Self-Management for Patients with Diabetes Mellitus Based on the Chronic Care Model: A Feasibility Assessment at the Karantina Primary Health Care Center

Abstract

Diabetes mellitus (DM) is a complex metabolic disease characterized by chronic elevated blood glucose levels. Globally, the number of patients with diabetes is on the rise. According to the International Diabetes Federation, in 2021, 537 million adults worldwide, aged between 20 and 79 years old, had diabetes compared to 463 million adults back in 2019. There are two major types of DM: T1DM and T2DM. T1DM also known as insulin dependent or juvenile diabetes, is caused by the destruction of the Beta cells of the pancreas and thus no insulin production. On the other hand, T2DM is caused by several pathologic pathways; mainly due to the decrease in the production of insulin and insulin resistance. T2DM constitutes the majority of diabetes cases in the World. As per the World Health Organization (WHO), more than 95% of people with DM have T2DM.

T2DM is a multisystem disease and causes many complications, macrovascular and microvascular. Management of such a complex disease requires both pharmacologic and non-pharmacologic interventions. The primary healthcare delivery system in Lebanon lacks a structured care delivery system for patients with T2DM. A protocol is proposed based on the Chronic Care Model (CCM) of self-management as an evidence-based model. It was developed by Wagner in the United States. In the literature, CCM has shown to improve blood glucose control, prevent serious complications, and improve the quality of life of patients with diabetes. The American Diabetes Association guidelines are utilized as the clinical guide of this protocol. The proposed protocol was later on piloted by the Advanced Public and Community Health Nurse (APCHN) at the Karantina Primary Health Care Center. SWOT analysis done showed the feasibility of applying the CCM for the care of patients with T2DM.