Özlem CANBOLAT, Şükrü EKENLER, Ülkü POLAT

DİYABET ÖZYÖNETİMİNDE ENGELLER VE KOLAYLAŞTIRICILAR

Diyabet, vücutta insülin azlığı/yokluğu nedeniyle ya da yeterince insülin olmasına rağmen istenilen düzeyde etki göstermemesi sonucunda kan şekeri yüksekliğiyle karakterize kronik bir hastalıktır. Diyabette istenilen glisemik kontrolün sağlanmasında öz yönetimin önemi büyüktür. Diyabetin yönetiminde engellerin belirlenmesi optimal sağlığa ulaşmada kritik bir adımdır. Diyabetin öz yönetiminde başlıca engeller; diyabetle ilgili yetersiz bilgi, inanç ve davranışları, kaynak yetersizliği, sağlık sorunları, olumsuz duygular ve destek eksikliğidir. Diyabetli bireylerin öz yönetimde karşılaştıkları sorunların farkında olmak ve bu sorunların üstesinden gelinmesinde hastayı desteklemek diyabet hemşirelerinin temel rollerinden birisidir. Bu derlemenin amacı diyabet öz yönetimindeki kolaylaştırıcılar ve engelleri tartışmaktır. Yapılan çalışmalar diyabet öz yönetiminde hastaların algıladıkları destek ve engellerin farkında olunarak yapılan diyabet öz yönetim eğitimlerinin daha etkili olduğunu ortaya koymaktadır.

Anahtar Kelimeler:

diyabet

BARRIERS AND FACILITATORS IN DIABETES SELF-MANAGEMENT

Diabetes is a chronic disease characterized by high blood sugar as a result of insufficient/absence of insulin in the body or not having the desired effect despite having enough insulin. Self-management is of great importance in achieving the desired glycemic control in diabetes. Identifying barriers in the management of diabetes is a critical step in achieving optimal health. The main barriers in diabetes selfmanagement are; lack of knowledge, beliefs and behaviors about diabetes, lack of resources, health problems, negative emotions and lack of support. Being aware of the problems faced by individuals with diabetes in self-management and supporting the patient in overcoming these problems is one of the basic roles of the diabetes nurse. The purpose of this review is to discuss the pillars and barriers in diabetes self-management. Studies show that diabetes selfmanagement trainings, which are made by being aware of the support and obstacles perceived by the patients, are more effective in diabetes selfmanagement.

Keywords:

diabetes,

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1. ADA. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):15-33.
2. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Practice. 2019;157:107843.
3. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169-80.
4. Chatterjee S, Davies MJ, Heller S, Speight J, Snoek FJ, Khunti K. Diabetes structured self-management education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol. 2018;6(2):130-42.
5. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A Systematic Review of Reviews Evaluating Technology-Enabled Diabetes Self-Management Education and Support. J Diabetes Sci Technol. 2017;11(5):1015-27.
6. Banerjee M, Chakraborty S, Pal R. Diabetes self-management amid COVID-19 pandemic. Diabetes Metab Syndr. 2020;14(4):351-4.
7. AADE. Role of the diabetes educator in inpatient diabetes management. The Diabetes Educator. 2018;44(1):57-62.
8. Hermanns N, Ehrmann D, Finke-Groene K, Kulzer B. Trends in diabetes self-management education: where are we coming from and where are we going? A narrative review. Diabetic Medicine. 2020;37(3):436-47.
9. He X, Li J, Wang B, Yao Q, Li L, Song R, et al. Diabetes self- management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine. 2017;55(3):712-31.
10. Mohamed A, Staite E, Ismail K, Winkley K. A systematic review of diabetes self-management education interventions for people with type 2 diabetes mellitus in the Asian Western Pacific (AWP) region. Nurs Open. 2019;6(4):1424-37.
11. Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Enablers and barriers to effective diabetes self-management: A multi- national investigation. PLoS One. 2019;14(6):e0217771.
12. Muslu L, Öncel S. Diyabet hastalarında öz yönetim ve izlemin önemi. R HA, editor. Ankara: Türkiye Klinikleri; 2019.
13. Eroğlu N, Sabuncu N. Diyabet Öz Yönetim Skalası’nın (DÖYS) Türk Toplumuna Uyarlanması: Geçerlik ve Güvenirlik Çalışması. Hemşirelik Bilimi Dergisi. 2019;1(3):1-6.
14. Hailu FB, Hjortdahl P, Moen A. Nurse-Led Diabetes Self-Management Education Improves Clinical Parameters in Ethiopia. Front Public Health. 2018;6:302.
15. Azami G, Soh KL, Sazlina SG, Salmiah MS, Aazami S, Mozafari M, et al. Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes. J Diabetes Res. 2018;2018:4930157.
16. Steinsbekk A, Rygg L, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012;12:213.
17. Tshiananga JK, Kocher S, Weber C, Erny-Albrecht K, Berndt K, Neeser K. The effect of nurse-led diabetes self-management education on glycosylated hemoglobin and cardiovascular risk factors: a meta-analysis. Diabetes Educ. 2012;38(1):108-23.
18. Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Vandermeer B, et al. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Ann Intern Med. 2015;163(11):848-60.
19. Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. Am Psychol. 2016;71(7):539-51.
20. Yüksel M, Bektaş H. Diyabete Bağlı Kronik Komplikasyonların Yönetiminde Güncel Yaklaşımlar. Current Approaches in the Administration of Chronic Complications Related to Diabetes. 2020;12(1):133-57.
21. Hemmingsen B, Gimenez-Perez G, Mauricio D, Roqué IFM, Metzendorf MI, Richter B. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev. 2017;12(12):Cd003054.
22. Wang Y, Xue H, Huang Y, Huang L, Zhang D. A Systematic Review of Application and Effectiveness of mHealth Interventions for Obesity and Diabetes Treatment and Self-Management. Adv Nutr. 2017;8(3):449-62.
23. Shan R, Sarkar S, Martin SS. Digital health technology and mobile devices for the management of diabetes mellitus: state of the art. Diabetologia. 2019;62(6):877-87.
24. Cahn A, Akirov A, Raz I. Digital health technology and diabetes management. J Diabetes. 2018;10(1):10-7.
25. Hunt CW. Technology and diabetes self-management: An integrative review. World J Diabetes. 2015;6(2):225-33.
26. Yüksel M, Bektaş H. Tip 2 Diyabet Öz Yönetiminin Güçlendirilmesinde Mobil Sağlık Uygulamalarının Kullanımı: Literatür Derlemesi. Türkiye Klinikleri Hemşirelik Bilimleri Dergisi. 2021;13(2):424-34.
27. Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber- Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011;34(9):1934-42.
28. Goh G, Tan NC, Malhotra R, Padmanabhan U, Barbier S, Allen JC, Jr., et al. Short-term trajectories of use of a caloric- monitoring mobile phone app among patients with type 2 diabetes mellitus in a primary care setting. J Med Internet Res. 2015;17(2):e33.
29. Robat Sarpooshi D, Taghipour A, Mahdizadeh M, Peyman N. Enablers of and Barriers to Effective Diabetes Self-Care in Iran: A Qualitative Study. Patient Relat Outcome Meas. 2020;11:109-18.
30. Browne JL, Ventura A, Mosely K, Speight J. 'I'm not a druggie, I'm just a diabetic': a qualitative study of stigma from the perspective of adults with type 1 diabetes. BMJ Open. 2014;4(7):e005625.
31. Chepulis L, Morison B, Cassim S, Norman K, Keenan R, Paul R, et al. Barriers to Diabetes Self-Management in a Subset of New Zealand Adults with Type 2 Diabetes and Poor Glycaemic Control. J Diabetes Res. 2021;2021:5531146.
32. Adhikari M, Devkota HR, Cesuroglu T. Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders' perspective. BMC Public Health. 2021;21(1):1269.
33. Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: Patient and provider factors. Diabetes Research and Clinical Practice. 2011;93(1):1-9.
34. Grant JS, Steadman LA. Barriers to Diabetes Self-Management Among Rural Individuals in the Workplace. Workplace Health Saf. 2016;64(6):243-8.
35. Kim SH, Lee A. Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs. 2016;13(4):324-33.
36. Mackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making. 2016;36(6):741-59.
37. Bains SS, Egede LE. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes Technol Ther. 2011;13(3):335-41.
38. Powell CK, Hill EG, Clancy DE. The relationship between health literacy and diabetes knowledge and readiness to take health actions. Diabetes Educ. 2007;33(1):144-51.
39. Marciano L, Camerini AL, Schulz PJ. The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis. J Gen Intern Med. 2019;34(6):1007-17.