When to educate? What do the guides say?

Abstract

Diabetes Education for Self-Management (EDAM) has been shown to improve glycemic control, reduce complications and reduce mortality. The concept of empowerment in structured education includes: identification of needs, exploration of psychosocial aspects, definition of objectives, planning focused on supporting informed decision making, self-care behaviors with problem resolution and evaluation of results. Educational programs require a structured curriculum with predefined learning objectives, based on updated scientific evidence and supported by a participatory pedagogical strategy.

The different international guidelines (ADA, IDF, SED, Canadian and Australian, among others) agree that there are four key moments in which the educational intervention has proven to be more effective, according to the cost effectiveness demonstrated by the evidence according to the GRADE criteria. about the impact: a) at the diagnosis of the disease; b) at annual check-ups or when objectives are not being met; c) when facing a new challenge (such as the appearance of complications or pregnancy; d) when there are changes in medical care or in the different stages of the life cycle.

Resolution 2820/2022 of Law 23753, based on the Clinical Practice Guide of the Ministry of Health 2019 of our country, establishes the objectives of duration, number and periodicity of the EDAM: Initial: 10 hours, in all people with DM regardless of the type, preferably within the first year of diagnosis or at any time during the evolution of the disease in those people who have not received it. Indicates a distribution of 5 to 6 sessions with a weekly or biweekly periodicity, with a Reinforcement of 2 hours/year at be performed in people with diabetes who present type 1 or poor metabolic control or in those in whom changes are made in treatment or when transitions occur in life (for example, from adolescent to adult) and also in special situations where they may require a greater load. initial and reinforcement time such as beginning of carbohydrate counting, use of continuous subcutaneous insulin infuser, among other technologies. A standardized program is recommended, containing the following topics in its structure, based on the seven self-care behaviors of the American Association of Diabetes Educators: 1) Healthy eating; 2) Physical activity; 3) Self-monitoring; 4) Therapeutic adherence; 5) Resolution of everyday problems; 6) Coping with a positive attitude; 7) Reduction of risks for complications.

It is recommended to base the behavioral change support process on the transtheoretical model of behavioral changes, with an interdisciplinary team approach including individual and group interventions.