optimal care. Subsequently, many diabetes centers, mostly but not exclusively within academic settings, routinely began including the services of nurses, dietitians, pharmacists, psychologists, and podiatrists in the daily management of diabetes and approach” seemed to be effective and efficient for many reasons, not the least of which was that every team member was aware of the other team members’ roles.

Essence of the Diabetes Clinic
The establishment of a Diabetes Clinic for diabetes management based on scientifically grounded practice guidelines presents an outstanding opportunity to improve the health of people with diabetes. This is most effectively carried out through a collaborative, interactive, multi-skilled approach that maximizes the use of health professionals.

The key function of the multidisciplinary team is to provide continuous, accessible and consistent care focused on the needs of individuals with type 2 diabetes.

Such a clinic would offer patients its facilities to educate him on what diabetes is, its various forms of management, the use of the food exchange list, the action of both oral and parenteral hypoglycemic agent, the correct way of administering insulin, the various monitoring devices both for determining urine and blood glucose, the proper way to care for himself on sick days, and lastly, the correct way to care for his feet, skin and teeth.

The clinic will also offer its facilities for in-patients and out-patients, regardless of who the doctor is or which hospital one goes to, for individual or group instruction, for the totality of its course or just a part of it.

At the end of a counseling program for diabetes, clinic educators will evaluate the patient and have the assessment done by the medical staff. Lectures are followed by good interaction with patients, and a question-and-answer session. Typically it may be conducted for two days with two hours per session.

The Team Members
The patient is the central team member. Thus, patients need to know about their daily roles as care providers and decision makers and to work with their provider team.

The ideal core team includes a physician as a coordinator and main medical decision maker, along with an array of other health professionals such as a nurse, a dietitian, at least one of whom is a Certified Diabetes Educator. Training to become a diabetes educator is provided annually by the Philippine Center for Diabetes Education Foundation (PCDEF) which was founded to answer the emerging needs of educating a diabetic client in the country. The nurse educator is a
registered and board certified nurse who conducts individual and group education programs to equip the patients and the next-of-kin with the necessary skills and knowledge to confidently live and manage their condition daily. Patients will learn about the following:

• Lifestyle changes, such as incorporating regular exercises
• The range and effects of available oral agents for diabetes
• Insulin therapy and home blood sugar testing
• Preventing and managing acute and chronic complications
• Emotional adjustments to diabetes, coping with it and the role of the family and support groups
• Other special needs such as caring for the elderly person with diabetes, travelling tips for people with diabetes and coping with their condition during sick days will be discussed

The Dietitian is a registered and board certified nutritionist who guides the patient to implement specific diet strategies and plan meals. She will also provide medical nutritional therapy for the following disease states that are linked to diabetes:

• Obesity
• Renal disease
• Liver disease
• Cardiovascular disease
• High cholesterol
• Osteoporosis

The podiatrist is a specialist who looks into foot problems. If the podiatrist is not available, the nurse educator who underwent specialized training on foot care will regularly screen the patient’s feet, using specialized equipment to detect neurological and vascular problems at an early stage. The feet of people with diabetes are prone to major problems due mainly to the loss of sensation and blood supply. Left untreated, minor callosities, corns and blisters can lead to severe infection and possibly require amputation of the limb. The podiatrist/nurse educator will give advice on foot care and footwear in order to prevent serious foot complications such as:

• Corns and calluses
• Thickened and deformed nails
• Ingrown and fungal-infected nails
• Diabetic foot ulcers
• Charcot joint deformity
• Gangrene

Additional functions of a multidisciplinary team:

• Provide input at diagnosis of condition and continually thereafter to:
  • adhere to standards of care
  • discuss rational therapeutic suggestions
  • monitor guideline adherence and short-term outcomes
  • avoid early complications or provide timely intervention to decrease diabetes-related complications
• Enable long-term patient self-management

Benefits of Multidisciplinary Team

Diabetes education is a broad term that has a variety of definitions, meanings and interpretations. In this era of internet sites and Webinars, technology has become a key enabler of education. However, information alone does not translate into action. Effective education on diabetes goes beyond the passive relay of information like brochures and pamphlet distribution. It is our job as diabetes educators to be at the forefront in the battle against diabetes thru intensive coaching that result in behavior change and improved health status that is sustainable over time.

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