The Way to a National Diabetes Program

by

Prof. Morsi ArabPresident, Egyptian Diabetes Association

Chairman , IDF - MENA Region

DM in the MENA RegionChanges in population and Prevalence

DM IN THE MENA REGIONChanges in Total numbers of patients from

2010 to 2030 (millions)

IGT

51.7

26.6

Diabetes in Egypt 2010Epidemiological Data :Total population : +/- 79.00 millionspopulation ( at age 20-79) : 45.9 millions-----------------------------------------------------------------------------number of p.w.d. (DM ) : 4.8 millions ( prevalence : 11.4%)number of p.w. (IGT ) : 2.2 millions ( prevalence: 5.1%)Total number 7.0 millions ( total prevalence : 16.5 %

Objective 4 attained!

I - Definition of National Diabetes Program II - The parties involved III – Potential Adverse and limitation Factors IV - Minimal Requirements - Deciding the priorities V - Duties and Obligations of different parties

Patient

IDF

NGO

Family

Pharmaceutical industries

WHO

Society

PhysicianNurseDietitianFoot CarePharmacistLaboratory

Medical Group

Work- schoolFriends

MEDIA

Ministry of Health

Government

ParliamentSyndicate

National Institute

Potential Adverse Factors 1- Economic :Poor Financial Res. /per capit./ Government expenditure/ House-hold expend. with High Prev. of diab.

2- Demographic Extensive areas with poor communications . High population density

3- Social : Illiteracy- Misconceptions – adverse habits and traditions .

Minimal requirements : 1- Insulin and medications availability ( affordable) 2- Primary centers for diagnosis and care 3- wide distribution of services allover the country 4- Basic requirements to manage complications 5- Education : knowledge & skills to patients – Public orientation 6- National basic studies in epidemiology and socioeconomics . 7- Care for Diabetes in School children 8- Care for diabetes in pregnancy

Obligations of Different Parties

The Government ( Ministry of Health)

1- Increase Investments in Health/Diabetes 2- provide Minimal Diabetes Care in Clinics & Hospitals 3- Insure Insulin & Medications Availability 4- provide Education :Patient, Health Care Team and Public

5- Coordinate with Health Care Syndicates 6- Coordinate with NGOs 7- attract International Aid programmes 8- promote National Research ( epidemiol.-socioeconomic)

Parliament (Legislation)

1- Budget planning to improve diabetes Care 2- Taxation Exemption for insulin & medical requirements 3- Put rules and regulations for NGO activities 4- Maintain and guard Patients’ Human Rights ( anti discrimination, working , children, women , elderly …etc) 5- Health Insurance Laws

The Non-Governmental Organizations (NGOs )

1- Advocacy 2- Education Programs for : -Patients and Families -Health Care Team -Community at large

3 - Rules & Regulations - legally recognized - non profitable - accountable and transparent - coordinated & complementary to government - no unhealthy competition, extravagance , business controlled ( by industries )

Education in Diabetes Programmes - For : patients , Health Care Team and community. - to cover knowledge + skills & attitudes - with added professional education expertise - By : MPH & NGOs

- At : clinics – hospitals –social meetings, etc - By all available methods - continuous re-education and evaluation Special rules in Public Mass Education - which priority subjects ? - do not induce panic. - general orientation rather than individual issues. - no business promotions or propaganda. - cautions in news on new discoveries & unproved treatment

The Health Care TeamThe Physician 1- is Leader of the HC team 2- is the Final reference for his patient’s education 3- keep harmony with others in the HC team 4- requires continuous training courses and updates 5- acquire education skills

Nurses 1- Training courses , by whom ? 2- Knowledge + skills & attitude 3- skills in education 4- keep Team work 5- Continuous education , scientific meetings and workshops

The Health Care Team ( cont…) The Pharmacist 1- ensure Insulin availability and proper storing . 2- keep working in team with HC group. 3- no play of physician’s role. 4- limited scope in education.

Dietitians

- great needs to cover deficiency in their number - training courses - acquire education skills - team working

Podologists - urgent needs to cover marked deficiency in their number - training courses : knowledge + skills - education skills

Diabetes Care for Special Groups

School Children - Registration at national level - Individual records in schools - basic equipments to manage emergencies - Education courses to school attendants. - protecting special rights : play- recreation - treatment .non discrimination …etc

Mothers with Diabetes Diabetes of Pregnancy

- Screening for diabetes of pregnancy - Protocols for management of GD - Care for the N.B. - After-labour follow-up of mothers

Elderly Diabetes

- Education courses for families. - Special elderly privileges. - Care for housing problems and family attendance .

The National Diabetes Registry

- essential as source of information for planning public services - Central location - - paper or computer recordings - contains individual patient data - complemented by local & peripheral registries (in schools - work – Health insurance, etc ) - network connections for exchange information

Priorities in National - Oriented Research for Diabetes

- Epidemiological studies ( to provide information for planning health services ) - Economic studies – cost : direct & indirect –

cost-benefit of programmes of prevention, etc.

Diabetes Screening Programmes - Specifically to high risk groups family history – obesity – hypertension -- PH of lab findings – PH of Diab of Preg. - By central planning and organization ( by MPH+ Research groups) - ensure unified criteria for diagnosis - Screening for early detection of complications : Retinopathy – Nephropathy – Coronary Heart Disease - Foot problems - Sending study groups to remote areas .

The National Diabetes Institute - Ideal site for the central national diabetes registry - Do national diabetes research ( coordinated with …) - Design protocols of diabetes care and management of complications - be a model training center for Health Care Personnel - Share in education especially mass education

- keep a Library for all educational material

International Relations

The International Diabetes Federation

1- get moral support from IDF to National Associations & programs 2- use as source of information & educational material 3- Benefit from IDF Task forces’ activities and programs 4- Benefit from WDD events

The WHO

1- Government / collaborative programmes for promotion of diabetes Care2- NGO : collaboration in promoting diabetes care through training & education programmes

The Patient Obligations 1- Take active role: seek to be educated 2- follow proper life style. 3- comply . 4- not to accept misconceptions and deceptive propaganda

Thank You

Alexandrie – Palais du Montazah

Thank You