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The Way to a National Diabetes Program by Prof. Morsi Arab President, Egyptian Diabetes Association Chairman , IDF - MENA Region
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Page 1: ueda2011 national diabetes program-d.morsi

The Way to a National Diabetes Program

by

Prof. Morsi ArabPresident, Egyptian Diabetes Association

Chairman , IDF - MENA Region

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DM in the MENA RegionChanges in population and Prevalence

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DM IN THE MENA REGIONChanges in Total numbers of patients from

2010 to 2030 (millions)

IGT

51.7

26.6

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Diabetes in Egypt 2010Epidemiological Data :Total population : +/- 79.00 millionspopulation ( at age 20-79) : 45.9 millions-----------------------------------------------------------------------------number of p.w.d. (DM ) : 4.8 millions ( prevalence : 11.4%)number of p.w. (IGT ) : 2.2 millions ( prevalence: 5.1%)Total number 7.0 millions ( total prevalence : 16.5 %

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Objective 4 attained!

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I - Definition of National Diabetes Program II - The parties involved III – Potential Adverse and limitation Factors IV - Minimal Requirements - Deciding the priorities V - Duties and Obligations of different parties

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Patient

IDF

NGO

Family

Pharmaceutical industries

WHO

Society

PhysicianNurseDietitianFoot CarePharmacistLaboratory

Medical Group

Work- schoolFriends

MEDIA

Ministry of Health

Government

ParliamentSyndicate

National Institute

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Potential Adverse Factors 1- Economic :Poor Financial Res. /per capit./ Government expenditure/ House-hold expend. with High Prev. of diab.

2- Demographic Extensive areas with poor communications . High population density

3- Social : Illiteracy- Misconceptions – adverse habits and traditions .

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Minimal requirements : 1- Insulin and medications availability ( affordable) 2- Primary centers for diagnosis and care 3- wide distribution of services allover the country 4- Basic requirements to manage complications 5- Education : knowledge & skills to patients – Public orientation 6- National basic studies in epidemiology and socioeconomics . 7- Care for Diabetes in School children 8- Care for diabetes in pregnancy

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Obligations of Different Parties

The Government ( Ministry of Health)

1- Increase Investments in Health/Diabetes 2- provide Minimal Diabetes Care in Clinics & Hospitals 3- Insure Insulin & Medications Availability 4- provide Education :Patient, Health Care Team and Public

5- Coordinate with Health Care Syndicates 6- Coordinate with NGOs 7- attract International Aid programmes 8- promote National Research ( epidemiol.-socioeconomic)

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Parliament (Legislation)

1- Budget planning to improve diabetes Care 2- Taxation Exemption for insulin & medical requirements 3- Put rules and regulations for NGO activities 4- Maintain and guard Patients’ Human Rights ( anti discrimination, working , children, women , elderly …etc) 5- Health Insurance Laws

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The Non-Governmental Organizations (NGOs )

1- Advocacy 2- Education Programs for : -Patients and Families -Health Care Team -Community at large

3 - Rules & Regulations - legally recognized - non profitable - accountable and transparent - coordinated & complementary to government - no unhealthy competition, extravagance , business controlled ( by industries )

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Education in Diabetes Programmes - For : patients , Health Care Team and community. - to cover knowledge + skills & attitudes - with added professional education expertise - By : MPH & NGOs

- At : clinics – hospitals –social meetings, etc - By all available methods - continuous re-education and evaluation Special rules in Public Mass Education - which priority subjects ? - do not induce panic. - general orientation rather than individual issues. - no business promotions or propaganda. - cautions in news on new discoveries & unproved treatment

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The Health Care TeamThe Physician 1- is Leader of the HC team 2- is the Final reference for his patient’s education 3- keep harmony with others in the HC team 4- requires continuous training courses and updates 5- acquire education skills

Nurses 1- Training courses , by whom ? 2- Knowledge + skills & attitude 3- skills in education 4- keep Team work 5- Continuous education , scientific meetings and workshops

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The Health Care Team ( cont…) The Pharmacist 1- ensure Insulin availability and proper storing . 2- keep working in team with HC group. 3- no play of physician’s role. 4- limited scope in education.

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Dietitians

- great needs to cover deficiency in their number - training courses - acquire education skills - team working

Podologists - urgent needs to cover marked deficiency in their number - training courses : knowledge + skills - education skills

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Diabetes Care for Special Groups

School Children - Registration at national level - Individual records in schools - basic equipments to manage emergencies - Education courses to school attendants. - protecting special rights : play- recreation - treatment .non discrimination …etc

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Mothers with Diabetes Diabetes of Pregnancy

- Screening for diabetes of pregnancy - Protocols for management of GD - Care for the N.B. - After-labour follow-up of mothers

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Elderly Diabetes

- Education courses for families. - Special elderly privileges. - Care for housing problems and family attendance .

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The National Diabetes Registry

- essential as source of information for planning public services - Central location - - paper or computer recordings - contains individual patient data - complemented by local & peripheral registries (in schools - work – Health insurance, etc ) - network connections for exchange information

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Priorities in National - Oriented Research for Diabetes

- Epidemiological studies ( to provide information for planning health services ) - Economic studies – cost : direct & indirect –

cost-benefit of programmes of prevention, etc.

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Diabetes Screening Programmes - Specifically to high risk groups family history – obesity – hypertension -- PH of lab findings – PH of Diab of Preg. - By central planning and organization ( by MPH+ Research groups) - ensure unified criteria for diagnosis - Screening for early detection of complications : Retinopathy – Nephropathy – Coronary Heart Disease - Foot problems - Sending study groups to remote areas .

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The National Diabetes Institute - Ideal site for the central national diabetes registry - Do national diabetes research ( coordinated with …) - Design protocols of diabetes care and management of complications - be a model training center for Health Care Personnel - Share in education especially mass education

- keep a Library for all educational material

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International Relations

The International Diabetes Federation

1- get moral support from IDF to National Associations & programs 2- use as source of information & educational material 3- Benefit from IDF Task forces’ activities and programs 4- Benefit from WDD events

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The WHO

1- Government / collaborative programmes for promotion of diabetes Care2- NGO : collaboration in promoting diabetes care through training & education programmes

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The Patient Obligations 1- Take active role: seek to be educated 2- follow proper life style. 3- comply . 4- not to accept misconceptions and deceptive propaganda

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Thank You

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Alexandrie – Palais du Montazah

Thank You