peer-led diabetes prevention program for tasc in melbourne nabil sulaiman “international congress...

Peer-led Diabetes Prevention Program for TASC in Melbourne

Nabil Sulaiman

“International Congress on CDSM, Melbourne Nov 2008”

Aims of Peer-led

Develop an evidence based, culturally appropriate peer-led diabetes prevention resources and program for TASC

Trial the program

Evaluate the program

Methodology- how?

Design: Pre and post intervention trial (action research methods)

• Advisory Group

• Peer- leaders

• Diabetes prevention program

• Participants

• Evaluation

Methodology- how?

• 12 peer leaders recruited from TASC

• Program was developed (food, exercise,

group dynamics ..etc)

• 2- full days training of leaders

• Each leader engage 10 people

Program components

• Principles of peer-led program

• Role of diet, physical activity and stress

• Group facilitation, engaging

• Motivational techniques and chronic

disease self-management

• Leaders were paid for their training time,

recruitment of participants and

implementing the program.

Outcome Indicators

• Changes in knowledge and attitudes

• Changes in behaviours

• Changes in body weight and waist

circumference

Data collection• Questionnaire and interviews:

knowledge, attitudes and behaviour

"Three-day Food Diary" and physical activity”

• Weight, waist circumference were

measured

• Pedometer to act as incentive for walking

RESULTS (N= 94)

Gender: females (73%)Age: 47% (40-45 y) and 25% (>55 y ) COB: Turkey (45%) Iraq (39%) Lebanon (12%)

Obesity: 50% (BMI=30+)

Knowledge of risk of diabetes?

54.8% said yes post intervention compared to 29.8% pre-intervention (p=.069).

Why do you think you are at risk factors of DM?

59.658.5

38.3

45.7

54.3

40.4

56.4

28.7

8.5

72.3 71.3

48.9

64.9

60.6

48.9

68.1

51.1

11.8

0

10

20

30

40

50

60

70

80

Overw

eight

Family

mem

ber

Blood p

ress

ure

Cholest

erol

Little

Exe

rcis

e

Fast F

ood

Stress

Smoki

ng

Other

%

PRE

POST

39.1

60.9

20.4

79.6

0

10

20

30

40

50

60

70

80

%

No

Yes

No 39.1 20.4

Yes 60.9 79.6

PRE POST

Have you done anything to lower risk during last 3 months (P<0.001)

Lifestyle changes after program

• 89% in food preparation

• 79% dietary intake

• 82% shopping

• 81% feeling of well being

• 79% physical activity

• 69% body weight

Mean walking time last week pre and post intervention

Exercise Pre Post P-value

Walking 180 258 0.007

Moderate 249 269 0.722

Vigorous 161 185 0.85

Weight and Waist

• Weight (kg): significant reduction in weight [mean weight pre=78.1, post=77.3; Z score=-3.415 (P=0.001)

• Waist circumference (cm): mean pre=99.5cm, post =96.5

Z=-2.569 (P=0.010)

Effectiveness of the program using 10-points scale

• 68% gave 9 or 10 points


• 2% gave 5 points (undecided)


What are the main reasons for not taking any actions to lower your risks?

Reasons Pre Post p-value

No time to cook

37.2% 20% 0.004

Like to eat fast food

24.5% 11.1% 0.029

What did you like?77% appreciated the information

69% the skills learned

63% the support provided

95% learned healthy eating skills

70% maintaining healthy weight

75% how to loose weight

73% value regular exercise

48% information access and

42% attitudinal change

Source of diabetes knowledge

Doctors (92%) Television (70%) Friends (54%) Nurses (35%) Brochures (35%) Family (36%) Internet (29%) Ethnic media (29%).

Comparison with other studies

Meta-analysis of 11 RCTs in CALD:

1. Improved HbA1c 3m after intervention

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 3m

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)

Limited intervention• Administered by trained peers equipped

with culturally appropriate education • Native language Significant improvement in:

• knowledge and attitudes• limited changes in lifestyle behaviour • The changes were maintained three

months after the intervention.

Conclusions

• The peer-led DPP was effective in improving knowledge and changeing behaviour

• The program could be replicated in other CALD

Conclusions

Diabetes Research Initiatives in Sharjah,

UAE Nabil Sulaiman

[email protected]

[email protected]

Diabetes Supercourse, Alexandria 12 Jan 2009

mailto:[email protected]


Sharjah Diabetes Study

Background Why the study Methods Preliminary results Conclusions Recommendations

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.

SummaryDiabetes is a major and complex health problem worldwide.

Prevalence in UAE (24% & IGT18%) is the 2nd highest in the world

Onset of the disease in the GCC is early in late 20s

With early Dx and appropriate Mgt diabetics can live better and longer


N. Sulaiman, Dh. Al Badri, N. Sajwani, S. Saleh, D. Young

Self monitoringNoYes

Fre

qu

en

cy

250

200

150

100

50

0

Self monitoring

1 Nabil Sulaiman, 2Dhafir Al Badry, 2Najla Sajwany, 1Amal Hussein, 1Saba Saleh, 2Doris Young(1Department of Family and Community Medicine, University of Sharjah, 2 Ministry of Health UAE, 3Department of General Practice, University of Melbourne)

The study design is a cross sectional baseline survey of patients with diabetes attending Primary Medical Care Centers in Sharjah during 2007/08.

Data Collection1. Research Assistant attended diabetes mini clinics at Riffa and Asit

centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals:2. Patients were invited to participate 3. Patients were interviewed using structured questionnaires4. Their data were extracted from medical records5. Data cleaning and analysis was performed using SPSS

Background Diabetes is a major and complex health problem worldwide. Diabetes prevalence in UAE is the 2nd highest in the world, reaching

about 24% in UAE nationals. The prevalence of pre diabetes is reported to be about 18%. With early identification and appropriate management, people with

diabetes can live better and longer

This project was funded by the University of Sharjah. For information please contact Dr Nabil Sulaiman, HOD Family and Community Medicine, The University of Sharjah E-mail: [email protected] or [email protected]

AimTo improve diabetes management, control and quality of life of patients

with diabetes in UAE

Objectives1. Establish an electronic database for diabetic patients in Sharjah

2. Audit their medical records to identify gaps in management.

3. Pilot test known EB intervention to investigate their appropriateness to Sharjah

4. Determine barriers and facilitators to the implementation of the intervention

METHODOLOGY

Diabetes Control Indicators

body weight and waist circumference from medical records knowledge and attitudes towards healthy eating using physical

activity questionnaire and Biochemical indicators such as AbA1c and cholesterol, lipids,

blood glucose and urine test

MissingOthersUnknownDiet, tablets & InsulinDiet & InsulinDiet & TabletsInsulin onlyTablets onlyDiet onlyNone

Current Diabetes management method

PRELIMINARY RESULTS

Participants: 347 diabetic patients were interviewed and their medical records were cheeked

Gender: 65.4% (n= 227) females and 34.6% (n=120) males

Nationality: UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, others 10% including Palestine, Lebanon, Yemen, Iraq, Poland , Syria, Iran and Sudan.

Marital Status: 8.9% single, 87.9% married, divorced 1.4% and 1.4% widowed.

Consanguineous Marriage: 16.4% (n=57)

Occupation: : 47.3% housewife, 28.2% clerks, 6.3% students, 0.6%retired.

Family History: 23.1% (N=80) had a positive family history of diabetes.

Smoking: 3.2% (n=11) current smokers, 3.2% (n=11), ex-smokers, never smoked 93.1% (n=323).


OthersUnknownDiet, tablets &

Insulin

Diet & Insulin

Diet & Tablets

Insulin onlyTablets only

Diet onlyNone

Freq

uen

cy

200

150

100

50

0


Diabetes in familyNot sureNoYes

Fre

qu

en

cy

250

200

150

100

50

0

Diabetes in family

CONCLUSIONS

1. Diabetes Mellitus is common problem in primary medical centers in Sharjah.

2. There is gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity.

3. Diabetes control in Sharjah measured by HbA1c could be improved compared with international guidelines.

4. Measures to improve control may include employing Diabetes Nurse Educators to assist doctors at the medical centers to train patients as well as CME courses for doctors working at the centers.

31.4%26.4%Diabetes complications%

9.4 ± 3.79.9 ± 4.3Fasting B Sugar (mmol/l)

27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes



27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes



Insulin

Diet & Insulin

Diet & Tablets


Diet onlyNone

Freq

uen

cy

200

150

100

50

0



Fre

qu

en

cy

250

200

150

100

50

0

Diabetes in family




Aim

To improve diabetes management, control and quality of life of patients with diabetes in UAE


Objectives

Identify gaps in diabetes management

Determine barriers and facilitators to implementation of known interventions

Pilot test known EB intervention in Sharjah

Study Design

Cross sectional baseline survey of patients with diabetes attending Primary Medical Centers in Sharjah during 2007/08.

Data Collection

Research Assistant attended diabetes mini clinics at Riffa and Wasit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals:Patients were invited to participate and interviewed using questionnairesTheir data were extracted from medical recordsData cleaning and analysis was performed using SPSS

Diabetes Control Indicators

Medical Records:Biochemical indicators such as HbA1c and cholesterol, lipids, blood glucose and urine testWeight and waist circumference

Patients questionnaire:Knowledge and attitudes healthy eating physical activity

Preliminary Results

Sample: 347 patients

Gender: 65.4% females

Mean age 53.2 (14.6)

BMI 29.8 (5.9)

Nationality

UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, Others: 10% (Palestine, Lebanon, Yemen,

Iraq, Syria, Iran and Sudan)

Diabetes in Families


Fre

qu

ency

250

200

150

100

50

0

Diabetes in family

Marital StatusMarital Status 87.9% married 8.9% single 2.8 divorced/widowed

Consanguineous Marriage: 16.4% (n=57)

Gender difference



27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes



27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes

HbA1c:

78% of patients has HbA1c (>7%) BP:

57% have high BP

Management Methods



Insulin

Diet & Insulin

Diet & Tablets


Diet onlyNone

Fre

qu

enc

y

200

150

100

50

0


Complications (83) 26 (Eye glaucoma, laser surgery)

74 (feet ulcer, loss of sensation)

2 (Kidney: protein urea or albumin urea)

4 (loss of toe/ foot)

6 (angina, heart attack)

Self monitoring

Self monitoringNoYes

Fre

qu

ency

250

200

150

100

50

0

Self monitoring

Self Management

I can exercise several times a week (25% strongly agree)

I can not exercise unless I feel like exercising (28% strongly agree)

I can recognize when my blood sugar is too high (27% strongly agree)

Self Management

I can do what was recommended to prevent low blood sugar (24% SA)

I can figure out what self treatment when blood sugar gets high (29% SA)

I can fit my diabetes self treatment routine into my usual lifestyle (26% SA)

CONCLUSIONS

Diabetes Mellitus is common problem in primary medical centers in Sharjah.

High levels of obesity

Low physical activity

Gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity.

Recommendations

Diabetes management in Sharjah could be improved compared with international guidelines

Measures to improve control: Diabetes Nurse Educators Patient’s self management education Peer-led or peer-support models CME for doctors at PHC centers

Thank You

peer-led diabetes prevention program for tasc in melbourne nabil sulaiman “international congress...

Documents