Pathophysiology of Diabetes Mellitus....

Pathophysiology of DM

1. Pathophysiology of dm

2. PREVALENCE Locally, only approximately 44-53% of patients on long-term therapy adhere to their medication The reasons for decreased adherence are : • Patient factors • Healthcare system • Condition • Therapy • Socioeconomic factors

3. Reasons for Non-adherence to Medications Categories of non-adherence Examples Patient Lack of understanding Lack of involvement in decision making Health beliefs & attitudes Concerning effectiveness of treatment High medication cost Lack of transportation Long wait Poor social support Psychological stress Forgetfulness Anxiety about side effect Low motivation

4. Reasons for Non-adherence to Medications Health care system Failure to recognize non-adherence Complex regimen Lack of continuation of care Lack volume of patients Poor communication Benefits and adverse outcome not explained Short consultation Weak capacity to educate patients & provide follow up Lack of knowledge on adherence & of effective interventions to improve it

5. Strategies to Improve Medication Adherence Categories Strategies Example Patients related factors Patient education Educate on the disease Use simple analogy Use illustrated picture/video Involvement in treatment decision when possible How quickly they would like to achieve desired outcome Avoid prescribing numerous medications & behavioral modifications at one visit Explained on the rational of the treatment Mental illness Recognize & treat mental illness Economic status

6. Categories Strategies Example Physician related factors Effective communication Consider patients cultural beliefs & attitudes Create blame free environment Assess Adherence Ask in a non-judgmental way I know it must be difficult to take all your medications regularly. How often do you miss taking them Of the medications prescribed to you. Which ones are you taking Have you had to stop any of your medications for any reasons? Prescribing Simplify regimen Use of pill boxes Cue to remind patients to take medication When prescribing new medicine, provide all importance information : name, purpose, rationale, frequency, duration, potential side effects Use teach back approach

7. Pathological Factors Contributing to T2DM : Nutritional Factors : Poor diet, excessive calorie intake, and unhealthy eating patterns contribute to insulin resistance. 2. Physical Inactivity : Lack of exercise exacerbates insulin sensitivity. 3. Gut Dysbiosis : Imbalance in gut microbiota may play a role. 4. Metabolic Memory : Prolonged hyperglycaemia can have lasting effects on tissues (legacy effects)

8. Why Diabetic Patient Gain Weight Improved insulin function : Weight gain can be a sign that insulin is working effectively, as the body utilizes sugar, fat, and protein more efficiently. Medications and sedentary lifestyle : Diabetes medications and lack of exercise can contribute to weight gain. Excess glucose storage : Elevated blood sugar levels can lead to weight gain, as excess glucose is often stored as fat. Insulin and calorie intake : Taking insulin allows sugar to enter cells, but consuming more calories than needed can lead to weight gain.

9. Why diabetic patient loss weight Insulin Resistance : Breakdown of fat & muscle for energy 2. Increased Urination : Osmotic diuresis 3. Dehydration : Dehydrated cells release stored glycogen and break down fat for energy

10. 4.Loss of Appetite : Some people with diabetes experience a reduced appetite due to fluctuations in blood sugar levels. 5.Ketosis : B reaks down fat for energy produces ketones, which can suppress appetite and lead to weight loss. 6.Uncontrolled Blood Sugar : Chronic high blood sugar can affect metabolism and lead to weight loss. 7.Other Factors : Diabetes-related complications, such as nerve damage (neuropathy) affecting digestion or gastrointestinal issues, can also contribute to weight loss.

11. Summary 1.Educate patient on DM 2.Entertain pt idea, concern & expectation 3.Involve pt in decision marking 4.Use teach back method to assess patient understanding 5.Help pt to achieved good glycemic control

12. THANK YOU