Managing diabetes for older people, Lebanon

Objectives

Risk factors for diabetes are highly prevalent among the Lebanese population. Almost two thirds (65.4%) of the population are overweight or obese, and almost half (45.5%) do not perform any vigorous physical activity (STEPS, 2009). The prevalence of metabolic syndrome is estimated at 25.4% (Sibai et al, 2008).

As for the Syrian population in Lebanon, despite limited availability of data about diabetes in Syria, the prevalence rate remains significant, at 8.1% (IDF, 2015), while a study conducted in Aleppo in 2006 showed a prevalence rate of 15.6%, rising to 33.5% among those over 45 (Albache et al, 2009).


Objectives
1. Enhance access to diabetes screening, treatment, referral and prevention care for older men & women
2. Increase the awareness of older men and women about diabetes risk factors and complications
3. Decrease diabetes distress and psychosocial distress among older men and women living with or at risk of developing diabetes

Approach

HAI together with local NGOs and MoH will expand and enhance capacity of 10 health facilities across areas in Lebanon with concentrations of Syrian refugees. Activities include:
Improvement of care delivery of 10 health facilities (9 PHCs and 1 mobile unit) through provision of equipment, training of HCPs, and improvement of screening services.
Rollout of screening services for at-risk populations reached through the established clinics as well as through outreach campaigns.
Establishment of a special care programme for diagnosed patients (incl. HbA1C testing) with intensified care, incl. referral of patients to medical consultations and specialised care if required.
Rollout of awareness raising through group education sessions at targeted health facilities; community based awareness campaigns, development of educational material; and WDD campaigns
Rollout of mental health component including training of psychologists and HCPs on management of diabetes-related distress; psychosocial support (PSS) activities for patients, incl. group-based as well as individual psychologist consultations for vulnerable individuals.
Implementation of an electronic patient registry at 6 out of 10 facilities directly linked to MoH database, incl. comprehensive clinical reviews of registered patients (HbA1C, complications, behavioural assessments); also measuring impact of the PSS activities via geriatric depression scale and mini-mental state exam.

Results at completion

20 HCPs receive training on how to manage diabetes related distress in older people, including psychosocial support (PSS)
7,816 at risk people screened for diabetes
1,792 patients treated at newly established clinics
2,745 patients diagnosed, registered and monitored in relation to clinical outcomes (incl. HbA1c); shared with MoH for advocacy purposes and referred for follow-up care and treatment
Impact indicators: 71% of patients (sample) showed improvement in HBA1C levels; and 22% of patients (sample) experienced a reduction in BMI