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Currently, more than 7 million people in Pakistan have diabetes. By the year 2025 the number is expected to have escalated to over 16 million.
The mainstay of diabetes management and prevention is diabetes education. Alas, the concept of diabetes education is almost non-existent in Pakistan.
In addition, 6-7% of the people with diabetes in the country suffer from diabetic foot problems. Since there is no integrated diabetic foot care strategy in Pakistan, most do not receive organised foot care, and consequently many will end up having limbs amputated.
Objective
The project's objective is to create diabetes awareness, initiate diabetes prevention and improve diabetes care including foot care in low resource and underserved communities in Pakistan.
Approach
The project partner, Baqai Institute of Diabetology and Endocrinology, is a constituent unit of the Baqai Medical University and is one of the leading forces in Pakistan in establishing diabetes clinics. Currently, 8 peripheral diabetes clinics are working in affiliation with the institute, a number, which is expected to increase gradually throughout this project.
The project consists of two components. The first is directed at lay people and people with diabetes through awareness raising, provision of diabetes self-care education and education on preventive foot care for people with diabetes. The other component aims at improving health care delivery through setting up diabetes clinics and training of health care professionals.
A total of 60-75 diabetes educators will be trained to educate people with diabetes and their families on diabetes and its complications including the diabetic foot. The diabetes educators are also to educate the general public on diabetes through awareness programmes.
The training of the diabetes educators will comprise of an initial 3 months of intensive teaching at the institute, followed by 9 months of practical training and internship at a peripheral diabetes clinic. One training course will be held every year, each training 20-25 diabetes educators.
Awareness of diabetes will also be created through large scale awareness programme for the general public. 3-4 programmes will be conducted each year and it is expected that more than 500 people will attend each programme. The programme will be a full day activity to which people with diabetes, their families and the general public are invited. During the programme, information on diabetes including diabetes prevention, how to live a healthy life with diabetes, chronic complications of diabetes and their prevention, healthy diet, physical activity and self monitoring of blood glucose will be provided.
In addition, an awareness programme aiming specifically at children will also be carried out in schools in cooperation with school authorities. The intention is to educate the children on healthy diet and the importance of exercise to ultimately prevent the children from becoming obese. In total 5,000 school children will participate in this awareness programme.
In order to improve health care delivery, more than 75 doctors will participate in a 1-year specialised training course in diabetes and its management. After the course each of the trained doctors is expected to start a peripheral diabetes clinic.
Moreover, a 1-day training programme on practical aspects of treatment will be conducted for 1,600 family physicians.
3-4 diabetes camps will be conducted nationwide each year. The purpose is to detect new cases of diabetes as well as known cases that are not managed properly. These cases will subsequently receive treatment from the doctors trained in this project. It is expected that 3,000 people will be screened for diabetes in these camps.
To improve the existing status of diabetes foot care in Pakistan, 120 foot care teams will be trained according to the "Step by Step" programme developed under the WDF funded project "Diabetes foot care - step by step" (WDF03-056). Each team consists of one doctor and one nurse, which initially will participate in basic course lasting 3 days.
The focus of the training is on teaching simple ways of preventing and treating diabetic foot problems and also to enable the teams to train other health care professionals in issues relating to the prevention of the diabetic foot.
After 1 year, the foot care teams will participate in an advanced course of similar length. During this course, the teams will be provided advanced training on management of complicated foot care problems.
Finally, approximately 50 podiatrists will be trained and 112 diabetic foot clinics established to further enhance the improvement of available preventive foot care to people with diabetes. The clinics will be established in major cities as well as more remote areas in Pakistan.
Expected impact
- 75 diabetes educators trained
- 40,000 people with diabetes and their families educated in self management of diabetes
- 5,000 school children educated in healthy lifestyles
- 75 doctors trained in specialised care. Each is expected to establish a diabetes clinic subsequently
- 1,600 family physicians trained in primary diabetes care
- 3,000 people screened for diabetes
- 120 foot care teams and 50 podiatrists trained
- 112 diabetic foot clinics established
- 60,000 patients with diabetic foot treated at the clinics, resulting in an expected 50% reduction in amputations
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