Teist tüüpi diabeediga haigete ravikuulekust mõjutavad patsiendipoolsed tegurid – kvalitatiivne uuring

Teist tüüpi diabeet on krooniline haigus, mis on seotud tõsiste tüsistuste, kaasuvate haiguste ning märkimisväärsete tervishoiuökonoomiliste kulutustega (1). Seoses keskmise eluea pikenemise, tervishoiu arengu ning üha tõhusamate sõeluuringutega ühelt poolt ning riskitegurite osakaalu suurenemisega (väheliikuv elustiil, kahjulikud toitumisharjumused, ülekaal, suitsetamine) teiselt poolt (1) prognoositakse aastaks 2015 haiguse levimuse kasvu arenenud maades 42% ja arengumaades 170% (2)

Food choices, physical activity and metabolic health in obese patients

The aim of the current study was to analyse the food choices and physical activity of obese adult Estonian persons, and associations with the prevalence of metabolic syndrome. The study was carried out on 76 patients aged over 35 years whose body mass index was ≥30 kg/m2. The subjects were recruited through family physicians. The subjects’ consumption of three food groups (fruit, vegetables, whole-grain products) and physical activity based on the IPAQ questionnaire was compared with the prevalence of metabolic syndrome based on five indicators (waist circumference, triglycerides, HDL- cholesterol and fasting plasma glucose, blood pressure). The prevalence of metabolic syndrome was found to be 50%. The results of the study did not show statistically significant correlations between prevalence of metabolic syndrome and age or gender. Neither were there any significant age or gender differences in the subjects’ nutritional and activity behaviour. Comparison of the nutritional behaviour of persons with and without the metabolic syndrome showed that daily consumers of fruit had a 4.48 times lower risk of metabolic syndrome than those who ate fruit more seldom. No statistically significant correlation was found between physical activity and prevalence of metabolic syndrome. Based on the current study, the daily consumption of fruit can be an essential protective factor against metabolic syndrome in obese patients and provides a simple recommendation physicians can give their patients to follow

2. tüüpi diabeedi Eesti ravijuhend 2016

Eesti Arst 2016; 95(7):465–47

Kokkuvõte kliinilisest auditist „Täiskasvanute kõrgvererõhktõve käsitlus esmatasandil“

Eesti Arst 2018; 97(4):185–190 &nbsp

Family doctors' knowledge and self-reported care of type 2 diabetes patients in comparison to the clinical practice guideline: cross-sectional study

BACKGROUND: It is widely believed that providing doctors with guidelines will lead to more effective clinical practice and better patient care. However, different studies have shown contradictory results in quality improvement as a result of guideline implementation. The aim of this study was to compare family doctors' knowledge and self-reported care of type 2 diabetes patients with recommendation standards of the clinical practice guideline. METHODS: In April 2003 a survey was conducted among family doctors in Estonia. The structured questionnaire focused on the knowledge and self-reported behavior of doctors regarding the guideline of type 2 diabetes. The demographic and professional data of the respondents was also provided. RESULTS: Of the 354 questionnaires distributed, 163 were returned for a response rate of 46%. Seventy-six percent of the responded doctors stated that they had a copy of the guideline available while 24% reported that they did not. Eighty-three percent of the doctors considered it applicable and 79% reported using it in daily practice. The doctors tended to start treatment with medications and were satisfied with treatment outcomes at higher fasting blood glucose levels than the levels recommended in the guideline. Doctors' self-reported performance of the tests and examinations named in the guideline, which should be performed within a certain time limit, varied from overuse to underuse. Blood pressure, serum creatinine, eye examination and checking patients' ability to manage their diabetes were the best-followed items while glycosylated hemoglobin and weight reduction were the most poorly followed. Doctors' behavior was not related to the fact of whether they had the guideline available, whether they considered it applicable, or whether they actually used it. CONCLUSION: Doctors' knowledge and self-reported behavior in patient follow-up of type 2 diabetes is very variable and is not related to the reported availability or usage of the guideline. Practice guidelines may be a useful source of information but they should not be overestimated

Physical activity of Estonian family doctors and their counselling for a healthy lifestyle: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Physical activity offers major health benefits and counselling for it should be integrated into the medical consultation. Based on the literature, the personal health behaviour of the physician (including physical activity) is associated with his/her approach to counselling patients. Our hypothesis is that family doctors (FD) in Estonia are physically active and their recommendation to counsel patients with chronic diseases to use physical activity is high. The study was also interested in how FDs value physical activity among other important determinants of a healthy lifestyle, e.g. nutrition, non-consumption of alcohol, and non-smoking.</p> <p>Methods</p> <p>Physicians on the electronic list were contacted by e-mail and sent a questionnaire. The first part assessed physical activity by the International Physical Activity Questionnaire (IPAQ) short form. Self-reported physical activity during one week was calculated as total physical activity in minutes per week (MET min/week). The second part of the questionnaire included questions about the counselling of patients with chronic disease concerning their physical activity and a healthy lifestyle. The study focused on female FDs because 95% of the FDs in Estonia are women and to avoid bias related to gender.</p> <p>Results</p> <p>198 female FDs completed the questionnaire. 92% reported that they exercised over the past 7 days to a moderate or high level of physical activity. Analysis revealed no statistically significant relationship between the level of physical activity and general characteristics (age, living area, body mass index [BMI], time spent sitting). FDs reported that patients with heart problems, diabetes, and obesity seek their advice on physical activity more often than patients with depression. Over 94% of the FDs claimed that they counsel their patients with chronic diseases about exercising. According to the FDs' reports, the most important topic in counselling patients for a healthy lifestyle was physical activity.</p> <p>Conclusion</p> <p>This study showed that female FDs are physically active. The level of physical activity is not related to their age, BMI, living area, or time spent sitting. Also, FDs reported that promotion of physical activity is part of their everyday work.</p

Teist tüüpi diabeedi käsitlus peremeditsiinis

The effectiveness of type 2 diabetes (DM2) care depends greatly on the collaboration of the physician and the patient as well their contribution to the treatment process. The present study assessed the obstacles in patient adherence to diabetes management, the patients’ quality of life and the accordance of clinical outcomes with the recommendations in the clinical practice guidelines. The study also evaluated the family doctors’ (FD) knowldge with the DM2 clinical practice guidelines, the correspondence of self-reported care of DM2 patients to the recommendations of clinical practice guidelines and analysed which factors influence the adherence to the guidelines. The qualitative study of the patients revealed that the course of the disease is imperceptible for the patients; the information about DM2 is unclear or insufficient; the coping with the disease is complicated in different life situations; and the relationship with the healthcare provider is important. The assessment of patient quality of life disclosed that that the patients assigned the lowest scores to their general health and role-physical. Better awareness of diabetes was the factor which had a negative effect on the assessment given on all eight scales of quality of life. Excessive weight is a risk factor which could be modified to improve patients’ wellbeing as overweight patients had especially low ratings in the physical functioning, role physical and role emotional scales. In general, the clinical outcomes of DM2 patients did not meet the requirements set in the guidelines, but were at the same time comparable with the results of DM2 patients’ worldwide. Glycaemic control – an important clinical outcome of the disease – was better (HbA1c<6.5%) in patients who were aware of the HbA1c test whereas the diabetes duration for more than 5 years had a negative impact on glycaemic control. DM2 clinical practice guidelines were available and used in daily practice by most FDs. However, the correspondence of self-reported behaviour to the guidelines varied to a great extent. Pharmacological treatment was usually started later than suggested in the guidelines and in follow-up of the patient the performance of recommended tests and examinations varied from overuse to underuse. Among the factors which hinder the FD’s adherence to the guidelines the most, the majority of FD’s highlighted patient-related factors, such as the patients’ low awareness of diabetes complications, their lack of motivation to change their lifestyle and the non-adherence to the medical regimen.Teist tüüpi diabeedi ravi tulemuslikkus sõltub suurel määral arsti ja patsiendi koostööst ning nende mõlema panusest raviprotsessi. Käesolevas uurimuses analüüsiti teist tüüpi diabeediga patsientide ravisoostumisega seonduvaid takistusi, nende hinnanguid elukvaliteedile ning kliiniliste tulemuste vastavust ravijuhendi soovitustele. Samuti hinnati uurimuses perearstide teadlikkust teist tüüpi diabeedi ravijuhendist, patsiente jälgimise vastavust ravijuhendile ning analüüsiti, millised tegurid mõjutavad ravijuhendist kinnipidamist. Patsientide kvalitatiivse uuringu tulemusena selgus, et diabeedi kulg on haigele tunnetamatu, diabeedi kohta saadav informatsioon on ebaselge või puudulik, haigusega toimetulek erinevates olukordades on keeruline ning suhtlemisviis meditsiinitöötajatega on oluline. Elukvaliteedi uuringust selgus, et diabeedihaigete hinnangud on kõige madalamad üldtervislikule seisundile ning igapäevaelu kehalistele piirangutele. Patsientide teadlikkus oma haigusest ja selle tüsistustest mõjutas negatiivselt hinnanguid kõigil kaheksal elukvaliteedi skaalal. Liigne kehakaal on riskitegur, mida mõjutades saaks patsientide elukvaliteeti parandada, sest ülekaalulised hindasid negatiivsemalt kehalist seisundit, kehalisi piiranguid ja emotsionaalset toimetulekut igapäevaelus. Üldiselt ei vastanud diabeediga patsientide kliinilised tulemused ravijuhendis soovitatule, kuid samas on tulemused võrreldavad teistes maades saavutatuga. Glükohemoglobiini sisaldus (HbA1c<6,5%) , kui oluline kliiniline tulemus, vastab ravijuhendis soovitatule suurema tõenäosusega patsientidel, kes on glükohemoglobiini analüüsist teadlikud, kuid haiguse kestus üle 5 aasta halvendas tulemust. Enamikule perearstidest oli teist tüüpi diabeedi ravijuhend hästi kättesaadav ning leidis igapäevatöös kasutust. Samas oli arstide tegutsemise vastavus ravijuhendiga väga varieeruv. Medikamentoosse raviga alustatakse tavaliselt kõrgemate veresuhkruväärtuste korral, kui on soovitatud ravijuhendis ning diabeedihaige jälgimisel tehtavate analüüside määramisel esineb nii üle- kui alakasutust. Ravijuhendi järgimist kõige enam takistavatest teguritest, nimetab enamik perearste patsiendist tingitud tegureid: haigete madal teadlikkus diabeedi tüsistustest, puuduv motiveeritus muuta eluviise ning halb raviga soostumine