More research evidence is needed on diabetic patients in the primary health care settingIn Finland, approximately 350,000 persons have type 2 diabetes, and another 100,000 individuals have diabetes without knowing it. Diabetes causes human suffering and may result in premature deaths, so it is vital to promote its care and control. Since the majority of patients with type 2 diabetes are being treated at the primary health care level, more research evidence is needed concerning this particular patient group.
Writer: Maria Hagnäs and Ilona Mikkola
Editing: Viestintätoimisto Jokiranta Oy
Type 2 diabetes is a familiar term for most of us. One in ten persons in Finland are estimated to have diabetes, and 75 percent of them have type 2 diabetes. The prevalence is expected to grow significantly in the future. Type 2 diabetes is, first of all, a cause of human suffering and premature deaths (measured as years of life lost) but it also has a burdening effect on health care resources. According to estimates, up to 15 percent of the health care expenditure is spent on the treatment of diabetes and its complications.
Both genetic factors and lifestyle habits play a role in the development of type 2 diabetes. If it’s of any consolation, several studies have shown that it is possible to prevent or delay the onset of type 2 diabetes through lifestyle changes. Basic pillars of prevention include physical activity, a healthy diet, weight management, sufficient sleep and non-smoking. In case type 2 diabetes has already been diagnosed, a healthy lifestyle is the key to proper care as well. A holistic approach is of essence; taking care of the disordered sugar metabolism alone is not enough but medication to treat elevated blood pressure and lipid levels is equally important.
In type 2 diabetes, blood sugar levels are elevated for a long period of time but the condition may remain symptomless. However, if the blood sugar levels stay high over an extended period, it may trigger a chain of events that leads to the development of diabetes-related complications. These additional diseases will impair the diabetic individual’s quality of life and even increase mortality.
Complications related to type 2 diabetes include cardiovascular diseases, diabetic retinopathy (eye condition), nephropathy (kidney disease) and neuropathy (nerve damage). Healthy lifestyle habits and medicinal treatment to protect against cardiovascular conditions are fundamental aspects in the prevention and care of diabetes-related diseases. Also, regular and careful screening for complications is important. Any complications should be detected – or preferably prevented – at the earliest possible stage so as to facilitate effective care and to significantly slow down their impact on the individual’s functioning.
A personalised care plan is an important tool
The majority of patients with type 2 diabetes are being treated at the primary health care level. Apart from supporting a healthy lifestyle and medicinal treatments, the regular screening and monitoring of additional diseases plays a key role. Self-care is the core element in the treatment of diabetes. Visits to a doctor or nurse are brief, totalling a few hours per year at most, so the main responsibility for carrying out treatment rests on the patients themselves. As with any chronic disease, self-care is not always easy and getting tired of treatment routines is only natural. It may appear straightforward on paper, but in real life, it is not always easy to eat, sleep and move as instructed and remember to take the medication on time. This is why the doctor and nurse should serve as a coach or cheerleader, rather than simply mechanically telling the patient what to do.
A personalised care plan is a tool that guides the discussion between a health care professional and the patient toward actual possibilities and desired inputs in the patient’s day-to-day life. The care plan is a written document prepared by the nurse and/or doctor together with the patient in a patient-centric manner. The key is to ask the patient: How could I, as a professional, help you to achieve your goals? The document should include information on relevant long-term medical conditions, their self-monitoring plans, the name of the professional in charge, and the date of the next contact with a health care professional.
Earlier, we have investigated the significance of a care plan in diabetes management. It appeared that personalised care plans are associated with more careful monitoring of diabetes-related complications, the use of medications that improve the patient’s prognosis, and the more systematic utilisation of health services. As a result, positive outcomes related to the therapeutic balance were achieved. The wider use of the care plan in the primary health care setting is a potential tool for better care and management of type 2 diabetes.
Internationally valuable research evidence
The funding granted by the Sakari Alhopuro Foundation enables us to continue our research and thereby advance better care and follow-up for patients with type 2 diabetes. In general, research on diabetes is largely conducted within specialised health care and based on selected patient material and data. In our research, however, the focus is on the daily clinical work within primary health care. The accumulation of knowledge on the care and management of type 2 diabetes will be of both national and international significance.
Our research will explore the prevalence of sleep disorders and mental health issues as well as musculoskeletal diseases among primary health care patients with type 2 diabetes. In our recent article, published in August 2022, a central finding was that 22 percent of patients had at least one of the four types of musculoskeletal pain. The most common pain locations were knee (44%), lower back (39%) and shoulder (25%).
Based on preliminary findings, we have also observed that sleep medication is common among patients with type 2 diabetes. The most frequently used drugs included hypnotics and sedatives affecting the central nervous system although they are not recommended as a first-line treatment for insomnia. We also observed that actual diagnoses on sleep disorders are relatively infrequent. A relevant question is how many cases of, for example, sleep apnoea remain undiagnosed. Snoring, interrupted breathing during sleep and daytime fatigue are good reasons to seek medical advice.
Maria Hagnäs, M.D., Ph.D., earned her doctoral degree from the University of Oulu in 2016. Her dissertation concerned the health behaviour of young adult men and its association with body composition and physical fitness during their military service. Currently, Hagnäs and her colleague researchers, Ilona Mikkola and Eveliina Heikkala, are working as primary health care doctors at Rovaniemi within the Wellbeing services county of Lapland.
Tyypin 2 diabetes. Käypä hoito -suositus. Suomalaisen Lääkäriseuran Duodecimin, Suomen Sisätautilääkärien yhdistyksen ja Diabetesliiton Lääkärineuvoston asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim, 2020. [Current Care Guideline: Type 2 Diabetes]. Available online in Finnish, with English summary (reference 3.1.2023): www.kaypahoito.fi