糖尿病的并發(fā)癥DiabetesComplicat課件

HealthEquity:DiabetesCare,HypertensionControlandCancerScreeningintheSanFranciscoKaiserPermanenteChineseClinicPopulation

AnneTangM.D.,FACP

Chief,BilingualChineseModule Chief,Pharmacy&Therapeutics KaiserPermanente SanFranciscoMedicalCenterHealthEquity:DiabetesCare,AssessmentofHealthCareNeeds

ofKPSFChinesePopulationPatientSurveyResultsBilingualChinesephysiciansandstaffHealthEducationMaterialsinChineseInterpretersConvenienceAffordableAssessmentofHealthCareNeedTheKPSFBilingualChineseModule(BCM)15BoardCertifiedPrimaryCarePhysicians1RNDiabeticHealthEducator(DHE)1ComplexChronicConditionRNCasemanager1BehavioralMedicineSpecialist(BMS)1ClinicalHealthEducator(CHE)1PhysicalTherapist(PT)15MedicalAssistants1Charge/TriageRN,?UnitManagerAllphysicians,staff,andalliedprofessionalsarebilingualTheModuletakescareof>20,000ChinesepatientsMission:Toprovideaffordable,integrated,culturallyappropriatehighqualitycaretoourChinesemembersTheKPSFBilingualChineseModTheKPSFBilingualChineseModuleTheKPSFBilingualChineseModChineseModuleDiabetesCare2010,2011,2012DiabetesComprehensiveDiabetesCareHgbA1cScreeningHgbA1c<9%LDLC<100mg/dlBloodPressure<140/90KPSFChineseModule95,95,9688,87,8774,74,7782,85,86KPNCAL92,94,9580,84,8466,68,7275,82,84KPSF89,93,9472,80,8247,65,7177,79,82ChineseModuleDiabetesCare20page6豆奶

加

鈣

乳酪

Butter糖尿病食物金字塔CHINESEFOODPYRAMIDFORDIABETICPATIENTS脂肪，糖，酒，鹽及醬油(盡量少用)奶類(lèi)(每日二至三份)一份=(等於)1杯奶1杯脫脂及低糖的酸乳酪1杯加鈣豆奶(無(wú)附加糖)肉類(lèi)(每日二至三份)一份=(等於)2-3安士瘦肉、家禽、或魚(yú)(一副紙牌的尺寸)

1湯匙花生醬

4安士(1/2碗)豆腐

1隻蛋水果(每日二至四份)一份=(等於)1個(gè)小的水果

(如網(wǎng)球的大小)

?個(gè)大水果?杯果汁?碗乾果1/3碗飯、

麵、米粉、粉絲?碗熟豆、豌豆或粟米?碗粥

、熟麥片1片方麵包1個(gè)小饅頭4片雲(yún)吞皮1/3碗芋頭4-6小塊無(wú)鹽梳打餅乾1碗=8安士1杯=8安士

相等於一安士的肉蔬菜(每日三至五份)一份=(等於)?碗煮熟蔬菜1碗生蔬菜穀物、豆類(lèi)及含澱粉質(zhì)較高的蔬菜(每日六至十一份)一份=(等於)page6豆奶加鈣乳酪Butter糖尿病食物金字塔page7糖尿病的併發(fā)癥DiabetesComplications

腎衰竭

Kidneys(nephropathy)

眼睛(視網(wǎng)膜病)

Eyes(Retinopathy)

神經(jīng)系統(tǒng)(足部問(wèn)題)

Nerves(Neuropathy)

血液循環(huán)(心臟及血管疾病)

Circulation(stroke,HeartDisease)

傷口復(fù)原較慢

Abilitytohealfromwounds牙齒(牙周病)

Teeth(Gumdisease)

性健康問(wèn)題Sexualwellbeingpage7糖尿病的併發(fā)癥腎衰竭page8護(hù)理糖尿病的四大要點(diǎn)CORNERSTONESOFDIABETESCARE健康的飲食習(xí)慣HealthyEating運(yùn)動(dòng)Exercise自我監(jiān)察SelfMonitor藥

物Medicationspage8護(hù)理糖尿病的四大要點(diǎn)健康的飲食習(xí)慣運(yùn)動(dòng)自我監(jiān)察藥page9ChineseModuleHypertensionControl2010,2011,2012CardiovascularDiabetesHighBloodPressureControlBP<139/89HighBloodPressureControlBP<139/89KPSFChineseModule82,83,8479,83,86KPNCAL80,82,8478,82,84KPSF79,79,8078,78,82page9ChineseModuleHypertensHypertensionControlProgramCulturallycompetentintegratedcarebyateamofhealthprofessionalsHealtheducationinpatients’preferredlanguageFreedrop-inwithtimelyinterventionandfollowupEnlistingpatientpartnershipintheircareChronicconditionmanagementprogramOutcomedatafeedbacktoprovidersandstaffCommunityoutreachtopromotepreventivecareHypertensionControlProgramCHypertensionEducationHypertensionEducationpage12

健康的外出飲食範(fàn)例

EXAMPLESOFEATINGOUTINAHEALTHYWAY

種類(lèi)較佳選擇盡少選擇建議及原因麵包/西餅西人麥方包、焗餐包、蒸饅頭雞尾包、叉燒包、奶油包、菠蘿包、蓮蓉包、蛋糕、蛋撻、西餅、沙翁最佳選擇:

全麥麵包含高纖維，有助控制血糖，降低膽固醇及利於排便茶樓點(diǎn)心食譜例子:1碗生菜魚(yú)片粥1小碗菜2-3件有肉點(diǎn)心

(如蝦鉸)腸粉、菜肉包、雞包、雞(脫皮，去肥)、蒸餃(如蝦餃、韭菜餃)、菜心(免油)高脂肪點(diǎn)心:

燒賣(mài)、鳳爪、牛什、叉燒包炸點(diǎn):

春卷、叉燒酥、鹹水角、芋角要求醬油與食物分開(kāi)白飯配一碟點(diǎn)心，如排骨(去肥，免汁)原盅焗飯如鳳爪、排骨飯?jiān)谥笤褵h飯的過(guò)程中排骨的脂肪已滲入飯內(nèi)湯麵或米粉、粥炒麵、炒粉、炒飯雖然湯粉麵含較少脂肪，但也要注意碳水化合物(澱粉質(zhì))的份量，以防血糖高中式小菜蒸魚(yú)、白灼蝦、蒸釀豆腐、雙菇扒豆腐、白切雞(脫皮，去脂肪)、白灼芥蘭、雜菜煲炸石班球、核桃蝦、炸釀豆腐、芝麻雞、牛腩煲、京都排骨、芋頭鴨要求減少油量及醬油來(lái)烹煮中式快餐粥粉麵生菜魚(yú)片粥、雲(yún)吞或水餃麵、米粉、粉絲牛腩或牛什麵腩肉及內(nèi)臟含高飽和脂肪飯盒冬菇蒸雞(去皮)飯菜遠(yuǎn)魚(yú)片飯燒臘(燒鴨、燒肉、叉燒、油雞等)飯、炒麵、炒粉、炒飯盡量減低脂肪，應(yīng)選擇少油煮的菜色中式西餐雜菜清湯、三文魚(yú)、焗薯仔、免醬意粉、西蘭花(少油)、奶茶(免糖，免煉奶，可用代糖)、雞絲或瘦肉湯麵/米粉忌廉湯、炸魚(yú)柳或有醬意粉、炸薯?xiàng)l、紅豆冰、珍珠奶茶、午餐肉、火腿、香腸湯麵/米粉、即食麵盡量減低脂肪，所以應(yīng)選擇清湯，瘦肉及少油煮的菜色page12 健康的外出飲食範(fàn)例種類(lèi)較佳選擇盡少選CancerScreening2010,2011,2012BreastCancerScreeningColonCancerScreeningKPSFChineseModule86,87,8877,83,85KPNCAL84,86,8670,74,82KPSF82,82,8468,78,80CancerScreening2010,2011,2012ColonCancerScreeningFITtestpacketsenttoallpatients>age50ColonscreeningreminderonregistrationslipStaffRemindertodoFITtestBilingualFITtestinstructionsFITtestvideoinCantonese/MandarinCommunityoutreachColonCancerScreeningFITtestBilingualPreventiveCareInformationonRegistrationSlipBilingualPreventiveCareInfoBilingualPhysicianHomepageBilingualPhysicianHomepageHealthEducationMaterialsinChinese[ADVANCEDIRECTIVES]AdvanceHealthCareDirective醫(yī)療護(hù)理指示

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[CUTS/BLEEDING]Cuts割傷Nosebleeds流鼻血

[DIABETES]DiabetesSelf-Care-SC糖尿病自我護(hù)理WhatisType2Diabetes-SC什麼是2型糖尿病DiabetesPrevention-SC預(yù)防糖尿病BloodSugarControl-SC控制血糖

HealthEducationMaterialsinpage18KeyFactorsinHealthEquityinKPSFChineseModuleMembersCulturallycompetentintegratedcarebyateamofhealthprofessionalsHealtheducationinpatients’preferredlanguageTimelyinterventionandfollowupChronicconditionmanagementprogramsOutcomedatafeedbacktoprovidersandstaff&followupServiceexcellenceandeasyaccessHealthpromotionincommunitiesEncouragememberparticipationinpreventivehealthpage18KeyFactorsinHealthEAsianAmerican&PacificIslander(AAPI)MembersTheAAPIgroupisthefastestgrowinggroupintheUnitedStates.Between1990and2000thispopulationgrewby48%,from6.9millionto10.2million.Currently,12mil