This prospective, study is considered as a strategic integrated project. It was established, as a clinical project including its infrastructure, man power, material, budget, policies and procedures. This project was established for full integrated management of diabetic patients. Our care rendered to the patients has been reflected on their outcomes. Therapy together with health education through social media, what-Sapp groups and focus group discussion together with individual face to face interviews, had a good impact on our patients. It was an effective intervention that had an observed effect on patients’ outcomes. We evaluated our patients, pre and post intervention to see the change in some pre-specified variables. (Fig. 5, 6) We noticed the change in their clinical statuses, anthropometric measures, laboratory results, psychosocial lives, lifestyles, and quality of lives.
702 patients is a good number to start a prospective study, with zero percent attrition or drop-outs. Indeed, building up of good friendly relationships, trust and rapport with your patients from the beginning, is better than insulin. Health education, patient motivation, self-management knowledge, skills, is useful in improving metabolic control. This will reduce the patient and family costs in secondary and tertiary management. Moreover, this improvement observed and maintained at 24 months.
There is no longer a need to justify the value of patient education: education is part of a patient-centered humanistic therapeutic approach; it enables patients to be actively involved in their own recovery with the goal of increasing the quality of life and adherence with medication, as well as minimizing possible complications. Thus, our healthcare professionals are therefore educating, advising, preparing, engaging with, inspire and support physicians in disease follow-up which takes long time.
Our study showed a portrayal in cognitive and behavioral therapy and inspirational interviews as a main contributor to clinical patient education, which occurs in an environment of understanding and emotions, correlated with several psycho-educational strategies. This paradigm had an obvious effect on clinical and laboratory outcomes, as well as, the psychological aspect and the quality of life. Many studies have shown that diabetic patients' education is a patient-centered humanitarian strategy that encourages clinicians to be protagonists in their own care, improve their well-being, and reduce the likelihood of possible complications. (Fig. 7)
Group preparation for patient education must start as soon as a training need is defined through diagnosis. Early diagnosis and education offers time to identify and overcome challenges, creates constructive practice opportunities and promotes the ability to solve and deal with issues and problems. Our aim was to provide the patient (or healthcare provider) with time to perform survival skills and self-management.
Our key nutritional targets were to improve glycemic control, offer appropriate nutrients and calories to satisfy metabolic needs, and establish a follow-up treatment life-plan. Some of the problems that may hinder the accomplishment of these targets in our facilities include: meal time planning and need-based modifications; in case of surgery laboratory testing, and procedures. When the patients lose their appetite or loss of ability of eating after drug administration or after acute diseases, glycemic control becomes very difficult. Other problems such as; inconsistent consumption of sugar, nutrition that is not addressed in the diet plan, inefficient food distribution arrangement with point of care sugar level monitoring and insulin treatment, lack of principles understanding by doctors, patients and families of the existing values of diabetes health, variability of requirements of insulin among patients, either on enteral or parenteral nutrition, decreased exercise and sedentary life. (Fig. 8)
We met maximum glycemic targets for our patients. To achieve optimal glycemic control and glycemic targets thus reducing hypoglycemia, successful insulin therapy needs to be understood and used. Recent studies have highlighted the significance of preventing hypoglycemia to minimize risk, but avoiding hyperglycemia is equally as important.
It is advised to develop guidelines, order sets, and glycemic goals by an interdisciplinary group of administrative support. Developing and enforcing hospital-wide protocols and uniform insulin order sets will assist patients in choosing the right insulin protocol while preventing adverse events. The use of a responsive "sliding scale" should be discontinued, and the standard of care should be therapeutic insulin schemes including basal, postprandial and corrective insulin.
Throughout tandem with a patient-centered strategy, the diabetes educator can also promote the production and use of structured insulin order sets and procedures to avoid hypoglycemic episodes, achieve optimal performance, and mitigate harm capacity. The diabetes educator should also promote the development and use of protocols to manage and control hypoglycemia and make recommendations for improvement.
When indicated for all patients with hyperglycemia or at high risk of hyperglycemia, our clinicians followed them through routine check of glycated hemoglobin and daily glucose monitoring. This includes diagnosis of cases with diabetes as well as patients received high-dose corticosteroids, immune suppressants, and intravenous and oral nutrition. After blood transfusions or with a record of uncontrolled glucose levels, the glycated hemoglobin level may not be accurate, or if there are hemoglobinopathies in case of dialysis patients or those receiving chemotherapy. In pediatric, obstetric, and emergency patients, point-of-care ketone screening should be recommended.
With this objective in mind, the diabetes educator may engage in the foregoing educational activities: evaluating the knowledge and skills of patients having diabetes; improving self-management skills; providing training in a variety of contexts, including staff induction, medical areas and big rounds; designing curricula for sharing with other team leaders; using a variety of educational tools; for example; case studies, workshops of self-learning, journal societies, templates of survival skills and flash cards to meet the needs and preferences of all environments and learners.
In our study, every patient had a good experience and take-home message after two years of hard work. After a countless episodes of depression, suicidal attempts, anxiety, upset, loss of hope, loss of self-esteem, loss of self-confidence and feelings of uselessness in life. Most of our patients, if not all of them, become full of hope and enthusiasm. Some of them become body builders; others win medals in championships of biking and mountain climbing, and many other examples, no space to mention.
For present, however, it is important to maintain the education systems while at the same time continuing to investigate the effects of social media in order to identify certain categories of patients who may prosper from this tool. Regular medical interaction may be more relevant to patients and families modifying their insulin protocol, promoting self-management and encouragement. It will also be very beneficial in pre-gestational diabetes, patients with constant subcutaneous insulin infusion and patients with a high risk of developing serious acute complications correlated with other therapies (corticosteroids). In order to know the impact on health care system and leadership performance to patients with chronic disorders, it is also important to identify the implications of education on the interaction of primary and secondary management.
To summarize, using an immersive tele-education system embedded into an intense face-to-face follow-up, produces significant changes in metabolic profile, quality of life, and self-care compared to traditional drug prescribing and reconciliation follow-up. Improving contact services, though, is important to provide effective cost reductions to the healthcare and diabetes community.