17. May 2018

Secrets of an award-winning diabetes programme

Gwendolyn Carleton
In Uzbekistan, a multi-year effort has improved diabetes prevention and care and reduced late-stage complications nationwide. WDF travelled to the heart of the Silk Road to learn more.
Dr Nilufar Ibragimova (right) consults with a project partner at the Regional Endocrinological Dispensary in Samarkand. Photo by Jesper Westley.
On a busy Monday morning, patients fill the tidy white-tiled halls of the Andijan Regional Endocrinological Dispensary, waiting for services. Clinicians in the diabetes eye and foot clinics are seeing patients, while down the hall, ’diabetes school’ is in session. In the gynaecological clinic, new standards for diagnosing gestational diabetes are taped to the desk, and anew GDM patient screening card recording the blood sugar levels of expectant mothers is quickly filling up.
There’s more that isn’t visible. Many of the diabetes patients here were diagnosed via a risk-based screening programme, and are being treated by multidisciplinary diabetes teams (an endocrinologist, GP, surgeon, cardiologist, ophthalmologist and nurse) who have received diabetes training and refresher courses over the past many years. Not surprisingly, diabetic retinopathy, amputations and other diabetes complications have decreased significantly since 2004, when the effort to improve diabetes care here began. 
Similar scenes are taking place across Uzbekistan, and late-stage diabetes complications are on the decline nationwide. It’s the outcome of a coordinated, long-term effort by Uzbekistan’s Charity Public Association of Persons with Disabilities and Diabetes Mellitus (UMID). Dr Nilufar Ibragimova worked on WDF’s first project in the country, introducing diabetes schools to regional dispensaries in 2004 – subsequently, as UMID’s president, she partnered with WDF on eye care, foot care, screening and hyperglycaemia in pregnancy projects.
In December of 2017, Dr Ibragimova received WDF’s first partner award for her and UMID’s efforts. WDF spoke with her about the organisation’s efforts, and what others can learn from them.
What is UMID, and why did it begin these projects?
UMID is a non-profit organisation working to stimulate and support effective measures for the surveillance, prevention and control of diabetes and its complications. UMID has been a full member of IDF since 2013, actively participating in international and regional congresses.
UMID has partnered with WDF on three projects - and is in the process of implementing our 4th to improve the prevention, early diagnosis and multidisciplinary approach to managing diabetes and its complications in Uzbekistan.  Our collaboration with WDF allows us to assist the Ministry of Health and REDs on-site in particularly in the adopting effective measures for the surveillance, prevention and control of diabetes and its complications, especially in primary care. 
What have you learned through these projects?
That prevention is the key to reducing the growth of diabetes – and effective prevention requires a team approach, not only involving the health care system, but also public organisations, the media, health centers, etc. Only by unifying our forces can we reduce the growth of diabetes in Uzbekistan.
We’ve also learned that a multidisciplinary approach is key to successful project implementation. A multidisciplinary team (cardiologist, endocrinologist, ophthalmologist, surgeon, podiatrist) is needed, and the experience of each team member should complement the others. 
Involving regional doctors in the work ensures the further sustainability of the projects. UMID has prepared a well-coordinated team of leading multidisciplinary specialists who clearly understand the objectives of the project and work towards successful implementation. I am very proud of and cherish my team.
Other key learnings include the importance of involving volunteers to raise public awareness about diabetes and its prevention, and the effectiveness of a questionnaire we developed, ‘Check yourself for diabetes’ at detecting people at risk of diabetes. 
You have worked closely with Uzbekistan’s Ministry of Health from the beginning. Why is this important?
UMID closely cooperates with the Ministry of Health of Uzbekistan in order to effectively implement our projects and ensure their further sustainability. The Ministry of Health supports us not only in the implementation of projects, but also in carrying out annual events like seminars for doctors and free consultative and diagnostic assistance to vulnerable people with diabetes on International Health Day and the World Diabetes Day.
What are you most pleased about in these projects?
There are many things! Our projects have established new infrastructure such as specialised diabetic eye and foot rooms in each region, equipped with the necessary tools. They have trained thousands of health care professionals in diabetes and its complications. They’ve created patient education in multiple formats and languages, trained volunteers to raise diabetes awareness, and launched a simple and effective screening method. They have collected relevant data about the prevalence of diabetes and its complications in Uzbekistan…
If I had to choose one thing, it might be the close relationship between endocrinologists, GPs, vascular surgeons, ophthalmologists, cardiologists and podiatrists, who, as a multidisciplinary team, are now working in tandem at the primary health care level. Primary health care providers now know how important it is for patients to control their diabetes to avoid developing severe complications. This truly pleases me. 
What are the main challenges you have faced?
There have been IT issues: most primary care physicians over 60 years old have had difficulties learning to work on the computer (we have drawn the MoH’s attention to this.) Also, poor internet connections in the districts have created difficulties in transferring information to the regional level.
Generally low awareness of diabetes is also an issue. The results of our screening project demonstrate again the need to improve awareness about diabetes among rural people. More materials should be published on prevention of diabetes and its complications, both for patients and for regional doctors. ass-media channels for awareness and advocacy campaigns  should be involved widely as well.  
What is your advice to others working to improve diabetes care in their countries?
First, associations should focus on the diabetes situation in their countries. Then, they should work actively to improve diabetes prevention and early detection through seminars, training, diabetes screening, development of materials, etc. – all tailored to the local situation. Financial support may be found through joint projects with international organisations (WDF, IDF, UNICEF, WHO, etc.) and companies.
Diabetes is a major public health problem that is approaching epidemic proportions globally. That’s why resolving it requires a common fight, unifying all our forces and possibilities. Our organization is ready to share its experience with diabetic associations of other countries (cooperation with Georgian and Kyrgyz associations is already under way). 
We all have the same goal to stop the growth of diabetes, and to improve quality of life and life expectancy for people with diabetes. Together we can make a greater difference and achieve these goals.