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1 Name Selected questions of general diabetology Subject code MF/END/M- V11 Cycle of course unit Integrated Study program Medicine Level of the course Not applicable unit Course VI Division Endocrinology Sybject type Optional clinic Course unit duration 4 weeks Mode of delivery Traditional Part of the program Study area Assessment strategy Exam Credits Total student workload hours Contact hours Independent work hours Requirements for student Examinations of preclinical disciplines passed. Examination of principles if internal medicine passed. Annotation During the cycle of selected questions of general diabetology difficulties in diabetes diagnostics are analyzed, that derived in the interpretation of glucose tolerance test, glycated hemoglobin test results; other issues like the features of diagnostics of other types of diabetes; discussions on international and Lithuanian diagnostic and treatment algorithms and consensus, management of gestational diabetes. The key components of diabetes treatment (physical activity, prudent diet, self-monitoring, patient education, pharmacological treatment), psychological aspects of training are examined in more detail. Features of childhood diabetes (type 2 diabetes in childhood, MODY, monogenic, etc.), diabetes pregress characteristics during puberty, the beta-cells of the pancreas-kidney transplant options are discussed. Insulin pump application, management principles and opportunities, glucose self-monitoring principles and rationality, continuous monitoring systems, using the latest technology are clarified. Compatibility of management of diabetes and other concommitant diseases is analyzed, the regulation of calcium metabolism in renal failure is introduced. Myths and reality in the treatment of patients with diabetes, non-traditional treatments, benefits and damage of food supplements, the rights and obligations of patients with diabetes, diabetes control while traveling in different time zones, working in shifts. Objectives: Competencies developed by study subject By completing this module, students should be able to define, analyze, clarify and link the phenomena studied in module problems. To achieve this, students need to acquire knowledge, skills and abilities of the following: Structure, function and dysfunction and mechanisms of the pancreas and other endocrine organs, related with carbohydrate metabolism disorders; Examining of patients with diabetes mellitus, rare form of diabetes, the latest tools for glycemic control, and new treatment regimens and insulin therapy techniques. Diagnosis of diabetes complications, features of treatment and long-term monitoring; Characteristics of diabetes mellitus in children and during pregnancy. 486

2 Results of program studies Attitude of professional activity Results of subject studies Be honest and honorable with patients suffering from endocrine or related diseases. Follow medical ethics. Comply with requirements of good medical practice. Be critical of other and his own respect. To be able to sympathize with the patient, be creative and proactive. Be proactive, seek to achieve your goals. Being able to interact with coleagues, tutors and medical personnel. Methods of subject studies discussion; error analysis; Shifts in department; Participation in visitation at the department Student achievement evaluation strategy Professional behavior To be able to organize and plan their activities, act independently, to communicate and work in teams to solve problems and make decisions, especially in new situations, be able to assess their competence and, if necessary, seek help. dialogue, demonstration; observation. ; Case history Dispersion of professional experience To be able to study - follow-up studies, independent and life-long studies, to apply the acquired knowledge in practice, and teach the others. Presentation; discussion; error analysis; Shifts in department; Participation in visitation at the department 487

3 Patient counseling Evaluation of clinical features, research assignment, differential diagnosis and composing of the monitoring plan To be able to formulate a clinical evaluation conclusion and make appropriate clinical decisions based on the clinical examination data. Gaining understanding and skills of how to advise patients with diabetes mellitus, depending on their condition and needs. To be able to collect disease, family and life history of the patient with diabetes. To be able to perform general and specialized clinical examination in patients with complicated and noncomplicated diabetes. To be able to formulate a clinical evaluation conclusion and make appropriate clinical decisions based on the clinical examination data. Learn to give patients the confidence, support, explanation and advice Gaining understanding and skills of how to advise patients with endocrine diseases, depending on their condition and needs. To be able to collect disease, family and life history of the patient with endocrine disease. Gaining understanding and skills of Be able to identify, assess, and characterize endocrine disease manifestation techniques and progress of disease symptoms, appoint targeted research and interpret its results; Be able to perform differential diagnosis, establish the treatment and monitoring plan of patient with diabetes and other endocrine diseases, discuss it with the patient and family Practical work; Presentations; Theoretical modeling; Traditional lecture, Shifts in department; Participation in visitation at the department Practical work; Theoretical modeling; Traditional lecture, Academical case history Treatment assignment Know and be able to describe the action mechanisms of th drugs for the treatment of diabetes; Prescribe an adequate and appropriate treatment, depending on the clinical situation; Be able to evaluate the potential benefits and risks of medications and other treatment metods. Practical work; Traditional lecture, Academical case history Akademinė ligos istorija Klinikinės situacijos sprendimas Praktikinis egzaminas Be able to perform differential diagnosis, establish the treatment and monitoring plan of patient 488

4 Application of achievements of biomedical sciences To be able to apply in practice the principles of biomedical sciences, techniques and knowledge (anatomy, histology, genetics, immunology, microbiology, pathology, physiology, etc.). Practical abilities Academical case history Effective communication in medical practice To be able to clearly, sensitively and effectively interact with patients, patient's relatives, the disabled, and colleagues. Work in groups, Dialogue; Method of evaluation Practical skills examination Student demonstrates acquired practical knowledge and the ability to put it into practice the theoretical knowledge, using the cases of patients curated during the cycle. 10 points system is used for evaluation. Student's knowledge and skills are evaluated by two doctors working in department Comparative weight Examination Evaluation criteria 30% Examination is held at the end of the cycle, after the student has completed the study program Up to 4 points - practical skills at the patient's bed - general and special clinical examination of the endocrine patient. Up to 4 points applying theoretical knowledge into practice (based on examination protocols, treatment method and drug dose and scheme selection, longterm treatment and monitoring recommendations for selected clinical situations). Up to 2 points - student practical work assessment during the cycle. The practical exam situations are selected from the patients curated by the student during the cycle. 70 % (50 %x2) Examination is held at the end of the cycle, after the student has completed the study program The assesment during the theoretical examination is on a written response to two questions. Each question is evaluated 10-point system. Formula of the accumulative score 30 percent (practical exam) + 70 percent (theoretical exam) 489

5 Lectures Consulting Seminars Exercises Practical work Practice Tutorial exercises Examinations Total Independent work Course content Topics Contact working hours and study forms Independent working hours and tasks Tasks Causes, differential diagnosis of diabetes, diagnosis of rare types of diabetes, features of diabetes treatment Diagnosis and treatment of acute complications of diabetes Diagnosis and treatment of chronic complications of diabetes Diagnosis, treatment characteristics of diabetic foot syndrome and teamwork opportunities Diabetes treatment and monitoring features in childhood and puberty Diabetes mellitus and pregnancy. Diagnosis and treatment of gestational diabetes Continuous glucose monitoring system, using the latest technology Application of iinsulin pump, management principles and rationality Patient education, psychological aspects of education Total:

6 Compulsory study reference 1. Baliutavičienė D. Nėštumas ir diabetas. Kaunas, Barauskas G., Bilskienė D., Boguševičius A. ir kiti. Chirurgija : [vadovėlis]. - Vilnius : Charibdė, Diabetologija. Sudarytojas A.Norkus. Kaunas, p. 4. Endokrinologija. Sudarytojas G.Kazanavičius. Kaunas, p. 5. Endokrinologijos praktinis vadovas. Sudarytojas A.Norkus. Kaunas, p. 6. Šulcaitė R. 2 tipo cukrinis diabetas. Gabija, Kaunas, Tarptautinis sutarimas diabetinės pėdos klausimu. (IDF DFSG darbo grupė lietuviškas vertimas); Additional study reference 1. Adeghate E, Schattner P, Dunn E. An update on the etiology and epidemiology of diabetes mellitus. Ann N Y Acad Sci 2006; 1084: 1 2. Alberti KG, Zimmet P, Shaw J. International Diabetes Federation: a consensus on Type 2 diabetes prevention. Diabet Med 2007; International Diabetes Federation. Clinical guidelines task force. Global guideline for type 2 diabetes. IDF, Brussels, Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, vol 35, supplement 1, January Managing preexisting diabetes for pregnancy. Summary of evidence and consensus recommendations for care. Diabetes Care Mazze RS, Strock E, Simonson GD. Staged Diabetes Management Mogensen CE. Microalbuminuria and hypertension with focus on type 1 and type 2 diabetes. J Intern Med 2003; 254(1): Pacientų mokymas stebėti ir valdyti ligą. A. Lacroix, J-Ph. Assal. Vitae Litera, Kaunas, Standards of Medical Care in Diabetes Diabetes Care, vol 35, supplement 1, January Turner H.E., Wass J.A.H. Oxford handbook of and diabetes Part XI. Diabetes Supervising teacher: Doc. E.Varanauskienė evaranauskiene@yahoo Valid from Valid up to