Research presentation:

The diabetic caregivers' role in type II Diabetes mellitus patients' eating behavior

6th Nov 2012

Authors

• Mr. Raksit Chinnarakbumrung• Ms. Suwannika Palee• Mr. Harit Vanakiatkul

Advisor• Sarinya Sutthanon, M.D.

Researchable Questions

• Primary research question–How do the role of family nutritional

support in patients with type II diabetes mellitus ?

• Secondary research question– Controlling of eating behavior of the

caregivers makes blood glucose level of Diabetic patients improved ?

Researchable Questions

• P : Type II diabetes mellitus patients

• I : The eating behavior of the caregivers

• C : none• O : The eating behavior of

diabetes mellitus patient

Contents

• Unit 1 : Introduction• Unit 2 : Review literature• Unit 3 : Methodology• Unit 4 : Results• Unit 5 : Discussion, conclusion

and suggestion• References

Unit 1 Introduction

• Diabetes mellitus is a chronic illness that requires significant behavior change in the family, because the demands of adhering to the patient's healthcare regime are associated with psychosocial conflicts for the patient and the family environment.

Unit 1 Introduction (cont.)

• Diabetes mellitus is a major problem for health system in Thailand.

• Some of studies have showed that DM patient also had a problem with controlling their blood sugar level and their eating behavior.

Unit 1 Introduction (cont.)

• Because the incidence of DM is dramatically increased when they’re growing older. The goal of treatment DM is to control blood sugar level within the normal range to reduce risk for microvascular complications such as diabetic retinopathy, diabetic nephropathy and diabetic neuropathy, the other is macrovascular complications.

Unit 1 Introduction (cont.)

• Nowadays there are some research about factors that affect to their eating behavior but the research about socioeconomic status and the behavior of the caregiver that were contributing factors making DM patient control their eating behavior, were not too much.

• So, we had noticed about this problem and try to study about this problem.

Unit 1 Introduction (cont.)

• Objective– To find out and explain the caregivers’

role in eating behavior about their konwlodge, attitude, feeling and limitation for caring diabetes patients

Unit 1 Introduction (cont.)

• Scope of interest– Populations : Diabetic patients who

came with their caregiver and had gone to health service system in diabetic clinic, department of Internal Medicine, Naresuan university hospital

– Timing : 7th – 30th November 2011

Unit 1 Introduction (cont.)

• Benefits – To clarify the role of the caregivers for

controlling blood sugar level of the diabetic patients

Unit 2 Review literature

• Family support for nutritional management had a beneficial effect on HbA1c − Koin Watanabe, Takeshi Kurose, Naomi Kitatani, et al. The Role of Family Nutritional Support in Japanese Patients with Type 2 Diabetes Mellitus: Inter Med 49: 986, 2010

• In a previous report of predominantly older African American adults with diabetes, it was found that family support is related to a pattern of diet self-care behaviors − Dye CJ, Haley-Zitlin V, Willoughby D. Insights from older adults with type 2 diabetes: making dietary and exercise changes. Diabetes Educ 29: 116-127, 2003.

Unit 3 Methodology

• Researchable question• How does the eating behavior of the caregiver

affect blood sugar level of diabetic patient?

• Population– Diabetic patients, who were diagnosed type

II diabetes mellitus for more than 1 year, came with their caregivers to the DM clinic between 21st to 25th November 2011

– The caregivers of diabetic patients who were more than 20 years of age and did not diagnose for type II DM before

Unit 3 Methodology (cont.)

• Sample– Thirteen diabetes mellitus patients who

were established DM type II for at least 1 year, without psychiatric problems and 13 diabetes’ caregiver who were age 20 or more and did not neither established DM type II nor psychiatric problems.

Unit 3 Methodology (cont.)

• Places for collecting the data– Out-patient department (OPD),

department of Internal medicine, Naresuan university hospital

– DM clinic, department of Internal medicine, Naresuan university hospital

Unit 3 Methodology (cont.)

• Source of information– Observation and in-depth interview– OPD card

• Study method– Qualitative study

Unit 3 Methodology (cont.)

• Methodology –Qualitative method– Observation and in depth interview

Unit 3 Methodology (cont.)

• Content in interviewing– Knowledge about controlling the diet– Factors that affect the controlling blood

sugar level– Do they control their eating and how–How do you feel about taking good care

to DM patient– Some restrictions for controlling the

diet

Unit 3 Methodology (cont.)

• Triangulation– Observe and in-depth interview– The patient and the caregiver will be

interviewed separately for reducing to the bias from embarrassed so they’ll feel free to answer to the question to make the research more reliable

Unit 3 Methodology (cont.)

• Instruments– Voice recorder–Notebook

Unit 3 Methodology (cont.)

• Method– Design the research topic and present to the

content-expert and methodology-expert advisors– Review the literature

– Present the research topic– Adjust and develop the topic– Present the research proposal– Performing the research

Observe and in-depth interview

Analyze and evaluate the data

– Present the research

Unit 3 Methodology (cont.)

• Collecting procedure– Get permission for data collecting– Explain to the health service provider in

the OPD and DM clinic for co-operating– Collecting the data by observation and

in-depth interview to the participants– Analyze, discuss and conclude the data

Time table7th November – 2nd December 2011

1st week

2nd week

3rd week

4th week

MT WT F MT WT F MT WT F MT WT FReviewing literaturePresent the topic proposal

Data collecting

Analyzing the data

Research presentation

Unit 3 Methodology (cont.)

• Data analyzing and statistical tools– Observation and in-depth interview

Unit 4Result

Unit4.Result

1. Eating Behaviors.2. Knowledge of diabetes.3. Family roles.4. Attitude.5. Feeling on Diabetes Mellitus.6. Difficulties and Limits that affect the

diet control.7. Observing the nutritionist.

1. Eating Behaviors.

.

1.1 Caregivers' behavior.

1.1.1 Some cargivers have a need to control eating.1.1.1.1 Appropriated control.

"In the morning,We eat no more than 2 ladles with tofu soup and the same in the evening. No fried food."

1.1 Caregivers' behavior.

1.1.1.2 inappropriated control.

"Eating about 2 ladles with boiled vegetable and fruit such as one or two kilograms of orange. Some time we eat fried foods."

1.1 Caregivers' behavior.

1.1.2 Some caregivers do not have a need to control eating.

"Eating same as other, no specific foods for patient."

1.2 Patients' behavior.

1.2.1 Some patient have a need to control eating.1.2.1.1 Appropriately control

"No sweets, no fats. I eat vegetables such as lettuce, morning glory but no roots“

1.2.1.2 inappropriately control

"One milk, 2 ladles of rice, with salts fish, rarely fruits, but no sweets."

1.2 Patients' behavior.

1.2.2 Some patient do not have a need to control eating.

"I eat everything, sweets, fruits."

2. Knowledge of diabetes.

2.1 Cause of Diabetes Mellitus.

2.1.1 Some participles do not have any knowledge.

"I do not know. None diabetes in my family.“

"I know only not to eat sweets."

2.1 Cause of Diabetes Mellitus.

2.1.2 Some participles think that Diabetes Mellitus cause from eating behaviors.

"It cause from cabohydrate.“

"I usually not eat sweets, but I do not know why it affects me."

2.1 Cause of Diabetes Mellitus.

2.1.3 Some participles think that other chronic disease cause Diabetes Mellitus.

"It cause from Hypertension and Lipids“

"First my father does not have Diabetes. He has Hypertension and Dyslipidemia. These cause Diabetes."

2.2 Controlling blood sugar.

2.2.1 Some participles think that dietary affects blood sugar level.

"Eat less. Less salts. Less sweets."

2.2 Controlling blood sugar.

2.2.2 Some participles think that drugs affects blood sugar level.

"I watch TV, it said that contraception affects blood sugar.“

"The Diabetes is controllable beacause my father used oral drugs, not injected."

2.3 Symptoms of Diabetes Mellitus.

"Fatigue, bored with food, moody“

"My father has thirsty, fatigue, frequent micturition."

2.4 Complication of Diabetes Mellitus.

“it is serious. Difficult wound healing and more.“

“If you have wounds, it will get bigger.“

“If not control, it will affect the eyes.“

3. Family roles.

3. Family roles.

3.1 Some families do not involve in diabetic cares beacause of they do not know how to cares and they do not realize how important of family roles.

"He do not control. he do not know much and not aware."

3. Family roles.

3.2 Some families give an instructive, exhort and encourage.

“I tell my mother not to eat sweets but eat vegetable and fruits“

“My father usually drink soft drink. I always criticize him."

3. Family roles.

3.3 Some families provide food for patient but do not give advices.

“My daughter prepare the foods. I just eat and sleep.“

3. Family roles.

3.4 Some families provide food for patient and give advices.

“It important to prepare the foods and advice him what to eat. If I am not prepare, he do not choose what to eat.“

3. Family roles.

3.5 Some families control eating as same as the patients.

“I diet with hers. I do not want to have diabetes.”

4. Attitude

4.1 Diabetes Mellitus.

4.1.1 Diabetes Mellitus is a common disease.

“In these day, everyone has diabetes.“

“It is a millionaire disease.“

“Everyone has diabetes when they grow up."

4.1 Diabetes Mellitus.

4.1.2 Diabetes Mellitus is a serious disease.

"It serious but if we control it, no matter.“

4.1.3 Diabetes Mellitus is not a serious disease.

"At first I worried but now it dose not matter."

4.2 Eating.

4.2.1 Family roles is important to the diet control.

"Family is important in the control of diabetes because he do not know what to eat.“

"It is a duty to care him."

4.2 Eating.

4.2.2 Family roles is not affects the diet control.

“Families do not matter much. We take care of ourselves.“

“Control or not depends on yourself.“

4.2 Eating.

4.2.3 Diet control is difficult.

"It difficult but depends on yourself.“

"If not eat when hungry, I will palpitate. Then I eat."

4.2 Eating.

4.2.4 Diet control is unnecessary or do not important.

"Let's the doctors do, and follow them. if not eat sweet much, It does not matter.“

"Fear but still eating."

5. Feeling on Diabetes Mellitus.

5.1 Some participle fear the complications of Diabetes Mellitus.

“I fear blindness then I do not eat sweet.”

“Fear it involve the eyes.”

5.2 Some participle worry about Diabetes Mellitus affects their live.

"Very nervous because he can not work and frequently fatigue."

5.3 Some participle tire of the medications.

"Bored to go to the hospital.“

"Bored to take drugs"

5.4 Some participles do not aware.

"Fear in the past but now it is normally"

6. Difficulties and Limits that affect the diet control.

6.1 Some participle can not choose what they eat.

“My children buy foods for us. We can not choose what they brought.”

“We live in countryside. We can not choose what to eat. We eat what we have”

6. Difficulties and Limits that affect the diet control.

6.2 Some participle do not take an advices.

“She dose not live long. Let’s she eat what she want.”

“I can not force him. He is father the he does not listen to his children.”

6. Difficulties and Limits that affect the diet control.

6.3 Occupation of Some participle is and difficulty.

“We sell foods. So we eat the leftovers.”

“Sometime I busy with my job then I can not go to hospital.”

6. Difficulties and Limits that affect the diet control.

6.4 Some participles think that other disease is more serious than Diabetes Mellitus so they do not control eating.

“If I do not eat I will weak. Then I can not fight the cancer.”

7. Observing the nutritionist.

7.1 Some participles ignore the nutritionist.

7.2 Types of food nutritionist presented does not match what the patient ate.

7.3 Some caregivers did not attend the nutritionist with the patient.

7.4 Some participles didi not attend the nutritionist.

Unit 5Conclusions,Discussion&Suggestions

Conclusion

• Eating behavior– Some of the participants• Appropriated diet control• Diet control but unappropriated• No diet control

Conclusion

• Knowledge about DM type 2– Some of participants • No knowledge about cause of DM type 2• Know that eating behavior ,chronic diseases

and drugs are risk factors of the disease• Know about symptoms and complications of

the disease

Conclusion

• The caregivers’role in type 2 DM patient’s eating behavior– Almost caregivers of DM patients are

their families.– Advice for treatment and encourage the

patient– Prepare food for the patients but not the

DM food– Some of the caregiver control their eating

behavior with the patient

Conclusion

• Attitude about type 2 DM – Some of the participants think that• The disease is common and not severe.• The family is important for the patients’ diet

control.• Diet control for type 2 DM patients is not

necessary and difficult to practice .

Conclusion

• Feelings about type 2 Diabetes mellitus– Some of the participant concern about

complications and treatment of the diseases.

• Obstacles and constraints that affect diet control– The family doesn’t control eating

behavior with the patients.– The occupation

Discussion

• Appropriately control their eating behavior

• Have a diet control but doesn’t valid.• No diet control

Discussion• No knowledge about the disease • Have a knowledge but cannot be

applied• No family support

Suggestions

• Communications and Cooperations – For Medical team ,Patients and

Caregivers• Knowledge and attitude about

– The disease– Diet control– Treatment– Complications

Acknowledgement

• Our project could not successfully completed without the kindness of our advisors for the valuable assistance in supporting our project.

• I would like to express my sincere thanks to my research advisor, Sarinya Sutthanon, M.D. for her invaluable help and constant encouragement throughout the course of this research.

• In addition, I am grateful for the teachers of our research method: Dr.Suwit Leartkajonsin, M.D., and Dr.Taweesak Nopkesorn, M.D. for suggestions and all their help.