This document discusses models of diabetes care in primary health care settings. It summarizes evidence that lifestyle interventions can reduce diabetes incidence by 57% by increasing physical activity and improving diet. However, uptake of lifestyle changes is poor. Several models are presented to help with uptake, including the diabetes nurse educator, coach program, and chronic disease self-management. The chronic disease self-management program empowers patients to better manage their condition through education and skills development.

1. Models of Diabetes
Care in PHC
Dr Nabil Sulaiman
The University of Sharjah
The University Melbourne
Brought to you by

2. This Presentation
 Trends in diabetes
 Lifestyle interventions- evidence
 Models of interventions in PHC:
Diabetes Nurse Educator
(DNE)
COACH model
Chronic Disease Self
management
Brought to you by

3. Diabetes in UAE
High prevalence in the Gulf
Countries. In the UAE the
prevalence is:
24% of adults
40% with diabetes and IGT
Diabetes is occurring in younger
age
Brought to you by

4. Environmental and
behavioral changes
New dietary habits (what and how we
eat),
Lack of physical activity,
Overweight/ obesity, and
Stresses of urbanization and working
condition
will lead to further rise of CVD and
diabetes, and their risk factors. Brought to you by

5. Evidence
RCT in Finland and the USA have
demonstrated that the incidence of
diabetes can be reduced by about
57% by modifying:
• Physical activity and
• Diet
(Tuomilehto et al 2001, Knowler et al 2002)
Brought to you by

6. Lifestyle Changes
However, uptake of such lifestyle
changes has been poor
Programs developed to enhance the
uptake, such as:
 Diabetes Nurse Educator
 Coach program
 Chronic Disease Self- management
 Others
Brought to you by

7. In Primary Health Care
In Australia, people with T2D have 80%
of their care in General Practice
Diabetes requires the GP to practise
biomedical, anticipatory and
psychosocial care using evidence-
based and patient-centred medicine and
Patient to engage actively in managing
their illness.
Brought to you by

8. Diabetes Nurse Educator
Trained nurse
Engage, educate and empower patient to
manage diabetes and impact of disease on
patient and family
Based on trust and partnership between
PHC centre- Diabetes nurse educator and
patient
Patient determines agreed targets
Continuity and access Brought to you by

9. Diabetes Coach Program
Tested in Melbourne using RCTs for CVD
Trained nurse or dietitian to do COACH
Following diagnosis or after discharge
from hospital
Education and empowerment
Patient determines agreed targets
Follow up consultation or phone calls
Showed benefit in several outcomes
Brought to you by

10. Chronic disease self
management
Is an effective way in which patients are
empowered to become more active and
effective in managing their disease.
Patient engages in “activities that protect
and promote health, monitoring and
managing of symptoms and signs of
illness, managing the impacts of illness
on functioning, emotions and
interpersonal relationships and adhering
to treatment regimes” Brought to you by

11. Brought to you by

12. Chronic Disease Self
Management
(CDSM) Stanford University
Kate Lorig
Director of the
Stanford Patient
Education Research
Center Brought to you by

13. Is a workshop where people with different
chronic diseases attend
Teaches the skills needed in the day-to-day
management of treatment and to maintain and/or
increase life’s activities.
The Program has been adopted by NHS, the
Diabetes Society of British Columbia in Canada,
Kaiser Permanente, etc
It has been translated into Chinese, Vietnamese,
Norwegian, and Italian. The patient book is
available in Japanese
Stanford CDSM Program
Brought to you by

14. Small-group workshops,
Generally 6 weeks long,
Meeting once a week for about 2 hours,
Led by a pair of lay leaders with health
problems of their own,
The meetings are highly interactive,
focusing on building skills, sharing
experiences and support.
Stanford Program
Brought to you by

15. One Step Ahead
Seminars for people with pre diabetes
Evidence of reduction of 0.5% HbA1C
Brought to you by

16. Patient empowerment
through CDSM
Patient empowerment has a crucial role in the
treatment of chronic disease:
knowledge and skill development to understand
and manage one’s condition and the confidence to
use that training for better self care and greater
compliance
Feeling of control and skill development to
achieve a more interactive relationship with health
care professionals, with the capacity to demand
good quality care
The patient becomes a better self advocate/agent,
more able to get from the health system what they
need in particular. Brought to you by

17. Uptake of lifestyle
However, uptake of such lifestyle changes has
been poor
Programs developed to enhance the uptake,
such as:
 Diabetes Nurse Educator
 Coach program
 Chronic Disease Self- management
 Others
Brought to you by

18. Number of people
< 5,000
5,000–74,000
75,000–349,000
350,000–1,500,000
> 1,500,000
No data available
Total cases = 300 million adults
Projected prevalence of diabetes in 2025
Adapted from World Health Organization. The World Health Report: life in the 21st century, a
vision for all. Geneva: WHO, 1998.
Brought to you by

19. The increasing global
prevalence of diabetes
50
100
150
200
250
1994 2000 2010
Year
Patients (millions)
Type 1
Type 2
McCarty and Zimmet, 1994
Estimates from Brought to you by

20. Projected growth of Type 2
diabetes by region
Amos et al. 1997
Type2diabetesprevalence(millions)
Africa
Asia
North
Am
erica
Latin
Am
erica
0
120
Europe
Oceania
100
80
60
40
20
0
120
100
80
60
40
20
Africa
Asia
North
Am
erica
Latin
Am
erica
Europe
Oceania
1997 2010
Brought to you by

21. Lifestyle modification
• Diet
• Exercise
• Weight loss
• Smoking
cessation
If a 1% reduction in HbA1c is
achieved, you could
expect a reduction in risk
of:
• 21% for any diabetes-
related endpoint
• 37% for microvascular
complications
• 14% for myocardial
infarction
However, compliance is poor and most patients will require
oral pharmacotherapy within a few years of diagnosis
Stratton IM et al. BMJ 2000; 321: 405–412.
Brought to you by

22. Type 2 diabetes in
different populations
Amos et al. 1997
Melanesian
European
African
Polynesian
0 5 10 15 20
Prevalence of Type 2 diabetes (%)
25
Chinese
Hispanic
Lowest rates
Highest rates
Arab
Micronesian
Asian Indian
(Rural India)
(Fijian Indian)
(Rural Kiribati)
(Urban Kiribati)
(Rural Tunisia)
(Oman & UAE)
(Central Mexico)
(US Mexican)
(Rural China)
(Mauritian Chinese)
(Rural W. Samoa)
(Urban W. Samoa)
(Rural Tanzania)
(US Afr. Amer.)
(Poland)
(Laurino, Italy)
(Rural Fiji)
(Urban Fiji)
Brought to you by

23. Diabetes Australia Facts 2008
T2DM in CALD populations:
1. Prevalence of diabetes
2. Prevalence of risk factors
3. Complications
4. Hospitalisations due to non-
treatable diabetes
5. Death rates due to diabetes
Brought to you by

24. Diabetes Australia Facts 2008
1. Prevalence of diabetes is increasing
over time
2. Reduces quality of life
3. Preventable via lifestyle modifications
4. Some population groups are at higher
risk including CALD
Brought to you by

25. Meta-analysis of 11 trials in CALD
1. Improved HbA1c after culturally at 3M
2. Weight Mean Difference -0.3% at 3M and
0.6% at 6M
3. Knowledge scores improved at 3M
4. Healthy life style improvement at
5. No difference in secondary outcomes:
lipid levels, qoL, self-efficacy, BP,
Hawthorne K, Robles Y, Cannings-John R, Edwards S. Culturally appropriate health
education for type 2 diabetes in ethnic minority groups. Cochrane Database of
Systematic Revies 2008 (3)
Brought to you by

26. What are the main reasons for not taking any
actions to lower your risks?
PRE POST
Practices n % n % p-value
No time to cook
own meal
35 37.2 18 20 0.004*
Like to eat fast
food
23 24.5 10 11.1 0.029*
Too busy to
follow a routine
23 24.5 34 37.8 0.053**
Brought to you by

27. Time in minutes you spent walking for
recreation/exercise in the last week (mean)
PRE POST
n n p-
value
Exercise 180 258 0.007*
Brought to you by

28. 2. Qualitative Study
Qualitative focus groups to
investigate feasibility and cultural
appropriateness, barriers and
facilitators of known interventions in
Sharjah
Brought to you by

29. Aims
The target setting is primary health
care centers. People visiting all
primary health care centers/
Hospitals in Sharjah will be targeted.
Risk factors are:
Diabetes
Physical activity
High cholesterol
Unhealthy eating (poor diet)
Smoking
Brought to you by

30. Interventions
Brought to you by

31. Interventions
Case-finding/ screening for prediabetes and
diabetes in PHC
Consultation with doctors, nurses and patients
to identify appropriate diabetes intervention
Engaging people with diabetes/ pre-diabetes in
CDSM programs and the COACH
Family study to look at the genetic profile
CME for doctors and nurses in EB diabetes
management
Training nurses to be diabetes nurse educators
(DNE) to provide the interventions in PHC
centres.
Brought to you by

32. Brought to you by

33. This platform has been started by
Parveen Kumar Chadha with the
vision that nobody should suffer the
way he has suffered because of lack
and improper healthcare facilities in
India. We need lots of funds
manpower etc. to make this vision a
reality please contact us. Join us as
a member for a noble cause.
Brought to you by

34. Our views have
increased the mark of
the 25,000
 Thank you viewers
 Looking forward for franchise,
collaboration, partners.
Brought to you by

35. 011-25464531,011-41425180,011-
66217387+91-9818308353+,91-
9818569476othermotherindia@gmail.com
www.other-mother.in
https://www.facebook.com/pages/Other-Mother-Nursing-Crusade/224235031114989?
ref=hl
http://www.linkedin.com/profile/view?
id=326103341&trk=nav_responsive_tab_profile
https://twitter.com/othermotherind
i
https://cparveen.wix.com/other-mother
A WORLDWIDE MISSITION
Contact Us:-
JOIN US
Saxbee Consultants Details :-www.parveenchadha.com
Brought to you by