Recognising nurses’ role in diabetes management

Azlan Othman

Diabetes is the third main cause of deaths in Brunei Darussalam. Diabetic patients should control the sugar level to avoid complications such as heart problems, kidney failure and amputation, said Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar.

Diabetic patients, caregivers and the community need to work with health professionals to ensure patients’ receive holistic care. They need to be provided with knowledge on prevention, effective management and ways to obtain clinical information resources.

Education on diabetes-related self-management is a very important basic component in diabetes prevention and should be accessible to the public, the minister said in a message to mark World Diabetes Day which falls today.

Dato Seri Setia Dr Haji Mohd Isham said the number of patients with diabetes is increasing worldwide.

According to International Diabetes Federation data, he said 463 million adults (equivalent to one in 11 adults) had diabetes in 2019 and the number is expected to rise to 578 million by 2030.

The minister’s message added, “One in two adults – which is about 232 million people – does not know that he or she has diabetes. Among those with diabetes, most have Type 2 diabetes (diabetes mellitus).

“Diabetes impacts the economy due to increased healthcare burden and loss of productivity.

Diabetes caused 4.2 million deaths in 2019 and the cost of diabetes treatment reached USD760 million in 2019. This is equivalent to 10 per cent of the total global healthcare spending.

“Brunei Darussalam National Health and Nutrition Status Survey (NHANSS) 2009-2011 found that 12.4 per cent of the country’s population suffered from diabetes mellitus. Meanwhile, the national STEPS-wise Survey 2015-2016 found that 9.7 per cent adults aged 18-67 had high blood sugar levels.”

Diabetes is a major non-communicable disease (NCD) worldwide, although there are advances in medicine, he continued.

“The World Diabetes Day has been celebrated since 1991 by the International Diabetes Federation and the World Health Organization (WHO) as one of the responses to the increasing threat to health by diabetes.”

Dato Seri Setia Dr Haji Mohd Isham said the celebration is observed on November 14 every year and the theme this year is ‘Diabetes: Nurses Can Make a Difference’ to highlight the importance of the nurses’ role in supporting diabetics.

The WHO states that nurses comprise 59 per cent of health professionals, and the total workforce of nurses worldwide is 27.9 million of which 19.3 million are professional nurses, he said.

The minister said, “In Brunei, according to Ministry of Health (MoH) 2019 statistics, a total of 2,507 nurses from various fields are serving the government and the private sector. They carry out extraordinary responsibilities in various areas of health and medical expertise in supporting community life. The nurses’ role this year is more prominent and has been highlighted as the frontline due to the COVID-19 pandemic.

“With the increasing number of diabetic patients every year, the role of nurses and health professionals is increasingly important in helping and managing the impact from diabetes.

“Nurses are among the first health professionals to interact more frequently with patients and family members. Therefore, it is very important for every nurse to provide quality assessment, care and treatment to patients.

“In line with the recommendations of the International Diabetes Federation on behalf of the government and health agencies to identify the importance of investing in education and training, the MoH has been providing nurses with diabetes education training since the late 90s. The objective is to train qualified nurses to take on the role of diabetes nurse educators (DNEs). DNEs are nurses who are specially trained in providing comprehensive diabetes care, while meeting the physical and psychosocial needs of patients.” Nineteen DNEs have been appointed by the MoH to serve government hospitals and health centres.

The minister said, “The main role of DNEs is to increase diabetes awareness and knowledge among diabetics and caregivers as well as encourage and improve patients’ abilities, skills and competencies in managing and controlling diabetes while providing individual counselling.

“To further enhance diabetes training in the country, the MoH in collaboration with the School of Health Sciences, Politeknik Brunei will start a Level 5 Diploma in Health Science for DNEs in January 2021. The course aims to facilitate and improve the development of nurses accredited by imparting knowledge, skills and competencies as a DNE in hospitals and health centres.

“It also serves as a mechanism for DNEs to demonstrate their professional performance and development. The course will also encourage nurses’ commitment to best practices, standards and the latest knowledge related to diabetes education.

“Among the diabetes education programmes conducted by DNEs also included the 3S Programme (Healthy, Balanced, Loving) at the Pengkalan Batu Health Centre, focussing on diabetic patients under the catchment of Pengkalan Batu Health Centre who are unable to control their sugar levels.

“The programme aims to increase knowledge and improve sugar levels to normal in patients and in turn reduce the risk of complications. The programme is implemented in collaboration with health professionals such as doctors, DNEs and dieticians.

“The results of the programme in 2016-2017 found that there was a decrease in blood sugar (HbA1c) among participants from 11.3 per cent to 10.5 per cent, six months after following the programme. Knowledge of diabetes has also increased among participants after engaging in the programme.”

Coinciding with the World Diabetes Day 2020 theme, Dato Seri Setia Dr Haji Mohd Isham called on the public to jointly appreciate the role of nurses in the prevention and treatment of diabetes, especially in identifying diabetes at an early stage to ensure patients receive immediate treatment; provide self-management training and psychosocial support to diabetics in helping to prevent complications; and overcoming risk factors to prevent Type 2 diabetes.

“The MoH will always strive to achieve excellence in healthcare to achieve Brunei Vision 2035 to ensure a high quality of life for the people of Brunei Darussalam by ensuring that every citizen and resident will get fair and accessible healthcare, while strengthening measures to prevent NCDs including diabetes,” he said.