The Challenges of Iran's Type 2 Diabetes Prevention and Control Program

Although diabetes control and prevention program has been initiated in Tehran, Iran and five other large cities in the country since 2010, patients' satisfaction with the services provided by this program has not been evaluated yet. The aim of this study was to determine the patient satisfaction with this program in Tehran. This cross-sectional study, were conducted in 15 primary health care centers in Tehran, Iran in 2013. We enrolled 386 people aged older than 30 yr referred to primary health care centers. A questionnaire was used to evaluate the degree of patients' satisfaction with the services (the questionnaire included six domains: access to services, continuity of care, the humanness of staff, provision of health education materials, effectiveness of services, comprehensiveness of care). The chi-square test, independent t test and one-way ANOVA were used for data analysis. Overall, 239 patients (62%) were female. The mean age (SD) of the patients was 51±11 yr. Overall, 263 patients (68%) were highly satisfied with providing services. The highest levels of patients' satisfaction were in the domains of continuity of care, the humanness of staff, and effectiveness of services. The lowest level of satisfaction was in the domain of provision of health education materials. Diabetes control and prevention program seems to be a suitable program in health care centers in Tehran, however, it is necessary to make further plans to improve the level of training materials provided to patients and comprehensiveness of care.

A critical review of national diabetes prevention and control programs in 12 countries in Middle East

The purpose of this study is to: (1) assess implementation of evidence-based programs and policies (EBPPs) related to diabetes prevention and control in local health departments, (2) assess feasibility of non-implemented diabetes prevention and control EBPPs, and (3) examine individual- and organizational-level factors associated with implementation of diabetes prevention and control EBPPs. An online survey was administered in January 2015 to key representatives of all local health departments in Missouri. Descriptive statistics were used to describe implementation and perceived feasibility of 20 diabetes prevention and control EBPPs. Logistic regression was used to examine the association between individual and organizational factors and diabetes prevention and control EBPP implementation. One hundred local health departments participated (89% response rate) in the online survey. Most frequently implemented diabetes-related EBPPs in local health departments included: nutrition education for agency or community members, increased fruit and vegetable access in community settings, and community-wide campaigns to promote physical activity. Increased encouragement to others in the department to use evidence-based decision making and agency incentives to help employees use evidence-based decision making were positively associated with implementation of diabetes prevention and control EBPPs. Local health departments are on the "front line" of public health, and this study demonstrates the important role these organizations play in implementing diabetes prevention and control EBPPs. Potential leverage points for more widespread adoption of diabetes-related EBPPs in local health departments include education about and encouragement of evidence-based decision making and organizational incentives for employees to integrate evidence-based decision making into their diabetes prevention and control activities.

In 1992, the Division of Diabetes Translation developed the Diabetes Today program to train representatives of state and local health departments on how to develop, implement, and evaluate community-based diabetes prevention and control programs. This commentary briefly describes the evolution of the Diabetes Today program in the United States. The Diabetes Today program utilizes a training curriculum to increase expertise in community assessment; coalition building; adult-learn principle, program planning, implementation, and evaluation. The training curriculum contains four modules: defining diabetes and mobilizing a community response; assessing diabetes in your community; planning your diabetes program, and evaluating your diabetes program. Two versions of the curriculum have been utilized--one in English and the other in Spanish. This commentary presents two examples of Diabetes Today efforts--The Missouri Diabetes Control and Prevention (English) and the United States/Mexico Border Diabetes Project (Spanish version)--to briefly describe how this program planning, implementation, and evaluation model can generate a community response to diabetes.

Background: In India National programme for prevention and control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) programme was launched in 2011 to reduce the burden of Non-Communicable diseases (NCDs). Udupi district was one of the first few districts of Karnataka where NPCDCS programme was started in the year 2010.Methods: A qualitative cross-sectional study was conducted among the stakeholders involved in the NPCDCS programme of Udupi District, Karnataka from January 2017- June 2017. Purposive sampling method was used for the sample selection. A total of 36 in-depth interviews were carried out among the stakeholders of NPCDCS programme.Results: The programme has achieved initial success and its successful implementation has to be observed in the coming years. Health staff posts which are critical in implementation of NPCDCS are vacant in many of the healthcare centres. Awareness about this programme was relatively low in the community.Conclusions: It is necessary to conduct regular awareness and screening campaigns with proper follow-up services to make the community sensitized about the programme. Regular supply of medicines should be ensured for the effective implementation of the programme in the future so that it can achieve its goal in reducing the burden NCDs.

Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.

Direction of the Ohio Diabetes Prevention and Control Program

Background Diabetes is a leading global public health challenge with 537 million cases worldwide in 2021 and significant economic and societal burdens. Despite global initiatives, feasibility constraints limit widespread implementation of diabetes prevention/control measures. The key to facilitating the implementation of diabetes prevention and control measures lies in prioritise them. Objectives This study aimed to determine the priority of diabetes prevention and control measures in China from the feasibility perspective. Methods From January to February 2021, an online survey was administered to professionals specifically responsible for implementing chronic disease prevention and control programs in 488 national demonstration areas in China. The survey assessed the importance and feasibility of 44 diabetes prevention and control measures across 10 dimensions. The Importance-Performance Analysis (IPA) model categorized these indicators into four quadrants: Highest Priority (high importance and feasibility), Priority Improvement (high importance, low feasibility), Lowest Priority (low importance and feasibility), and Secondary Improvement (low importance, high feasibility). Results Quadrant 1 (‘Highest Priority’) included health education, community action, high-risk discovery and intervention, and medical insurance and family doctors, which should be maintained and strengthened. Quadrant 2 (‘Priority Improvement’) included patient management and complication screening, necessitating targeted efforts to enhance implementation. Quadrant 3 (‘Lowest Priority’) included personal health services assessment follow-up, environmental support, sugar reduction policy, and diabetes co-infection prevention, indicating a risk of overinvestment. No indicators were categorized into Quadrant 4 (‘Secondary Priority’). Conclusions Prioritizing diabetes prevention and control measures based on feasibility maximizes the utilization of limited resources, providing implementable recommendations for policymakers.

The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'.

BackgroundMany Diabetes Prevention Program (DPP) translation efforts have been less effective for underresourced populations. In the cluster-randomized Prediabetes Informed Decision and Education (PRIDE) trial, which evaluated a shared decision-making (SDM) intervention for diabetes prevention, Hispanic and non-Hispanic Black participants lost less weight than non-Hispanic White participants at 12-month follow-up.ObjectiveTo explore perspectives about weight loss from PRIDE participants of different racial and ethnic groups.ParticipantsSample of participants with prediabetes who were randomized to the PRIDE intervention arm (n=24).ApproachWe conducted semi-structured interviews within three groups stratified by DPP participation and % weight loss at 12 months: (DPP+/WL+, enrolled in DPP and lost >5% weight; DPP+/WL−, enrolled in DPP and lost <3% weight; DPP−/WL−, did not enroll in DPP and lost <3% weight). Each group was further subdivided on race and ethnicity (non-Hispanic Black (NHB), non-Hispanic White (NHW), Hispanic). Interviews were conducted on Zoom and transcripts were coded and analyzed with Dedoose.Key ResultsCompared to NHW participants, Hispanic and NHB participants more often endorsed weight loss barriers of limited time to make lifestyle changes due to long work and commute hours, inconvenient DPP class locations and offerings, and limited disposable income for extra weight loss activities. Conversely, facilitators of weight loss regardless of race and ethnicity included retirement or having flexible work schedules; being able to identify convenient DPP classes; having a strong, positive support system; and purchasing supplementary resources to support lifestyle change (e.g., gym memberships, one-on-one activity classes).ConclusionsWe found that NHB and Hispanic SDM participants report certain barriers to weight loss more commonly than NHW participants, particularly barriers related to limited disposable income and/or time constraints. Our findings suggest that increased lifestyle change support and flexible program delivery options may be needed to ensure equity in DPP reach, participant engagement, and outcomes.

GooD4Mum: A general practice-based quality improvement collaborative for diabetes prevention in women with previous gestational diabetes

BackgroundEach year around 5–10% of people with non-diabetic hyperglycaemia will develop type 2 diabetes mellitus. Diabetes prevention is a national and global public health concern. Diabetes Prevention Programmes, which seek to identify at-risk individuals and support entry to health improvement initiatives, recognise that enhanced identification and referral of at-risk individuals is required within primary care and beyond, through community-focused prevention approaches. We report an evaluation of a demonstrator site for the NHS Diabetes Prevention Programme in the UK, which piloted an enhanced Primary Care referral programme (sampling from patients identified as at-risk from general practice databases) and a Community identification programme (sampling from the general population through opportunistic identification in community locations) in an effort to maximise participation in prevention services.MethodsWe used mixed-methods evaluation to assess the impact of the two referral routes on participation in the Diabetes Prevention Programmes in line with the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). Individual level patient data was descriptively analysed to assess identifications and eligible referrals made in each route. Semi-structured interviews conducted with referral staff and key stakeholders were analysed using thematic analysis and informed by Normalisation Process Theory.ResultsThe nurse facilitated primary care referral route provided 88% of all referrals to the telephone DPP, compared to the community referral route which provided 5%, and the proportion joining the programme was higher among primary care referrals (45%) than community referrals (22%), and retention rates were higher (73% compared to 50%). The nurse-facilitated route integrated more easily into existing clinical processes. The community programme was impeded by a lack of collaborative inter-agency working which obscured the intended focus on high-risk populations despite conversion rates (numbers identified at risk who entered prevention programmes) being highest in areas of high deprivation.ConclusionsThe study demonstrates the interaction of components, with effective Adoption and Implementation necessary to support Reach. The NPT analysis demonstrated the importance of consensus around not only the need for such programmes but agreement on how they can be delivered. Future programmes should support inter-agency communication and collaboration, and focus identification efforts on areas of high-risk.

IntroductionIschaemic heart disease (IHD) is one of the leading causes of death and disease burden in India affecting all age groups. To reduce the deaths and tackle the burden of...

Objective: Implement in an electronic health record (EHR) a predictive model for people with prediabetes that provides individualized benefit estimates for taking metformin or participating in the Diabetes Prevention Program (DPP). This model stratifies people with prediabetes by the potential to reduce their risk of progression to diabetes based on regression models developed directly on the DPP trial and recalibrated to Optum data. With 1/3 of adults having prediabetes, health systems need a way to prioritize. Study Design: Pre/post implementation study including provider and patient surveys and data on use of the predictive model. The model estimates risk of progression to diabetes with usual care, the DPP, or metformin, based on 11 demographic, biometric and diagnosis variables available in the EHR. Population Studied: Patients with prediabetes at 10 pilot primary care clinics, where providers access the model via an EHR click and the data elements are automatically populated from the EHR. Principal Findings: The predictive model was used on 68% (n=2,304) of patients with prediabetes between 5/1/18 and 1/31/19. A total of 43% of patients were classified as high-risk, 54% as moderate-risk, and 4% as low-risk. Treatment - either referrals to the DPP or prescriptions for metformin - was provided for 63% of high-risk, 15% of moderate-risk, and 4% of low-risk patients. DPP referrals and metformin prescriptions for these high-risk patients increased substantially after implementation of the calculator (DPP: 0% to 44%; Metformin: 2% to 19%). Conclusions: A predictive model, embedded in the EHR, that predicts individual patient risk for developing diabetes at the point of care improved treatment for patients with prediabetes. Use of individualized risk estimates resulted in the prioritization of treatment for patients at greatest risk of developing type 2 diabetes. Disclosure E.L. Ciemins: None. J.E. Powelson: None. J.P. Nelson: None. F.R. Colangelo: None. J.K. Cuddeback: None. D.M. Kent: None. Funding Patient-Centered Outcomes Research Institute

BackgroundDigital diabetes prevention programs (digital-DPPs) are being implemented as population-based approaches to type 2 diabetes mellitus prevention in several countries to address problems with the uptake of traditional face-to-face diabetes prevention programs. However, assessments of digital-DPPs have largely focused on clinical outcomes and usability among those who have taken them up, whereas crucial information on decision-making about uptake (eg, whether a user downloads and registers on an app) and engagement (eg, the extent of use of an app or its components over time) is limited. Greater understanding of factors that influence uptake and engagement decisions may support large-scale deployments of digital-DPPs in real-world settings.ObjectiveThis study aimed to explore the key influences on uptake and engagement decisions of individuals who were offered the National Health Service Healthier You: Digital Diabetes Prevention Programme (NHS-digital-DPP).MethodsA qualitative interview study was conducted using semistructured interviews. Participants were adults, aged ≥18 years, diagnosed with nondiabetic hyperglycemia, and those who had been offered the NHS-digital-DPP. Recruitment was conducted via 4 providers of the NHS-digital-DPP and 3 primary care practices in England. Interviews were conducted remotely and were guided by a theoretically informed topic guide. Analysis of interviews was conducted using an inductive thematic analysis approach.ResultsInterviews were conducted with 32 participants who had either accepted or declined the NHS-digital-DPP. In total, 7 overarching themes were identified as important factors in both decisions to take up and to engage with the NHS-digital-DPP. These were knowledge and understanding, referral process, self-efficacy, self-identity, motivation and support, advantages of digital service, and reflexive monitoring. Perceptions of accessibility and convenience of the NHS-digital-DPP were particularly important for uptake, and barriers in terms of the referral process and health care professionals’ engagement were reported. Specific digital features including health coaches and monitoring tools were important for engagement.ConclusionsThis study adds to the literature on factors that influence the uptake of and engagement with digital-DPPs and suggests that digital-DPPs can overcome many barriers to the uptake of face-to-face diabetes prevention programs in supporting lifestyle changes aimed at diabetes prevention.