DOI: 10.11118/978-80-7509-832-0-0058

EDUKACE PACIENTŮ S DIABETEM V AMBULANCI PRAKTICKÉHO LÉKAŘE

Petr Kachlík

Diabetes mellitus is a serious chronic metabolic disease, which is associated with a number of risk factors, especially genetic predisposition, immune system disorders, improper diet, low physical activity, high stress. Almost every tenth person suffers from diabetes in the Czech Republic. Late complications of untreated or decompensated diabetes include severe damage to a number of organs and tissues due to failure of their vascular and nervous supplies. Therefore, early detection of the disease, dispensarization and education of the patient, implementation of appropriate treatment, supportive and preventive measures are key. These measures help to stabilize the patiens’ good quality of life and save material and human resources usable elsewhere. Education is an important component of the nursing process, it also finds its place in the general practitioner’s office. Appropriate individual action on the patient maintains and strengthens his motivation for treatment, willingness to follow the doctor’s advice and the rules of a healthy lifestyle. It helps to understand the nature of the disease, examinations, treatment and prevention procedures, promotes a higher level of trust, feedback and openness in the health – patient relationship. The aim was the preparation of educational lessons, implementation and verification of the diabetic patients’ structured regular education in the general practitioner’s office. Three working hypotheses were established concerning the existence and significance of differences in body weight, fasting blood glucose and glycated hemoglobin between the group of patients with type 2 diabetes affected by education and patients non-educated. The survey took place in a general practitioner’s office within one year, using mixed research. Its quantitative component concerned the recording and processing of numerical values (body weight, fasting blood glucose and glycated hemoglobin), the qualitative component was represented by semi-structured interviews with patients (educational lessons, lifestyle assessment, feedback) and participatory observation. The research sample was obtained by deliberate selection. It included 58 middle-aged adults (19 women, 39 men) with uncomplicated type 2 diabetes. In the cohort, 38 patients participated in three educational lessons of 50 minutes each, 20 did not. Patients were examined by a physician and educated by a nurse in the office during three preventive check-ups. They were invited for inspections by phone or SMS messages. Using the ANOVA method and non-parametric tests (Kruskal-Wallis, Mann-Whitney), the observed values were compared between groups of educated and uneducated persons and within individual groups at the beginning and end of the survey. The mean values of the observed traits obtained during all three patient visits were evaluated. Three educational lessons were compiled, which dealt with the nature of diabetes, related risks, diagnosis, treatment and prevention. Furthermore, information was provided on self-control of important parameters in urine and blood, the role of lifestyle (diet, exercise, stress, addictive behavior), warning signs and addressing the complications of diabetes. The results show that 53 % of the educated patients had an adjustment in body weight, 66 % had an improvement in their fasting blood glucose and 55 % had an improvement in their glycated hemoglobin. In the non-educated patient group, normalization of body weight was reported in 35 %, enzymafasting glycemia improved in 25 %, and glycated hemoglobin improved in 40 %. The differences between the two groups were statistically insignificant in the case of body weight and glycated hemoglobin values adjustment, and statistically significant in the case of fasting blood glucose values adjustment (p <0.01). The importance of diabetics’ individual structured education in preventive check-ups in the general practitioner’s office was confirmed. The limits of the research are mainly the small size of the files and complications caused by the coronavirus pandemic.

Keywords: ambulance, type 2 diabetes, educational lessons, physician, patient, prevention, therapy, research, health

pages: 58-73, online: 2022