Peer-led Diabetes Prevention Program for TASC in Melbourne

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• Peer-led Diabetes Prevention Program for TASC
  in Melbourne
• Nabil Sulaiman
• International Congress on CDSM, Melbourne
  Nov 2008

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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

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Methodology- how?

• Design Pre and post intervention trial (action
  research methods)
• Advisory Group
• Peer- leaders
• Diabetes prevention program
• Participants
• Evaluation

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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

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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.

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Outcome Indicators

• Changes in knowledge and attitudes
• Changes in behaviours
• Changes in body weight and waist circumference

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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

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RESULTS (N 94)

• Gender females (73)
• Age 47 (40-45 y) and 25 (gt55 y )
• COB
• Turkey (45)
• Iraq (39)
• Lebanon (12)
• Obesity 50 (BMI30)

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Knowledge of risk of diabetes?

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

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Why do you think you are at risk factors of DM?
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Have you done anything to lower risk during last
3 months (Plt0.001)
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Lifestyle changes after program

• 89 in food preparation
• 79 dietary intake
• 82 shopping
• 81 feeling of well being
• 79 physical activity
• 69 body weight

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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
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Weight and Waist

• Weight (kg) significant reduction in weight
  mean weight pre78.1, post77.3 Z score-3.415
  (P0.001)
• Waist circumference (cm)
• mean pre99.5cm, post 96.5
• Z-2.569 (P0.010)

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Effectiveness of the program using 10-points
scale

• 68 gave 9 or 10 points
• 18 gave 7 or 8 points
• 2 gave 5 points (undecided)
• 2 gave 3 or 4 points

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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
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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

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Source of diabetes knowledge

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

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Comparison with other studies
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Meta-analysis of 11 RCTs in CALD

• Improved HbA1c 3m after intervention
• Weight Mean Difference -0.3 at 3m and 0.6 at 6m
• Knowledge scores improved at 3m
• 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)

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Conclusions

• 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.

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Conclusions

• The peer-led DPP was effective in improving
  knowledge and changeing behaviour
• The program could be replicated in other CALD

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Diabetes Research Initiatives in Sharjah, UAE

• Nabil Sulaiman
• nsulaiman_at_sharjah.ac.ae
• n.sulaiman_at_unimelb.edu.au
• Diabetes Supercourse, Alexandria 12 Jan 2009

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Sharjah Diabetes Study

• Background
• Why the study
• Methods
• Preliminary results
• Conclusions
• Recommendations

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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.

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Summary

• Diabetes 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

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• Sharjah Diabetes Study
• N. Sulaiman, Dh. Al Badri, N. Sajwani, S. Saleh,
  D. Young

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Sharjah Diabetes Study
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)

• 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

METHODOLOGY

• PRELIMINARY RESULTS
• Participants 347 diabetic patients were
  interviewed and their medical records were
  cheeked
• Gender 65.4 (n 227) females and 34.6 (n120)
  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 (n57)
• Occupation 47.3 housewife, 28.2 clerks, 6.3
  students, 0.6retired.
• Family History 23.1 (N80) had a positive
  family history of diabetes.
• Smoking 3.2 (n11) current smokers, 3.2
  (n11), ex-smokers, never smoked 93.1 (n323).

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

• Data Collection
• Research Assistant attended diabetes mini clinics
  at Riffa and Asit centres and diabetes clinic at
  Al-Qassimi and Kuwaiti Hospitals
• Patients were invited to participate
• Patients were interviewed using structured
  questionnaires
• Their data were extracted from medical records
• Data cleaning and analysis was performed using
  SPSS

• Aim
• To improve diabetes management, control and
  quality of life of patients with diabetes in UAE
• Objectives
• Establish an electronic database for diabetic
  patients in Sharjah
• Audit their medical records to identify gaps in
  management.
• Pilot test known EB intervention to investigate
  their appropriateness to Sharjah
• Determine barriers and facilitators to the
  implementation of the intervention

• 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

• CONCLUSIONS
• Diabetes Mellitus is common problem in primary
  medical centers in Sharjah.
• There is gap in self-management education
  including self monitoring, manifested by high
  levels of obesity and lack of physical activity.
• Diabetes control in Sharjah measured by HbA1c
  could be improved compared with international
  guidelines.
• 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.

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 nsulaiman_at_sharjah.ac
.ae or n.sulaiman_at_unimelb.edu.au
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Sharjah Diabetes Study

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

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Sharjah Diabetes Study

• Objectives
• Identify gaps in diabetes management
• Determine barriers and facilitators to
  implementation of known interventions
• Pilot test known EB intervention in Sharjah

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Study Design

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

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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 questionnaires
• Their data were extracted from medical records
• Data cleaning and analysis was performed using
  SPSS

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Diabetes Control Indicators

• Medical Records
• Biochemical indicators such as HbA1c and
  cholesterol, lipids, blood glucose and urine test
• Weight and waist circumference
• Patients questionnaire
• Knowledge and attitudes
• healthy eating
• physical activity

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Preliminary Results

• Sample 347 patients
• Gender 65.4 females
• Mean age 53.2 (14.6)
• BMI 29.8 (5.9)

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Nationality

• UAE 83.9,
• Pakistan 3.5,
• Egypt 2.6,
• Others 10 (Palestine, Lebanon, Yemen, Iraq,
  Syria, Iran and Sudan)

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Diabetes in Families
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Marital Status

• Marital Status
• 87.9 married
• 8.9 single
• 2.8 divorced/widowed
• Consanguineous Marriage 16.4 (n57)

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Gender difference
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• HbA1c
• 78 of patients has HbA1c (gt7)
• BP
• 57 have high BP

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Management Methods
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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)

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Self monitoring
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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)

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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)

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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.

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Recommendations

• Diabetes management in Sharjah could be improved
  compared with international guidelines
• Measures to improve control
• Diabetes Nurse Educators
• Patients self management education
• Peer-led or peer-support models
• CME for doctors at PHC centers

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• Thank You