World Diabetes Day is celebrated today to raise awareness on diabetes. The theme for this year is ‘Eyes on Diabetes’. Both type 1 and type 2 diabetes can be serious and may lead to the same complications – however, there are many important measures that one may take to stay healthy, by making appropriate lifestyle changes.
The first WHO Global report on diabetes says it is estimated that 422 million adults aged over 18 years worldwide are living with diabetes and that the number has quadrupled since the 1980s. The most common type of diabetes is type 2, and this dramatic surge in numbers is mostly due to people being overweight and obese. Diabetes is a serious, chronic disease. Once it occurs it cannot be cured, but can only be controlled.
Complications of diabetes can lead to heart attack, stroke, blindness, kidney failure and lower limb amputation. Thus it is imperative that people who have diabetes, or who have a tendency towards diabetes take important first steps to improve on or change their lifestyle habits by eating healthily, doing regular physical exercise and stopping smoking. The Primary Health Care Department is supported by the Ministry for Health in its endeavour to ensure that persons keep healthier for a longer time by encouraging positive health behaviours including that of maintaining a healthy weight.
The whole process encourages the implementation of strategies that are acceptable, manageable and realistic to the person
The lifestyle clinics within the community aim to address both the national obesity, nutrition and chronic disease policies and fulfil both the principle of offering holistic and seamless care within the community, closer to where people live and work, as well as offering a proactive and preventive approach towards the health of individuals.
As a strategy to increase accessibility, a self-referral system has been implemented to ensure that those who want to tackle their health issues may have unbridled access to do so. Persons making use of the clinic must be over 18 years of age and are assured of complete confidentiality as a thorough assessment would require honest cooperation from the person in order to ensure an accurate health assessment.
The lifestyle clinics are run by nurses who are specialised at post-graduate level in community nursing. During the clinic encounter that lasts around 45 minutes, an individualised and holistic health needs assessment of the client is carried out by the nurse. The nurses provide education, support, information and guidance on healthy lifestyles, and the goal is to reduce risk factors as much as possible.
Clients are made aware of these risk factors, and at the end of the session an action plan is discussed together with the client, who is encouraged and guided on how to take responsibility for his health. The nurses are also trained to adopt strategies such as motivational interviewing. This is often used to ascertain the client’s readiness to undertake change.
The client is thoroughly encouraged to take a proactive role towards health and, while people are made aware of the identified risks to health, they are also fully involved in the choice of which health risks to tackle first.
Certain health risks may be the direct result of familial history or past health issues and, therefore, may require medical monitoring or screening interventions. Therefore clear referral pathways enable the guiding of clients who require further support to existing health services according to their respective identified needs.
The whole process encourages the implementation of strategies that are acceptable, manageable and realistic to the person, in order to increase the chances of success. The intended outcomes of the service are to intervene early and to postpone the onset of disease as much as possible or to encourage self-management of disease where this is already present.
This, in turn, will decrease the costly levels of intervention that are sometimes required when advanced disease has set in, thereby increasing the quality of life of individuals.
The service was launched initially in the locality of San Ġwann in July 2014 and has now expanded to many other localities including Gozo. The district clinics of Żurrieq, Żabbar, Gudja, Tarxien, Msida, St Paul’s Bay, Mosta area, Birkirkara, Siġġiewi, Santa Lucija, Għaxaq, Kerċem and Għarb are all locations where a person may access the service, which is free of charge.
Those wishing to attend a clinic can call the respective health centre to leave their details. They will then be contacted to set an appointment date. Alternatively interested persons may also send an e-mail to phc@gov.mt, or call 2557 6100.
Living a healthy lifestyle will help to decrease the risks for developing diabetes and improve the control of diabetes where this is already present. Very often health risks result from health behaviours and therefore merit strategic interventions that support health behaviour change.
Dorothy Scicluna is senior staff nurse, Lifestyle Clinic Coordinator, Primary Health Care Department and Rebecca Cachia Fearne is a practice nurse, Practice Development Primary Health Care Department.