Innovations of Community

Nursing Care Based on

Population (NCD-Diabetes)
Ma. ELIZABETH C. BAUA, RN,RM,MSN,DNS
DEAN, SCHOOL OF NURSING & ALLIED HEALTH SCIENCES
ST PAUL UNIVERSITY PHILS. Tuguegarao City Cagayan Phils.
 Order of Presentation

The Global Burden of Non Communicable Diseases

Philippines and Indonesia Mortality Rates in

relation with NCD Diabetes
Facts about NCD- Diabetes

Innovations of Community Based Nursing Care

on NCD-Diabetes
 The Global Burden of Non
Communicable Diseases (NCDs)
Non-communicable diseases (NCDs) a major public
health concern worldwide
60 % of the total deaths globally

80 % of deaths come from low and middle income

countries
In 2020, the total deaths worldwide will increase to
73%
The burden will be greater in low and middle
income countries (WHO, 2015)
 Mortality rates NCDs
The Philippines, as a developing country, reflects the
global trend of rising deaths from NCDs.
Data from 1990 2015 showed that NCDs, specifically,
diseases of the heart and vascular system have replaced
infectious diseases such as pneumonia and tuberculosis as
top leading causes of mortality.
Other NCDs also feature in the top ten, such as cancer,
chronic obstructive pulmonary diseases, accidents,
diabetes and kidney disorders.
Diabetes is 6th leading cause of deaths

The mortality rates due to NCD continue to rise, although

with the recent initiatives not as steep as predicted.
 I Mortality Rate (NCD-
Diabetes)
7.6 million people are living with diabetes, while
another 12.6 million have pre-diabetes.
By 2030, the number of people with diabetes in
Indonesia will hit 11.8 million.
This equates to a 6% annual growth that exceeds
the countrys overall population growth.
4.3 % are aware of their condition and likely many
are poorly informed of the risk factors and the
appropriate behaviours to mitigate the risk.
 The Global Burden of Diabetes :

346 Million People suffer from Diabetes Globally

10 % suffer with type 1; 90% with type 2 DM

2030, 552 Million people will suffer from Diabetes

globally
22,000 children with Diabetes

5th cause of death in the world

 Diabetes Mellitus
A group of metabolic diseases in which the body
cannot regulate the amount of sugar (specifically,
glucose) in the blood (hyperglycemia)
Disease that prevents your body from properly
using the energy from food you eat
Absence or insufficient production of insulin

Diabetes was first associated with sweet urine

and excessive muscle loss in ancient world.
 Types of Diabetes

Type 1 Diabetes: Little to No Insulin

used to be called as Juvenile Diabetes
an autoimmune disease
Common among children and young adults

Needs to take insulin daily

Type 2 DIABETES : INSULIN RESISTANCE

used to be called adult onset diabetes,

accounting to 90-95% of Diabetes cases.

tends to develop in people who are obese and

physically inactive.
People who have family history of Diabetes or
personally history of gestational diabetes are also
increased risk of having Diabetes Type 2
Type 3 GESTATIONAL DIABETES
-Condition that occurs in 3-8% of pregnant women
during late pregnancy.

Caused by pregnancy related hormonal fluctuations

and a shortage of insulin that often occurs in
pregnancy.

Women who have gestational diabetes have 40-60%

chance of developing type 2 diabetes in 5-10 years
after their pregnancy.
 Additional Types of
Diabetes
LADA- Latent autoimmune diabetes in adults, or
LADA, is a less common form of diabetes that usually
affects people over the age of 30. In LADA, initial type
2 diabetes symptoms eventually develop into a
condition resembling type 1 diabetes.
Double Diabetes Double diabetes occurs when
someone who already has type 1 diabetes develops a
resistance to the insulin medication they are taking,
similar to type 2 diabetes. This condition is more and
more frequently seen in children, especially those who
are overweight or obese
 Causes of Diabetes
Causes of Diabetes type 1
-genetic causes (positive family history
-environmental factors including common and
unavoidable viral infections.
-most common among people in non-Hispanic,
Northern European descent (especially Finland and
Sardinia), followed by African Americans, and Hispanic
Americans. Rare among Asian
Slightly more common in men than in women
 Causes of Diabetes

Type 2 Diabetes

Genetics (family history) sedentary lifestyle /

physical inactivity (lack of exercise) unhealthy meal
planning, overweight/obesity.
Risk Factors for Type 2 Diabetes

-High Blood Pressure

-High Triglyceride (fat) levels in the blood
-Gestational Diabetes
-High Fat Diet
-High Alcohol Intake
-Sedentary lifestyle
-Obesity
-Ethnicity such as African Americans, Native Americans
and Japanese Americans have a greater risk
-Aging: Increase in age is one of the significant factors
for type 2 Diabetes. Risk begins to rise significantly
about age 45 years and rises considerably after age 65
years old.
Diabetes type 1 Signs and
Symptoms
-Increased thirst
-frequent urination
-bedwetting in children who previously didnt wet
in the bed during night.
-extreme hunger
-unintended weight loss
-irritability and other mood changes
-fatigue and weakness
-blurred vision
Type 2 Signs and symptoms
-Increased thirst
-Increased hunger especially after eating
-dry mouth
-Unexplained weight loss
-fatigue
-frequent urination
-blurred vision
-headache
-slow healing sores or cuts
-itching of the skin
-frequent yeast infection
-velvety changes of dark skin in the neck, armpit
-numbness or tingling sensation of the hands and feet
-erectile dysfunction
 Diagnostics
Glycated Hemoglobin (A1C) Test
indicates your average blood sugar level for the past
two to three months.
It measures the percentage of blood sugar attached to
hemoglobin, the oxygen-carrying protein in red blood
cells.
The higher your blood sugar levels, the more
hemoglobin you'll have with sugar attached. An A1C
level of 6.5 percent or higher on two separate tests
indicates that you have diabetes.
An A1C between 5.7 and 6.4 percent indicates pre-
diabetes. Below 5.7 is considered normal.
DIAGNOSTICS

Random Blood Sugar Test

-A blood sample will be taken at a random time. Regardless
of when you last ate, a random blood sugar level of 200
milligrams per deciliter (mg/dL) 11.1 millimoles per liter
(mmol/L) or higher suggests diabetes.

Fasting Blood Sugar Test

-blood sugar level less than 100 mg/dL (5.6 mmol/L) is
normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6
to 6.9 mmol/L) is considered pre-diabetes. If it's 126 mg/dL (7
mmol/L) or higher on two separate tests, you have diabetes
Diagnostics

Urine tests

- tests performed in a clinical laboratory or at home

using self-test kits and a sample of the patient's urine.
Urine tests can be performed for a variety of reasons,
but in people with diabetes, they are most commonly
used to look for ketones or micro albumin. Urine
Glucose can also be measured but this is less valuable
than blood glucose levels for testing Diabetes
Diagnostics

Oral Glucose Tolerance Test

-For this test, you fast overnight, and the fasting

blood sugar level is measured. Then you drink a
sugary liquid, and blood sugar levels are tested
periodically for the next two hours. A blood sugar
level less than 140 mg/dL (7.8 mmol/L) is normal. A
reading of more than 200 mg/dL (11.1 mmol/L) after
two hours indicates diabetes. A reading between 140
and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L)
indicates pre-diabetes.
 Impact of Diabetes

220 million worldwide have diabetes

80% of deaths from diabetes in low and middle-

income countries
Diabetes deaths will double between 2005 and
2030
Diabetes has significant financial impact
 WHO statistics on NCDs

57 M deaths occurred globally in 2008

36 % were due to NCDs ( cardiovascular diseases,

cancers, chronic respiratory conditions and
DIABETES.
Estimated 80% of NCDs are preventable with
appropriate diet and lifestyle choices
 Causes of NCDs

POOR DIET ( high calories, high fats, sugar, salty

food, low fruit and vegetable intake)
PHYSICAL INACTIVITY ( Lack of Exercise)

HARMFUL USE OF TOBACCO

 The Need for Health Care
Innovations in ASEAN
Prevalence rate high
Top 5 for countries with DM
(WHO)
10 M Indonesians with DM
Diabetes 6 %
Cardiovascular 37%
-proportional % of mortality
Risk Factors : obesity, physical
inactivity and overweight
More common among females
than males
Pre-diabetes affects 8M
Diabetes occurs among
Filipinos during their
productive years
6.1 M Prevalence rate among
Filipinos
Risk Factors : family history,
obesity, overweight, lifestyle
choices, high fat diet, lack of
exercise
More common in males than
females
 The Need for Innovations
in Health Care
According to the WHO, without intervention,
deaths from NCD are predicted to increase by 15%
between 2010 and 2020.
The biggest increase would occur in the African,
Eastern Mediterranean, and Southeast Asian
regions.
Fortunately, most premature deaths from heart
disease, stroke, and diabetes can be averted with
behavioural modifications and health care
innovations and interventions.
 Mortality Rates due to
Diabetes
Diabetes a major risk factor is now increasing
rapidly in all countries.
Some 336 million people had diabetes in 2011, but
this is expected to increase to 552 million by 2030.
About half of those with diabetes are undiagnosed.
Diabetes are accounted for 11% of healthcare
expenditure in the US in 2011.
COMMUNITY HEALTH
CARE INNOVATIONS
TO COUNTER NCDs

 1. Population Screening
Program called WEGAYA Screening

In Arabic countries like Abu-Dhabi integrates

screening of the entire adult Emirati population for
risk of CVD ( 18 yrs & above ) in 2008 ; first round
of screening showed more than 2/3 of adults were
overweight or obese, 44% were either diabetic or pre
diabetic, almost half had increased cholesterol; 71 %
had at least one risk factor for CVD.
UAE 2nd highest rate of diabetes in the world

94 % of total population have been screened ;

second round of screening after 2 years.
 Interventions
Reduce high levels of risk from health and non
health sectors.
All screened are given confidential health reports-
secure a web account with their risks color-coded
with recommendations for actions to reduce risks.
All identified at high risk undergo devising
programs to reduce tobacco use, encourage healthy
diets and increase physical activity.
 2. Low cost sustainable
Interventions for NCDs
a simple low cost prevention and control
programme for CVD, Diabetes delivered by
primary care providers (village doctors, once known
as barefoot doctors)
a community based salt reduction and health
promotion program, delivered by community
health workers.
3. Partnership in Managing
Chronic Diseases
Patient-Doctor Collaborative Relationship thru the
use of Technology ( chats, emails, skype, android
phones)
Tele-Collaboration - collaborative interface, make
clinical decisions and treatments
Patients engage with their data and take actions in
their lives, self manage in partnership with doctors
Doctors can monitor adherence to medications and
treatments, diets, etc.
 4. Social Innovations in providing
health care in remote areas
3 strategies : education, prevention & community
mobilization
Volunteers treat common ailments, give advise to
families and monitor community health.
Education campaigns focus on health, family hygiene
& sanitation. Hygiene & proper waste disposal are
the core of community participation.
Access to safe water local committees create and
manage sewage treatment facilities.
Ambulatory prevention & community health services
 5. Options for long-term care: The
Money Follows the Person
Rebalancing Demonstration Program

The aim of the demonstration programme is to

develop services for people requiring long-term
care, and to expand the options for the elderly and
those with disabilities to receive care in the
community.
Use of Medicaid funds helping the people get out
of residential settings and into the care setting of
their choice.
 6. Primary Care 101
Primary Care 101 are clinics with set of evidenced
based carefully designed guidelines that covers all
chronic conditions staffed by nurses who have
experience to treat patients with NCDs and other
conditions in primary care.
Nurses are trained intensively and didactic
conducted off site but closely integrated with
clinical setting.
7. Community-based, professionally
supervised interventions to increase
physical activity
The US Centers for Disease Control & Prevention has
funded a guide for useful interventions for Physical
Activity in Brazil and Latin countries known as project
GUIA
The aim is to reduce obesity by identifying evaluating &
diffusing interventions that promote physical activity.
Brazil recognizes the priority of promoting physical activity,
work with GOs NGOs and support research, practice and
policy regarding the promotion of physical activity.
E.g. City Gyms focusing on physical activity, leisure and
healthy eating.
 8. Incentivising people to be more
healthy: Discovery Vitality, South
Africa
Discovery, through its Vitality programme, has
excelled in finding ways to incentivise people to live
a healthier life. Those in the programme begin with
a full health review, which assigns them a Vitality
age and prescribes a pathway to better health
covering disease management, smoking issues,
mental health, preventive health, nutrition, and
physical activity.
 9. Programmes to prevent patients progressing from
pre-diabetes to diabetes, and to improve management
of patients with diabetes: UnitedHealth Group, US
The Centers for Disease Control and United Health Group (US)
has created a scalable, affordable program to reduce health costs.
People at high risk are identified via analysis of claims and
other data.
These people were contacted and encouraged to attend a free
test for pre diabetes.
If they do, they are urged to join a free 16 weeks group program
run by YMCA that helps them lose weight, eat a healthier diet
and adopt a healthier lifestyle.
The Program is paid for by UnitedHealth. These are ways to
incentivize people to go for testing, stay in the program, and
maintain weight loss and healthy lifestyles.
Food List for Diabetes
 10. Diabetes Self Care
Management
Diabetes education is important but it must be
transferred to action or self-care activities to fully
benefit the patient. Self-care activities refer to
behaviors such as following a diet plan, avoiding
high fat foods, increased exercise, self-glucose
monitoring, and foot care.
It is recommend that all adults, including those with
diabetes, should engage in regular physical ac
 Benefits of EXERCISE

Physical activity promotes weight reduction and

improves insulin sensitivity, thus lowering blood
glucose levels
Together with dietary treatment, a programme of
regular physical activity and exercise should be
considered for each person. Such a programme
must be tailored to the individuals health status
and fitness.
People should, however, be educated about the
potential risk of hypoglycaemia and how to avoid it.
Exercise Guideline for
Diabetic Fitness
 Innovation Diffusion

To have impact, innovations must diffuse widely, but within

health systems they all too often do not diffuse. Drivers of
diffusion include: professional discussion, markets,
consumers, governments, international organizations, and
businesses.

However, there are barriers: the risk that existing healthcare

providers and professional hierarchies might resist changes
that threaten their dominance and income; fears that
innovations will not be safe; and the risk that financial benefits
from the innovation might occur in a different budget from
that of the costs, and might take some years to become visible
and be appreciated.
 What happens next ?
This presentation is intended as a springboard to action, and duly
identifies seven things that should start happening right away:

expanding and improving the database of innovations; developing

a business case for self-management; working with a government to
diffuse at least one innovation;

working with finance and health ministers to make the health,

economic, and business case for investment in innovation;

attempting to build a social movement around one of the

innovations;

working specifically on innovations in areas that the taxonomy

shows to have few innovations; and

building a global collaboration to implement and trial one

innovation to tackle an NCD.
Terima Kasih. Thank you.
Dr Ma Elizabeth C. Baua
Email : ebaua@spup.edu.ph