Diyabetik Nefropatili Hastalarda Kronik Böbrek Hastalığının Önlenmesinde Hasta Merkezli Bakım/ Patient-Centered Care in Preventing Chronic Kidney Diseases in Patients with Diabetic Nephropathy

Abstract

Diabetes Mellitus, insülinin yeterli üretilememesi ya da üretilen insülinin kullanımında bozukluk olması veya her ikisindeki kusurların bir sonucu olarak oluşan, kronik kan glukozunda yükseklikle seyreden metabolik bir hastalıktır. Diabetes Mellituslu birey sayısı dünya çapında giderek artmaktadır. Diyabetik nefropati, diyabetin böbrekler üzerindeki olumsuz etkilerinden kaynaklanan bir komplikasyondur ve dünya genelinde son dönem böbrek hastalığının önde gelen nedenlerinden biridir. Diyabetik nefropati, glomerüler filtrasyon hızı düzeylerine göre sınıflandırılmaktadır. Mikroalbuminüri taraması, diyabetik nefropati tanısında önemlidir ve genel olarak Tip 1 diyabette tanıdan beş yıl sonra, Tip 2 diyabette ise tanı sırasında ve sonrasında yıllık olarak yapılmalıdır. Diyabetik nefropatinin gelişiminde hiperglisemi ve arterial hipertansiyon temel risk faktörleridir. Ayrıca, kontrolsüz hipertansiyon, dislipidemi, obezite, sigara kullanımı, genetik faktörler ve ailesel yatkınlık gibi diğer faktörlerdir. Diyabetik nefropatinin tedavisi multidisipliner bir ekip müdahalesi gerektirir. Hemşireler, bu ekipte önemli rol oynar ve hastaların eğitimi, tedaviye uyumu ve kendi kendine takip yetenekleri konusunda aktif bir rol üstlenir. Hasta merkezli bakım, hasta perspektifine saygı duymayı, hasta katılımını teşvik etmeyi, hasta konforunu sağlamayı ve hasta haklarını savunmayı içerir. İletişim, hemşire-hasta ilişkisinde kritik bir rol oynar ve sağlık hizmeti sağlayıcılarının hastalarla duyarlı, saygılı ve işbirlikçi iletişim kurmalarına olanak tanır. Hasta merkezli bakım ve etkili iletişim, diyabetik nefropati yönetiminde başarılısonuçlara ulaşmada önemli bir temel oluşturur.

Keywords

• Diyabetik Nefropati
• Hasta Merkezli Bakım
• İş Birliği
• Kronik Böbrek Hastalığı

Patient-Centered Care in Preventing Chronic Kidney Diseases in Patients with Diabetic Nephropathy

Abstract

Diabetes Mellitus is a metabolic disease characterized by chronic high blood glucose levels, resulting from either insufficient insulin production, impaired insulin utilization, or defects in both. The number of individuals with Diabetes Mellitus is steadily increasing worldwide. Diabetic nephropathy is a complication arising from the negative effects of diabetes on the kidneys and is one of the leading causes of end-stage renal disease globally. Diabetic nephropathy is classified based on glomerular filtration rate levels. Microalbuminuria screening is important in the diagnosis of diabetic nephropathy and is generally conducted five years after diagnosis in Type 1 diabetes, and annually from the time of diagnosis in Type 2 diabetes. Hyperglycemia and arterial hypertension are primary risk factors in the development of diabetic nephropathy. Additionally, uncontrolled hypertension, dyslipidemia, obesity, smoking, genetic factors, and familial predisposition are other contributing factors. The treatment of diabetic nephropathy requires a multidisciplinary team intervention. Nurses play a significant role in this team and take an active role in patient education, treatment adherence, and self-monitoring capabilities. Patient-centered care involves respecting the patient's perspective, encouraging patient participation, ensuring patient comfort, and advocating for patient rights. Communication plays a critical role in the nurse-patient relationship and enables healthcare providers to communicate with patients in a sensitive, respectful, and collaborative manner. Patient-centered care and effective communication form a crucial foundation for achieving successful outcomes in the management of diabetic nephropathy.

Keywords

• Diabetic Nephropathy
• Patient- Centered Care
• Collaboration
• Chronic Kidney Diseases

References

1. 1. International Diabetes Federation (IDF). Diabetes Atlas, 9th ed.; International Diabetes Federation: Brussels, Belgium [Internet]. 2019[cited 2023 September 1]. Available from: https://www.diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf
2. 2. IDF Diabetes Atlas [Internet]. Brussels: IDF, 2022[cited 2023 September 1]. Available from: www.diabetesatlas.org.
3. 3. Salman S, Satman İ, Özdemir D, Adaş M, Pekkolay Z. ve ark. Diabetes mellitus ve komplikasyonlarının tanı, tedavi ve izlem kılavuzu [Internet]. Ankara: TEMD Diabetes Mellitus Çalışma ve Eğitim Grubu.2022[cited 2023 September 1]. Available from: https://file.temd.org.tr/Uploads/publications/guides/documents/diabetes-mellitus_2022.pdf
4. 4. Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world wide difference of prevalence and risk factors. J Nephropharmacol. 2015[cited 2023 September 1];5(1):49-56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297507/pdf/npj-5-49.pdf
5. 5. World Health Organization. Diabetes-Health Impact [Internet]. [cited 2023 September 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=The%2520number%2520of%2520people%2520with,% 2525%2520in%25202014%2520(1)
6. 6. Gembillo G, Ingrasciotta Y, Crisafulli S, Luxi N, Siligato R., Santoro D. et al. Kidney disease in diabetic patients: from pathophysiology to pharmacological aspects with a focus on therapeutic inertia. Int J Mol Sci. 2021;22(9):4824. https://doi.org/10.3390/ijms22094824
7. 7. Yüksel M, Bektaş H. Diyabete bağlı kronik komplikasyonların yönetiminde güncel yaklaşımlar. Turkiye Klinikleri J Nurs Sci. 2020;12(1):133-57. https://doi.org/10.5336/nurses.2019-70201
8. 8. American Diabetes Association (ADA). The Journal of Clinical and Applied Research and Educatıon, 2023[cited 2023 September 1];46(1):191-99. Available from: https://diabetes.org/newsroom/press-releases/2022/american-diabetes-association2023-standards-care-diabetes-guide-for-prevention-diagnosis-treatment-people-living-with-diabetes

9. 9. Yılmaz MT, Kaya A, Balcı MK, Karadeniz Ş, Şahin İ ve ark. TÜRKDİAB Diyabet Tanı ve Tedavi Rehberi [Internet]. 2021[cited 2023 September 1]. Available from: https://www.turkdiab.org/admin/PICS/webfiles/Diyabet_Tani_ve_Tedavi_Rehberi_2021.pdf
10. 10. Samsu N. Diabetic nephropathy: challenges in pathogenesis, diagnosis, and treatment. Biomed Res Int. 2021. https://doi.org/10.1155/2021/1497449
11. 11. Thipsawat S. Early detection of diabetic nephropathy in patient with type 2 diabetes mellitus: A review of the literature. Diab Vasc Dis Res. 2021;18(6):1-9 https://doi.org/10.1177/14791641211058856
12. 12. Natesan V, Kim SJ. Diabetic nephropathy- a review of risk factors, progression, mechanism, and dietary management. Biomol Ther (Seoul). 2021;29(4):365-72. https://doi.org/10.4062/biomolther.2020.204
13. 13. Hu F, Zhang T. Study on risk factors of diabetic nephropathy in obese patients with type 2 diabetes mellitus. Int J Gen Med [Internet]. 2020;13:351-60. https://doi.org/10.2147/IJGM.S255858
14. 14. Liao D, Ma L, Liu J, Fu P. Cigarette smoking as a risk factor for diabetic nephropathy: A systematic review and meta-analysis of prospective cohort studies. PLoS ONE. 2019;4(2):e0210213. https://doi.org/10.1371/journal.pone.0210213
15. 15. Jitraknatee J, Ruengorn C, Nochaiwong S. Prevalence and risk factors of chronic kidney disease among type 2 diabetes patients: a cross-sectional study in primary care practice. Sci Rep. 2020;10(1):6205. https://doi.org/10.1038/s41598-020-63443-4
16. 16. Li L, Chen H, Peng C, Yang L. Analysis on value of continuous nursing based on wechat in ımproving healthy quality of life and self-management behavior of patients with diabetic nephropathy. Evid Based Complement Alternat Med. 2022;2022:5131830. Retraction in: Evid Based Complement Alternat Med. 2023:9769745. https://doi.org/10.1155/2022/5131830
17. 17. Yıldırım A, Hacıhasanoğlu AB, Bozdemir N, Hacıhasanoğlu Aşılar R. Diyabet öz yönetiminde çok disiplinli ekip yaklaşımı. TJFMPC. 2020;14(3):479-91. https://doi.org/10.21763/tjfmpc.698927
18. 18. Levengood TW, Peng Y, Xiong KZ, Song Z, Elder R, Ali MK. et al. Community preventive services task force. Team-based care to improve diabetes management: a community guide meta-analysis. Am J Prev Med. 2019;57(1):17-26. https://doi.org/10.1016/j.amepre.2019.02.005
19. 19. Sivrikaya SK, Ergün S. Diyabet eğitimi ve hemşirenin rolü. Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Dergisi [Internet]. 2018[cited 2023 September 1];2(2):25-36. Available from: https://dergipark.org.tr/en/pub/ahievransaglik/issue/65352/1006882
20. 20. Erdoğan M, Kırılmaz H. Hasta merkezlilik ve hasta merkezli bakım. İnsan ve İnsan Dergisi. 2020; 7(24): 97-126. https://doi.org/10.29224/insanveinsan.668806
21. 21. Höglander J, Holmström IK, Lövenmark A, Van Dulmen S, Eide H, Sundler AJ. Registered nurse-patient communication research: An integrative review for future directions in nursing research. J Adv Nurs. 2023;79(2):539-62. https://doi.org/10.1111/jan.15548
22. 22. Gökçe E, Atıcı M, Arslan S. Hemşireler ile hastalar arasındaki iletişim sorunları ve beklentiler: Nitel bir araştırma*. SHYD. 2021;8(2):171-80. https://doi:10.5222/SHYD.2021.79206.
23. 23. Hwang SJ, Tan NC, Yoon S, et al. Perceived barriers and facilitators to chronic kidney disease care among patients in Singapore: a qualitative study. BMJ Open. 2020;10(10):e041788. Published 2020 Oct 16. https://doi:10.1136/bmjopen-2020-041788
24. 24. Shlipak MG, Tummalapalli SL, Boulware LE, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021;99(1):34-47. https://doi:10.1016/j.kint.2020.10.012
25. 25. Kourkouta L, Papathanasiou IV. Communication in nursing practice. Mater Sociomed. 2014;26(1):65- 7.https://doi.org/10.5455/msm.2014.26.65-67)
26. 26. Awang Ahmad NA, Sallehuddin MAA, Teo YC, Abdul Rahman H. Self-care management of patients with diabetes: nurses' perspectives. J Diabetes Metab Disord [Internet]. 2020[cited 2023 September 1];19(2):1537-42. Available from: https://link.springer.com/article/10.1007/s40200-020-00688-w
27. 27. Alshammari M, Duff J, Guilhermino M. Barriers to nurse–patient communication in Saudi Arabia: an integrative review. BMC Nurs. 2019;18(1):1-10. https://doi.org/10.1186/s12912-019-0385-4
28. 28. Joolaee S, Joolaei A, Tschudin V, Bahrani N, Nikbakht Nasrabadi A. Caring relationship: the core component of patients' rights practice as experienced by patients and their companions. J Med Ethics Hist Med [Internet]. 2010[cited 2023 September 1];3(4):1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714119/pdf/jmehm-3-4.pdf
29. 29. Muslu L, Ardahan M. The effect of the motivational interview program on coping and adaptation of patients with type 2 diabetes: An action research study. JBACHS. 2022;6(1):33-46.https://doi.org/10.30621/jbachs.930592.
30. 30. Beaubien-Souligny W, Leclerc S, Verdin N, Ramzanali R, Fox DE. Bridging Gaps in Diabetic Nephropathy Care: A Narrative Review Guided by the Lived Experiences of Patient Partners. Can J Kidney Health Dis. 2022;9:20543581221127940. Published 2022 Oct 11. https://doi:10.1177/20543581221127940
31. 31. Sezgin H, Çınar S. Tip 2 diyabetli hastaların cep telefonu ile takibi: randomize kontrollü çalışma. MÜSBED. 2013;3(4):173-83. https://doi.org/10.5455/musbed.20131203074020