Diyabetik Hastada Hemşirelik Yaklaşımı
Özet
DM, tüm kardiyovasküler hastalıklar (KVH) için bağımsız risk faktörü olarak kabul edilmektedir ve DM mevcut hastalarda ilgili hastalıkların prognozu da daha kötü seyretmektedir. Glisemik kontrolün sağlanması, mikro ve makrovasküler komplikasyonları azaltır. Tip 2 DM tanısı olan hastaların hipoglisemi ve hiperglisemiden korunması, glisemik variabilite (GV- glisemik değişkenlik) açısından önem arz eder. Diyabet kalp yetmezliği sebebiyle hastanede yatış riskini, hastane kalma süresini, mortaliteyi artırır. Diyabetik hastalarda cerrahi işlemler, diyabeti olmayanlara göre daha çok uygulanmaktadır. Opere olacakların yaklaşık %25’ini diyabetli hastalar oluşturmaktadır. Diyabetli hastalarda cerrahi girişimlerin riski daha fazladır. Diyabetliler, diyabetik olmayanlara göre daha fazla morbidite, hastanede kalış süresi ve %50 daha fazla mortalite oranına sahiptir. Hemşirelerin diyabetik hastalarını izlerken komplikasyonların erken belirtileri yönünden uyanık olmaları bakım ve eğitim planlamalarını da bu şekilde yapmalıdır. Hem hipoglisemiden hem de glisemik variabilitenin olmaması için hastaya verilecek SC insülin tedavisi ya da insülin infüzyon tedavisiyle yakın kan şekeri takibi yapmakla hastayı normoglisemik düzeyde veya öglisemik düzeyde tutmak hemşirenin en önemli katkı sağlayacağı durumlardan birisidir. Dolayısıyla morbidite ve mortalite azalttığına göre diyabetik bir hastada hemşirelik bakımı son derece önemlidir.
DM is considered an independent risk factor for all cardiovascular diseases (CVD), and the prognosis of related diseases is worse in patients with DM. Ensuring glycemic control reduces micro and macrovascular complications. Protecting patients diagnosed with Type 2 DM from hypoglycemia and hyperglycemia is important in terms of glycemic variability (GV-glycemic variability). Diabetes increases the risk of hospitalization due to heart failure, length of hospital stay, and mortality. Surgical procedures are performed more frequently in diabetic patients than in those without diabetes. Approximately 25% of those who will undergo surgery are diabetic patients. The risks of surgical interventions are higher in patients with diabetes. People with diabetes have more morbidity, longer hospital stays, and a 50% higher mortality rate than non-diabetics. Nurses should be alert for early signs of complications while monitoring their diabetic patients and plan their care and education accordingly. One of the most important contributions of the nurse is to keep the patient at the normoglycemic level or euglycemic level by closely monitoring the blood sugar with SC insulin therapy or insulin infusion therapy to prevent both hypoglycemia and glycemic variability. Therefore, nursing care for a diabetic patient is extremely important as it reduces morbidity and mortality.
Referanslar
TEMD. (2022). TEMD Diabetes Mellitus ve Komplikasyonlarinin Tanı, Tedavi ve İzlem Kılavuzu.https://file.temd.org.tr/Uploads/publications/guides/documents/diabetes-mellitus_2022.pdf. Erişim Tarihi:01.06.2024.
Nathan DM, DCCT/EDIC Research Group. The diabetes control and complicationstrial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014;37:9–16. https://doi.org/10.2337/dc13-2112
Lumley W. Controlling Hypoglycemia and Hyperglycemia. Nursing 1988 ;18:34.
Muslu, L., & Ardahan, M. (2018). Kan Şekeri Regülasyonunda Hemşirelik Bakımının Önemi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, (4), 344-348.
Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M. S., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a nurse‐led diabetes self‐management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research, 2018(1), 4930157.
Dağdelen, Selçuk., Balcı, M., Deyneli, O., Karadeniz, Ş., Sargın, M., Demir, T., Yılmaz, M. (2023). Diyabet Tanı ve Tedavi Rehberi.
McGuire, D. K., & Marx, N. (2014). Diabetes in cardiovascular disease: a companion to Braunwald's heart disease. Elsevier Health Sciences.
Standl E, Schnell O, McGuire DK. Heart failure considerations of antihyperglycemic medications for type 2 diabetes. Circ Res. 2016;118:1830–1843.
ESC. (2023). Guidelines for the management of cardiovascular disease in patients with diabetes ESC Clinical Practice Guidelines. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-and-Diabetes-Guidelines
American Diabetes Association Professional Practice Committee. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022;45(Suppl 1):S144–S174. https://doi.org/10.2337/dc22-S010
Ox CS, Coady S, Sorlie PD, Levy D, Meigs JB, D’Agostino RB, et al. Trends in cardiovascular complications of diabetes. JAMA 2004;292:2495–2499. https://doi.org/10. 1001/jama.292.20.2495
Fauchier L, Boriani G, de Groot JR, Kreutz R, Rossing P, Camm AJ. Medical therapies for prevention of cardiovascular and renal events in patients with atrial fibrillation and diabetes mellitus. Europace 2021;23:1873–1891. https://doi.org/10.1093/europace/ euab184
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41:255–323
American Diabetes Association. Cardiovascular disease and risk management: standards of medical care in diabetes-2020. 10 Diabetes Care. 2020;43:S111–S134.
Fox CS, Golden SH, Anderson C, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American heart association and the American diabetes association. Circulation. 2015;132:691–718.
Standl E, Schnell O, McGuire DK. Heart failure considerations of antihyperglycemic medications for type 2 diabetes. Circ Res. 2016;118:1830–1843
Ferrannini G, De Bacquer D, Vynckier P, De Backer G, Gyberg V, Kotseva K, et al. Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC-EORP EUROASPIRE surveys. Cardiovasc Diabetol 2021;20:1–12. https://doi.org/10.1186/s12933-021-01233-6
Standl E, Stevens SR, Armstrong PW, Buse JB, Chan JC, Green JB, et al. Increased risk of severe hypoglycemic events before and after cardiovascular outcomes in TECOS suggests an at-risk type 2 diabetes frail patient phenotype. Diabetes Care 2018;41: 596–603. https://doi.org/10.2337/dc17-1778
Standl E, Stevens SR, Lokhnygina Y, Bethel MA, Buse JB, Gustavson SM, et al. Confirming the bidirectional nature of the association between severe hypoglycemic and cardiovascular events in type 2 diabetes: insights from Exscell. Diabetes Care 2020;43:643–652. https://doi.org/10.2337/dc19-1079
Referanslar
TEMD. (2022). TEMD Diabetes Mellitus ve Komplikasyonlarinin Tanı, Tedavi ve İzlem Kılavuzu.https://file.temd.org.tr/Uploads/publications/guides/documents/diabetes-mellitus_2022.pdf. Erişim Tarihi:01.06.2024.
Nathan DM, DCCT/EDIC Research Group. The diabetes control and complicationstrial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014;37:9–16. https://doi.org/10.2337/dc13-2112
Lumley W. Controlling Hypoglycemia and Hyperglycemia. Nursing 1988 ;18:34.
Muslu, L., & Ardahan, M. (2018). Kan Şekeri Regülasyonunda Hemşirelik Bakımının Önemi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, (4), 344-348.
Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M. S., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a nurse‐led diabetes self‐management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research, 2018(1), 4930157.
Dağdelen, Selçuk., Balcı, M., Deyneli, O., Karadeniz, Ş., Sargın, M., Demir, T., Yılmaz, M. (2023). Diyabet Tanı ve Tedavi Rehberi.
McGuire, D. K., & Marx, N. (2014). Diabetes in cardiovascular disease: a companion to Braunwald's heart disease. Elsevier Health Sciences.
Standl E, Schnell O, McGuire DK. Heart failure considerations of antihyperglycemic medications for type 2 diabetes. Circ Res. 2016;118:1830–1843.
ESC. (2023). Guidelines for the management of cardiovascular disease in patients with diabetes ESC Clinical Practice Guidelines. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-and-Diabetes-Guidelines
American Diabetes Association Professional Practice Committee. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022;45(Suppl 1):S144–S174. https://doi.org/10.2337/dc22-S010
Ox CS, Coady S, Sorlie PD, Levy D, Meigs JB, D’Agostino RB, et al. Trends in cardiovascular complications of diabetes. JAMA 2004;292:2495–2499. https://doi.org/10. 1001/jama.292.20.2495
Fauchier L, Boriani G, de Groot JR, Kreutz R, Rossing P, Camm AJ. Medical therapies for prevention of cardiovascular and renal events in patients with atrial fibrillation and diabetes mellitus. Europace 2021;23:1873–1891. https://doi.org/10.1093/europace/ euab184
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41:255–323
American Diabetes Association. Cardiovascular disease and risk management: standards of medical care in diabetes-2020. 10 Diabetes Care. 2020;43:S111–S134.
Fox CS, Golden SH, Anderson C, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American heart association and the American diabetes association. Circulation. 2015;132:691–718.
Standl E, Schnell O, McGuire DK. Heart failure considerations of antihyperglycemic medications for type 2 diabetes. Circ Res. 2016;118:1830–1843
Ferrannini G, De Bacquer D, Vynckier P, De Backer G, Gyberg V, Kotseva K, et al. Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC-EORP EUROASPIRE surveys. Cardiovasc Diabetol 2021;20:1–12. https://doi.org/10.1186/s12933-021-01233-6
Standl E, Stevens SR, Armstrong PW, Buse JB, Chan JC, Green JB, et al. Increased risk of severe hypoglycemic events before and after cardiovascular outcomes in TECOS suggests an at-risk type 2 diabetes frail patient phenotype. Diabetes Care 2018;41: 596–603. https://doi.org/10.2337/dc17-1778
Standl E, Stevens SR, Lokhnygina Y, Bethel MA, Buse JB, Gustavson SM, et al. Confirming the bidirectional nature of the association between severe hypoglycemic and cardiovascular events in type 2 diabetes: insights from Exscell. Diabetes Care 2020;43:643–652. https://doi.org/10.2337/dc19-1079
