# Developing diabetes care - Savonia AMK

> The objective of treating type 2 diabetes is to prevent acute and long-term complications conducted by diabetes and support people with diabetes on their self-management.

## The Challenge of Diabetes Care in North Karelia
Diabetes is a worldwide growing problem in health care. At North Karelia wellbeing services county (Siun sote) we have about 16 000 people with diabetes. The national health index shows that North Karelian patients (along Northern Savonia) are the most multimorbid in Finland. We also suffer from lack of doctors. There is a 35,3 % deficit of doctors in North Karelia. This all together sets an enormous pressure for the nurse’s expertise on diabetes care.

## Developing a Regional Treatment Program
At spring 2023 a group of Siun sote diabetes professionals started creating the regional type 2 diabetes treatment program. It was recognized that if we want to give our patients equal, high-quality care in every corner of North Karelia wellbeing services county, there has to be some kind of model of how to treat our patients. While the national *Type 2 diabetes Käypä hoito* recommendation guides treatment, we found it necessary to create our own model alongside it.

The model of type 2 diabetes self-management education was created as a development assignment for my studies as an advanced nurse practitioner at Savonia UAS. The objective was to standardize the care of people with type 2 diabetes across the North Karelia wellbeing services county.

## Structure of the Self-Management Education Model
The model includes guidance for recently diagnosed patients, continuing monitoring visits, and yearly appointments. It is based on evidence-based knowledge, research, and the experience of professionals at the Siun sote Diabetes center.

### Guidance for Recently Diagnosed Patients
The guidance is divided into three appointments occurring within two months of diagnosis:
1. **First Appointment:** Patient measurements (weight, blood pressure), blood glucose monitoring guidance, medication guidance, and setting care goals.
2. **Second Appointment:** Diet education, discussion on exercise and its effects on blood glucose, and potential referral to a physiotherapist.
3. **Third Appointment:** Discussion of diabetes complications, continuation of care, foot examination, and planning for retinopathy screening.

### Follow-up and Yearly Appointments
The need for follow-up visits depends on the balance of sugar levels and the patient's need for support. Yearly visits are essential to detect symptoms or laboratory results indicating complications. These visits also provide an opportunity to assess the patient's overall situation, including social factors like financial status, employment, family status, and mental health.

## The Role of the Diabetes Nurse
The main point in treating people with diabetes is self-management support. Patients need to feel capable and hopeful. The diabetes nurse’s role is to stand beside, support, and encourage the patient, while also accepting the choices the patient makes regarding their own treatment.

## Conclusion
Creating this model has highlighted the importance of questioning existing practices and adopting new, evidence-based ways of working. The model has been published on the Siun sote website as part of the regional type 2 diabetes treatment program to serve as an introduction for nursing staff.

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**Writer:**
Hanna-Maria Rummukainen, Advanced Nurse Practitioner student from Savonia UAS

**References:**
* Ilanne-Parikka, Pirjo, Niskanen, Leo, Rönnemaa, Tapani, Saha, Marja-Terttu 2019. Diabetes. Kustannus Oy Duodecim.
* Lääkäriliitto 2022. Terveyskeskusten lääkäritilanne 2022. Saastamoinen Peppiina. [Link](https://www.laakariliitto.fi/site/assets/files/5223/2022_terveyskeskusten_laakaritilanne_final3.pdf)
* Terveyden- ja hyvinvoinnin laitos 2023. Kansallinen terveysindeksi. Hyvinvointialueiden tiedot vuosilta 2019–2021. Koponen, Päivikki, Lindell, Elsi, Sarnola, Kati, Luoto, Riitta. [Link](https://thl.fi/documents/10531/10548970/Kansallinen+terveysindeksi_julkaisu_31_05_2023_korj.pdf/ec0582bd-0ce9-984d-ebad-593a8392614e?t=1686552716379)
* Tyypin 2 diabetes. Käypä hoito -suositus. Suomalaisen Lääkäriseuran Duodecimin, Suomen Sisätautilääkärien yhdistyksen ja Diabetesliiton Lääkärineuvoston asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim, 2020. [Link](https://www.kaypahoito.fi/hoi50056#s11)