8 million people in Mexico have diabetes, which corresponds to a prevalence of 14%. The incidence of diabetes has increased dramatically the past few decades and it is now the leading cause of death in the country. With almost two thirds of the adult population being overweight or obese, the incidence will continue to increase in the coming years contributing to further strain on an already overstretched health care system resulting in huge individual and societal costs.One of the main problems is that people remain undiagnosed until they develop severe complications. It has been estimated that undiagnosed cases represent 20% of the population with the largest proportion found amongst people below the age of 40.Access to good quality diabetes care in general is rather limited. The health care system is not geared towards the multidisciplinary approach needed for patients with chronic conditions. This leads to fragmented care, inconsistent with treatment guidelines as in many other developing countries in the world.The aim of the project is to deliver comprehensive primary level diabetes care and to promote prevention of diabetes and complications in a rural town community in Mexico.
The project seeks to establish and deliver comprehensive primary diabetes care and implement prevention and awareness programmes for the entire town of Real del Monte in Hidalgo State. The state is among the poorest in the country and health care coverage is extremely low in this area.The project is based upon a signed, ten-year agreement between REMEDI and Real del Monte Municipality, which defines responsibilities of the municipality and local town leaders. The project wishes to consolidate a model for effective chronic diabetes care that REMEDI started devising in the 1990s and that has been proven efficient in Mexico.The project consists of two major components: 1) primary prevention with specific interventions targeting specific population groups, and 2) outpatient diabetes care. The scope of the WDF support is three years and covers the establishment of a new diabetes clinic, including training of health care professionals and purchase of equipment.The project wishes to improve primary diabetes care by delivering patient-centred, multidisciplinary care ensuring coordinated efforts and follow up. In absence of acute complications, follow up visits will be scheduled with all patients enrolled in the project every three months. Comprehensive testing and foot examinations will be provided at each patient visit, while diabetic retinopathy screening will be offered annually. All patients will go through nutrition and diabetes self-management education and counselling, both in groups and individually.An educational programme with the aim of reducing the rates of GDM among pregnant women will also be implemented. Women with GDM enrolled in the project will be monitored closely with weekly consultations and follow up at the newly established clinic. They will furthermore be assigned to an intensive lifestyle moderation programme with individual and group educational sessions.The Emory Latino Diabetes Education Programme (ELDEP) created in 2006 with the aim of providing culturally appropriate diabetes education to patients and health care providers will be used in all education activities of the project. Doctors, nurses and nutritionists will be using the latest Spanish version of the Staged Diabetes Management guidelines.To ensure continuity of care, a diabetes registry will be established for the whole town. This will also provide the basis for the surveys on cardiovascular risk factors among diabetes patients that will be conducted in relation to the project.An awareness campaign targeting the whole community will be launched. The campaign will be based upon principles of social marketing, and frequent contact between the project, selected social leaders and the community will be ensured to address the needs of the population.It is envisioned that 10,000 people will be screened for diabetes during the project. A survey among 20,000 inhabitants of Real del Monte will be conducted to investigate the prevalence of cardiovascular risk factors among patients with type 2 diabetes.The specific aims of the project include a 10% reduction in BMI among persons who are obese or overweight, reduced blood pressure and blood glucose levels, early detection of complications etc.
• A diabetes clinic was established in Real del Monte, first as a separate unit, but ending up as an integrated care services of local public health care.• A multidisciplinary team established to operate the clinic• 92 doctors trained in diabetes care (Staged Diabetes Management)• 244 nurses and 18 dieticians trained in diabetes care• 1,682 pregnancy visits conducted• 6,309 patients have received care and follow-up medical visits , incl nutritional counselling and foot examinations • 1,200 patients have received diabetic retinopathy examinations (fundus camera)• At least 11,000 people reached through awareness campaign, with printed materials produced and distributed to patients and community members• A diabetes and cardiovascular disease risk factor survey with close to 18,000 respondents was carried out