A Guide to National
Diabetes Programmes
What is a national diabetes
programme?
A National Diabetes Programme is a systematic and co-ordinated approach to
improving the organisation, accessibility, and quality of diabetes prevention
and care which is usually manifest as a comprehensive policy, advocacy and
action plan covering the:
•
Main types of diabetes ie type 1 diabetes, type 2 diabetes and
gestational diabetes
•
Whole continuum of care from primary prevention to treatment and
palliative care
•
Resources, services and systems that support prevention and care
National Diabetes Programme
The guide contains several sections:
• Getting started
• Determining the extent of the problem
• Preventing the problem
• Addressing the problem
• Evaluating progress
• Where to next?
Section 1: Getting started
• Making the Advocacy Case for Diabetes
• Developing a Framework for a National Diabetes Programme
• Establishing a National Diabetes Organisation
Getting started
Make the Advocacy case for diabetes
Play the hearts and minds game and play hard:
- use evidence
- use emotion
But keep it simple
and make it
Getting started
Developing a Framework for a National Diabetes Programme
What will be its focus and scope?
Who will the National Diabetes Program target?
•
•
•
People at risk of diabetes
Particular types of diabetes, eg. type 1 diabetes, type
2 diabetes, gestational diabetes
The three main types of diabetes
Getting started
Developing a Framework for a National Diabetes Programme
Mission
State in a few words what is the fundamental issue being addressed, for
example, “fight diabetes and win”, “reduce diabetes risk factors”.
Getting started
Developing a Framework for a National Diabetes Programme
Vision
What would the diabetes situation in your country look like if your
National Diabetes Programme achieved its mission.
Getting started
Establishing a National Diabetes Organisation
Having a national diabetes organisation enables a country to become a member of the
IDF. Membership of the IDF provides the country member association with:
- a voice in diabetes affairs at both regional and global levels
- access to the IDF network of members associations, resources, and
information
Section 2: Determining the
extent of the problem
• Conducting a Situation and Needs Analysis
• Conducting a Baseline Prevalence Survey
• Assessing the Cost of Diabetes
• Assessing Community Awareness
Determining the extent of the
problem
Conducting a situation and needs analysis
Be clear why you are conducting a situation and needs analysis
What aspects of diabetes will the situation and needs analysis focus on: eg. services, costs, availability of
medications.
Will the situation and needs analysis be conducted nationally or will it be applied selectively to particular
geographic areas
What are the specific aims of the situation and needs analysis?
What will be measured, assessed, counted, audited or analysed in order to achieve the aims of the situation
and needs analysis?
What strategies and techniques will be employed to collect the required information?
Deciding how and to whom the results will be disseminated and how they can best be used will help
determine what to focus on, what to assess and which methods are best suited to answer the questions
being asked.
Determining the extent of the
problem
Conducting a Baseline Prevalence Survey
In conducting a baseline survey, it may be useful to consider the following:
•
•
•
•
•
Rationale for conducting the survey
Scope (what other parameters will the survey assess in addition to basic demographics and
diagnosis of diabetes)
Focus (who will be surveyed?)
Aim (agree on and clearly state and document the aim of the survey)
Sampling (an accurate representation of the overall composition of the population eg. age,
gender, socio-economic level)
•
•
Data collection and management (designing data collection forms, ordering of data fields)
•
•
•
•
Laboratory issues (eg. the supply, storage, and transport of reagents)
Assessment issues (explicit protocols to guide the manner in which assessment procedures
are carried out)
Location and set up of survey venue
Training of survey staff
Ethical and safety considerations
Determining the extent of the
problem
Assessing the cost of diabetes
•
Focus/viewpoint of the analysis
•
Timeframe and study size
•
Study designs
Determining the extent of the
problem
Assessing Community Awareness
Example of a tool for assessing community awareness of diabetes:
Section 3: Preventing the
Problem
• Individual/ High Risk approach
• Environmental approach
Preventing the problem
The individual/High risk approach
Focus on high risk individuals and encourage health professionals to:
- identify people with risk factors
-treat/manage to reduce risk factors
- +/- community education programs
Preventing the problem
The Environmental approach
•
Healthy urbanisation
•
Healthy food
•
Healthy business
•
Healthy public policy
Preventing the problem
Focus on the whole population - or high risk groups within the population to
develop health promoting, risk reducing environments:
Involve a range of sectors
eg agriculture, education, transport
Focus on a variety of settings eg schools, workplace
+/- community education programs
Section 4: Addressing the
problem
Develop a community awareness campaign
Early diagnosis of Type 2 Diabetes
Routine Care and Monitoring of Diabetes
Patient Education
Psychological Issues
Developing and Implementing Guidelines
Developing the Diabetes Workforce and Services
Addressing the problem
Develop a community awareness campaign
•Rationale
•Scope
•Aim
•Preparing the workforce
•The message
•Who the lead organisation/s
•Who else should be involved
•Key strategy
•Evaluation
Addressing the problem
Key Components of Good Diabetes Care
• Early diagnosis
• Routine monitoring & management
• Early detection & management of complications
• Self care education
Addressing the problem
Routine Care and Monitoring of Diabetes
• Glycaemic control
• Kidney function
• Blood pressure
• Lipids
• Eyes
• Feet
Addressing the Problem
Patient Education
All people with diabetes should have access to self-care education to
optimise the management and outcomes of their diabetes care.
Education should include information about:
-The causes, effects and management of diabetes
-Self-care recommendations specific to the person’s type of diabetes and treatment
-Strategies for avoiding short and long term diabetes complications
-Principles and recommendations for nutrition and exercise
-The administration of diabetes and related medications where applicable
-Where and when to seek professional help for assistance with diabetes care
Addressing the Problem
Psychological issues
Addressing the Problem
Developing and Implementing Guidelines
• The complexity of guidelines for diabetes
• Expertise required for developing evidence based guidelines
• Lead agency or group
• Endorsement of guidelines
• Options for generating guidelines
Addressing the Problem
Developing the Diabetes Workforce and Services
Horizontal Integration
Diabetes
Cardiovascular
Disease
Diabetes
Tablets
Services
Ambulatory Care
Hospitals
Community Health Services
Addressing the Problem
Developing the Diabetes Workforce and Services
Role Delineation - Vertical Integration
Highly specialised care
Tertiary
Semi specialised care
Secondary
Routine care
Primary
Section 5: Evaluating Progress
Collecting diabetes data
• What should be assessed?
Process indicators, eg. Number of weight loss or physical activity programs
Surrogate outcome indicators, eg. Frequency and duration of hospital admissions
Outcome (endpoint) indicators, eg. Incidence and prevalence of diabetes
Evaluating Progress
Collecting diabetes data
• How should the data be collected and used?
A common reason for collecting clinical diabetes data is to evaluate
the effectiveness of care.
This requires identifying and tracking people with diabetes to
determine what happens to them.
This, in turn, requires record linkage, financial resources and
available local expertise
Evaluating Progress
Evaluating National Diabetes Programmes
National diabetes Programmes (NDPs) are essentially a policy process.
The three stages of policy are development, implementation and
evaluation.
1.
2.
3.
4.
5.
6.
7.
8.
Does a National Diabetes Programme exist?
Is it a comprehensive or single component programme?
Who is responsible?
Who is involved?
Are goals and priorities being actioned?
What is known about diabetes nationally?
Is appropriate diabetes care available to people with diabetes?
General implementation and evaluation strategy?
Section 6: Where to next?
National Diabetes Programmes of the future
Some possible changes in the focus of national diabetes programmes of
the future might include consideration on:
•
Diabetes and the environment
•
Diabetes and the link with communicable disease
•
Diabetes as a development issue
•
New horizons – new partners
What do we need to do?
• Develop agreed consistent standards
• Delineate service roles
• Train staff to the roles and standards
• Earlier diagnosis
• Better quality of prevention and care
• Information - not just data
Standards for National Diabetes Programmes
The IDF Task Force on Diabetes and NCD Prevention, Policy and Practice has
developed an initial set of 10 core standards for National Diabetes Programmes:
1. A National Diabetes Programme exists and is publically available
2. The goals and objectives of the National Diabetes Programmes are clearly
documented
3. The National Diabetes Programme is endorsed and led by the Ministry of Health
4. The National Diabetes Programme has been allocated dedicated funding by the
Government
5. The National Diabetes Programme includes: type 1 diabetes; type 2 diabetes;
gestational diabetes
Standards for National Diabetes Programmes
The IDF Task Force on Diabetes and NCD Prevention, Policy and Practice has
developed an initial set of 10 core standards for National Diabetes Programmes:
6. The National Diabetes Programme covers specific areas, eg: ensuring equitable
access to prevention and care services for all who need them; workforce
development
7. There is a documented implementation plan for the National Diabetes Programme
8. An appropriately constituted steering committee or group is tasked with overseeing
the implementation of the National Diabetes Programme. This should include a
range of stakeholders, eg. Government authorities; community leaders;
9. The National Diabetes Programme takes a Patient Centred Approach
10. The National Diabetes Programme involves monitoring and surveillance of:
prevalence and incidence; access to and outcomes of routine clinical care and
services; availability of essential medications and supplies
Community-based Services
Primary Health Care
Guidelines, protocols referral criteria & pathways
Training, equipping, and auditing of quality of care
Referral Centres and Pathways
Centre of clinical excellence for training and referral
in Diabetes & Hypertension
Consumer Action
Consumer organisations, activities, advocacy
Refocussing Health Systems
• Determine what needs to be done - define the tasks
• Identify who can do the job or who can be
retrained/refocussed to do it - role delineation
• Shift resources to support the new focus
What do we need to do?
• Refocus health systems on the priorities
• Make diabetes everybody’s business
• Make providers and services more effective
• Emphasise the role of communities
• Focus on families
• Make healthy lifestyle choices available and “inviting”
THE PLANNING PROCESS
Planning is about
“making what’s there work better!”
WHO SHOULD PLANS ENGAGE?
Professional
Diabetes
Associations
Associations
Health
Departments
Other Govt
Sectors
Communities
Governments
Local Health
Services
The
Workplace
Funders
Industry
FIND A BALANCE
Between the requirements of stakeholders and needs of the
target groups
Primary prevention vs care of those already diagnosed
Type 1 and Type 2 diabetes
What do we need to do?
 Define the tasks
Train staff on the competencies required
Equip the health facilities
Provide guidelines
 Monitor the processes and outcomes
Examples
Goal 1: Prevent or delay the onset diabetes in susceptible
communities and individuals
Goal 2: Prevent or delay the development and progression
of long term diabetes complications
Goal 3: Increase the capacity of the health systems to
deliver and monitor (equitable, effective, affordable
services) for the care and prevention of diabetes
Framework
Prevention
Best practice
Information
Integration
Capacity
building
Early Diagnosis and Care
Systems
Goals to outcomes
• Clear and agreed Goals and Objectives
• Key strategies
• Indicators or expected outcomes
• Implementation plan
Critical factors for success
• Wide consultation and endorsement
• Commitment of Government
• Involvement of a range of stakeholders
• Strong, cohesive leadership
• Local champions