Contents
  1. Type 1 Diabetes
  2. diabetes protocol program pdf - diabetes protocol book free download
  3. Resources for People with Diabetes

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Diabetes Protocol Program Pdf

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Type 1 Diabetes

Discussion The Copenhagen Type 2 Diabetes Rehabilitation Project evaluates a multi-disciplinary non-pharmacological intervention programme in a primary care setting and provides important information about how to organize non-pharmacological care for type 2 diabetes patients.

Trail Registration ClinicalTrials. Background Type 2 diabetes mellitus T2DM is a chronic disease with severe late complications and high mortality. The increasing prevalence of T2DM is mainly due to reduced physical activity and consumption of unhealthy food and larger portion sizes in genetic susceptible individuals. Lifestyle intervention can prevent development of T2DM in subjects with impaired glucose tolerance [ 1 , 2 ].

To improve metabolism and reduce the risk of late complications of T2DM, permanent changes in lifestyle and lifelong multi-pharmacological treatment are needed [ 3 ]. Group-based lifestyle intervention programmes for T2DM patients, including patient education or supervised exercise, have been evaluated in several randomized controlled trials.

Education programmes alone improves glycaemic control in some studies [ 4 , 5 ], but not in all [ 6 ]. Group-based diabetes education seems to have a better effect on glycaemic control than individual education [ 7 - 10 ].

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You want to find a company that has a good inventory of all the kinds of services that you will need. Every county has their own policies and customs when it comes to holding delinquent tax sales. Step 5: Designing an implementation plan In step 5 programme adoption, implementation and sustainability were considered [ 23 ].

In this step, step 2 and 3 of the intervention mapping protocol were repeated, to identify the required behaviours of the implementers. Key components of this step included production of implementation plans and a meeting with implementers to discuss adoption and implementation of the maintenance programme.

Results Step 1: Needs assessment Literature study In the literature study determinants of maintained behaviour and habitual behaviour were explored.

To ensure that the healthy behaviour becomes habitual, the behaviour needs to be repeated [ 34 ]. It was decided to use the TTM to tailor the maintenance programme to the stage of change participants are in, a purpose for which the model is frequently used [ 15 , 36 ].

According to the TTM, people progress through a series of stages when they change their behaviour [ 15 ]. In order to progress from action to maintenance, participants particularly need to be supported with regard to attitude, subjective norms and perceived behavioural control.

Regarding maintained exercise behaviour in older adults, multiple studies found that attitude, perceived behavioural control and subjective norm are important predictors [ 41 , 42 ].

Subjective norm and perceived behavioural control seem to be important predictors with respect to nutrition behaviour [ 43 ]. However, the importance of determinants with respect to behaviour maintenance differs. Several studies found that perceived behavioural control is likely to be more important than attitude [ 38 , 44 ], and reducing actual barriers might be an important strategy in behaviour maintenance.

In addition to individual-level determinants, research suggest that family, work, study and neighbourhood environment may be important factors influencing behaviour maintenance [ 46 ], indicating that the social-cultural environment is more important than the physical environment.

diabetes protocol program pdf - diabetes protocol book free download

However, evidence on environmental determinants is limited because of lacking high-quality studies and study replications [ 47 ]. Focus group discussions The FGDs with former SLIMMER participants, representatives of sports clubs, and representatives of physiotherapists and dieticians resulted in the identification of inhibiting and facilitating factors to maintain a physical activity pattern and a healthy diet for SLIMMER participants, as well as suggestions for the maintenance programme.

Regarding physical activity, many former SLIMMER participants mentioned lack of confidence to join a sports club or gym as an important barrier to continue physical activity, which was confirmed by representatives of sports clubs and literature [ 48 ]. Other important barriers for physical activity mentioned by all groups of respondents were physical complaints, lack of motivation and financial constraints.

These barriers are also often reported in literature [ 48 — 51 ]. On the other hand, the social aspects of sporting together were mentioned in all FGDs as an important facilitating factor to continue physical activity. Other facilitating factors that were frequently mentioned were feeling healthier, being motivated to prevent T2DM, receiving social support from family and friends, and receiving guidance when exercising.

This was confirmed by participants in the FDG with physiotherapists and dieticians and by other studies [ 52 — 55 ]. SLIMMER respondents thought they had sufficient knowledge and skills to maintain a healthy diet, although two respondents mentioned they lacked creativity to cook healthy and tasty dishes. Respondents mentioned they were able to handle tempting eating situations independently, as they had received sufficient advice to resist these situations.

In all FGDs, respondents mentioned that introducing SLIMMER participants to local sports clubs was regarded as a useful component of the maintenance programme, as this would help to reduce the threshold for participants.

Furthermore, SLIMMER respondents expressed that they would like to receive information about cooking clubs, as this could support them to become more creative in composing healthy dishes.

In addition, physiotherapists and dieticians mentioned that a concluding meeting with SLIMMER participants could help participants to focus on maintenance of a healthy lifestyle, as they noticed that a majority of participants did not prepare themselves for the period after the extensive intervention. In addition, SLIMMER respondents, physiotherapists and dieticians proposed to organise a return session a few months after the extensive intervention.

In this session the maintenance of a healthy lifestyle could be discussed. SLIMMER respondents also mentioned they would like to receive a blood glucose test one year after the extensive intervention to determine whether their glucose levels have improved or stabilized.

Concluding, the literature study and FGDs showed that determinants of the TPB are important in behaviour maintenance, although perceived behavioural control and self-efficacy seem to be more important than attitude.

Even though environmental determinants are also likely to influence behaviour maintenance, evidence is limited. Reducing actual barriers might be an important strategy to maintain the healthy behaviour in participants, as well as continuation of support. The performance objectives of the two behavioural outcomes were based on the needs assessment in IM step 1, Dutch dietary guidelines [ 56 ] and Dutch healthy physical activity norms [ 57 ].

The literature study and FGDs in IM step 1 resulted in the identification of determinants of maintained and habitual behaviour, used to formulate change objectives [ 15 , 37 , 58 , 59 ].

Resources for People with Diabetes

Furthermore, knowledge was selected as a determinant, as it is a prerequisite for instigating behaviour change and other behavioural determinants including attitude, subjective norm and perceived behavioural control [ 23 , 60 — 62 ]. Even though evidence suggests that attitude is of minor importance for behaviour maintenance, it was decided to include attitude as a determinant.

Participants need a positive attitude towards the new behaviour to maintain their healthy lifestyle independently, and towards new activities offered to them. In addition, limited evidence suggests that environmental determinants are related to behaviour maintenance.

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