Improving supported self-management for people with …

1 Improving supported self - management for people with diabetes November 2009. Personalised High quality, Access to care planning tailored structured information education Access to healthcare Emotional Support from professionals and peers, and trained psychological family, specialist support friends advice when and carers required Contents Foreword 3. Scope 4. About self - management 6. Finding out what people with diabetes want 9. High quality, tailored information 10. Access to structured education 11. Personalised care planning 12. Support from peers, family and friends / Emotional and psychological support 14. Access to healthcare professionals and trained specialist advice when required 16. Barriers to supporting self - management 17. Conclusion and priorities for action 20. Further information 22. Improving supported self - management for people with diabetes Foreword There are over two and a half million people in the UK with diabetes . By 2025. it is estimated that this number will rise to over four million.

2 While this statistic is concerning for the simple reason that more people will be living with diabetes , it also has huge implications for the levels of care, services and support that will need to be provided in order for those people to live with and manage their diabetes . Because living with diabetes is just that. people with diabetes only have contact with a healthcare professional for a few hours per year. The rest of the time they care for and manage their diabetes themselves. It is estimated that 95 per cent of diabetes management is self - management . self - management means that people have to make choices and decisions about how to manage their life and their diabetes . Through good self - management , people with diabetes can improve their quality of life and reduce the risk of developing complications. It can also help to prevent hospital admissions, or make those times when they do need to go into hospital, for whatever reason, a better experience, with a reduced length of stay.

3 To enable people to self -manage well requires support. What type of support people need will vary depending on how they are managing or whether they feel the need to access that support. The important thing is that the support is there. In this document we look at what we consider are the essential components that make up good supported self - management . While there are many things that enable people to self -manage, we have outlined what should be provided at the very least. Whether this is good quality information for someone who has been recently diagnosed, or the knowledge that someone is on the other end of a telephone to offer advice for someone with established diabetes , it is vital that people are able to manage their lives with diabetes , rather than because of it. Douglas Smallwood Chief Executive, diabetes UK. 3. Improving supported self - management for people with diabetes Scope people with diabetes have to manage their condition on a day-to-day basis, with the support of their healthcare professionals, their families, friends or other carers.

4 In this document, diabetes UK examines supported self - management and how the further development of self - management , education and care planning will enable people to better manage their lives with diabetes . 4. Improving supported self - management for people with diabetes Background The UK is facing a huge increase in the number of people with diabetes . Since 1996 the number of people diagnosed with diabetes has increased from million to million. By 2025 it is estimated that over four million people will have diabetes . Most of the increase in cases will be Type 2 diabetes , because of our ageing population and rapidly rising numbers of overweight and obese people . The figures are alarming and confirm that diabetes is one of the biggest health challenges facing the UK today. If we are to curb this growing health crisis and see a reduction in the number of people dying from diabetes and its complications, we need to increase awareness of the risks, bring about wholesale changes in lifestyle, improve self - management among people with diabetes and improve access to integrated diabetes care services.

5 Good diabetes management has been shown to reduce the risk of developing complications, enhance quality of life and reduce hospital admissions. But when diabetes is not well managed, it is associated with serious complications including heart disease, stroke, blindness, kidney disease, nerve damage and amputations leading to disability and premature mortality.. Many people with diabetes may only have contact with a healthcare professional for a total of a few hours per year, the rest of the time they care for and manage their diabetes themselves. Health services in the UK need to do more to support people with long-term conditions to help them to self -manage. They need to focus on prevention and early intervention and to ensure that services are developed around the needs of people with diabetes , rather than people having to fit in with what is available to them. What is diabetes ? Type 1 diabetes develops if the body cannot produce any insulin. Insulin is a hormone which helps the glucose to enter the cells where it is used as fuel by the body.

6 Type 1 diabetes usually appears before the age of 40. It is the least common of the two main types and accounts for around 10 per cent of all people with diabetes . Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). In most cases this is linked with being overweight. This type of diabetes usually appears in people aged over 40, though in South Asian and Black people , it can appear from the age of 25. It is becoming more common in children and young people of all ethnicities. Type 2 diabetes accounts for around 90 per cent of people with diabetes . diabetes in the UK 2009: Key statistics on diabetes 5. Improving supported self - management for people with diabetes About self - management What is self - management ? supported self - management and self -care are terms to describe how a person living with a long-term condition controls their condition and health themselves.

7 self -care is what each person does on an everyday basis, but which may be more difficult for a person living their life with a long-term condition. self - management is the process by which a person develops the skills to manage their condition. Support for self - management and self -care is the responsibility of health and social care providers and is often provided by unpaid carers. Successful self - management requires knowledge about the condition, how it needs to be treated and what needs to be done. This might also include behaviour changes and learning problem-solving skills and how to cope when things go wrong or become more difficult. It is essential that information about the condition, education and training is a key component of the self - management approach. It also needs to be recognised that people who have more than one long-term condition will need the information, skills and training to manage the different needs of their conditions. The key self - management activities specific to diabetes care and living with diabetes are: managing the relationships between food, activity and medications self -monitoring of blood glucose, blood pressure and having retinal screening carried out targeting goals tailored to individual need, for example around footcare, weight loss, injection technique and self -monitoring activities applying sick day rules when ill, or what to do if going into hospital understanding diabetes , what care to expect and how to access services managing acute complications hypoglycaemia and hyperglycaemia understanding legislative issues such as those related to employment and driving.

8 Why is supporting diabetes self - management important? Approximately 95 per cent of a person with diabetes ' management is self - management . Living with diabetes means just that, that diabetes becomes part of a person's life. Once a person has been diagnosed with diabetes , their life goes 6. Improving supported self - management for people with diabetes on, and diabetes management has to fit in' with whatever else is going on in their life. Supporting self - management of people with long-term conditions can lead to positive outcomes such as: fewer primary care consultations, reduction in visits to outpatient departments and A&E. reduced length of stay when in hospital better communication between professionals and patients behaviour change leading to a healthier lifestyle better symptom management resulting in a reduction in pain, stress, anxiety, depression and tiredness improved feelings of wellbeing and coping skills improved quality of life and health outcomes improved understanding of the person's own condition greater independence and increased patient satisfaction.

9 The majority of people living with diabetes want to maintain an independent, healthy and active life and if they need support to achieve this, it should be widely available. However, self - management does not mean that people are left to do everything on their own, but that health and social care professionals, peers and family members help to provide relevant and tailored support. people with diabetes make decisions every day about what they eat, what and how much activity to undertake, how they will react to certain situations or stresses and if and when they will take their medications. supported self - management is about enabling people to have the confidence and skills to better deal with their diabetes , and forms a key part of the wider programme for supporting people with long-term conditions, including structured education programmes, the provision of high quality information, care planning and peer support. supported self - management policy in the UK.

10 self -managing on a day-to-day basis is a key part of good diabetes care. Once diagnosed, people with diabetes and their families need support to come to terms with the condition. They also need to learn the skills that will allow them to take control, and which contribute to the long-term reduction in risks associated with diabetes . How they do this and the support required will vary from person to person. 7. Improving supported self - management for people with diabetes In England, Wales and Scotland, Service Frameworks set out the standards required for the health of people with diabetes , and to reduce inequalities in access to care. The frameworks provide a structure in which to promote the integration of high quality diabetes services and self - management . Similarly, all nations are aiming to shift the focus of care of complex long-term conditions towards primary or community care, to be more accessible to the people who access it. In Northern Ireland, the last strategic guidance that related to diabetes was the CREST Report of 2003.