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The combined prevalence of impaired glucose tolerance (IGT) and diabetes in Iran is almost 20%. As everywhere else, the number is expected to rise within the next decades. Being a country undergoing an epidemiologic transition, Iran faces a double burden of disease when having to deal with communicable diseases as well as the rapidly emerging non-communicable diseases such as diabetes.
This puts a strain on a health care system, already not reaching people living in the lesser-developed and more remote provinces of the country. Diabetes care is not available to the majority of the population.
Moreover, the few existing diabetes clinics, which are mainly placed in the big cities, are not collaborating and there is no overall strategy in order to utilise the facilities for better management of diabetes in Iran.
Approach
This project will be implemented by Isfahan Endocrine & Metabolism Research Centre in close collaboration with the Iranian Ministry of Health.
The core element of the project is the establishment of diabetes clinics throughout the country. These clinics will function as centres for awareness raising, treatment of diabetes and prevention of complications resulting from diabetes.
Initially, 150 staff members of the diabetes clinics will be trained, incl. 30 physicians, 30 nurses, 30 nutritionists, 30 laboratory technicians and 30 receptionists. Each group will be trained according to their future tasks in the clinics.
The physicians will participate in a 3-week course including theoretical, interactive workshops about diabetes, its complications and related issues, practical supervised visits to patients with diabetes in day clinics as well as lectures on management skills. After completing the course the participants should be able to diagnose and manage diabetes, refer complicated cases to the next level of the health care system and supervise other staff groups.
The training programme for the nurses has a 2-week duration and will focus on fundamental medical information about diabetes and its complications, information about the importance of educating patients on self-management, practical supervised patient education sessions and skills used to educate patients with diabetes.
Nutritionists will attend a 1-week course focusing on the latest nutritional recommendations for patients with diabetes and providing skills for educating and guiding patients with diabetes on nutritional topics.
The laboratory technicians and the receptionists will each participate in a 3-day course. The laboratory technicians will improve their skills in laboratory methods related to diabetes whereas the receptionists will learn basic principles of diabetes and be introduced to computer software used in the management of diabetes.
Upon completion of all the training, a total of 30 diabetes clinics are established - one in each of the 30 provinces in Iran. The clinics will be provided with standard equipments for diabetes management. The clinics will register new patients as well as known patients with diabetes in a computer system in order to be able to carry out evaluations and keep track of follow-ups.
Apart from delivering regular diabetes care, the clinics will conduct educational training sessions for the patients on a regular basis. At these sessions, the nurses and nutritionists will perform face-to-face education and disseminate educational materials.
It is expected that in total 24,000 new patients and 90,000 already known patients will receive treatment and education during the 3 year project period.
In addition to the established clinics, community outreach programmes will be conducted on a monthly basis. These outreach programmes will target high-risk individuals such as first-degree relatives of registered diabetes patients and others with one or more risk factors for diabetes.
The content of the outreach programmes will be general information on diabetes including signs and symptoms, methods for prevention and information on high-risk groups, importance of diabetes management and possible complications of diabetes.
It is anticipated that the outreach programmes will have reached between 288,000 and 360,000 people by the end of the project.
WDF also supports a foot care project in Iran, WDF07-283. | 
