1. Peer-led Diabetes Prevention Program for TASC in Melbourne Nabil Sulaiman “International Congress on CDSM, Melbourne Nov 2008”

2. Aims of Peer-led Develop an evidence based, culturally appropriate peer-led diabetes prevention resources and program for TASC Trial the program Evaluate the program

3. Methodology- how? Design: Pre and post intervention trial (action research methods) Advisory Group Peer- leaders Diabetes prevention program Participants Evaluation

4. Methodology- how? 12 peer leaders recruited from TASC Program was developed (food, exercise, group dynamics..etc) 2- full days training of leaders Each leader engage 10 people

5. Program components Principles of peer-led program Role of diet, physical activity and stress Group facilitation, engaging Motivational techniques and chronic disease self-management Leaders were paid for their training time, recruitment of participants and implementing the program.

6. Outcome Indicators Changes in knowledge and attitudes Changes in behaviours Changes in body weight and waist circumference

7. Data collection Questionnaire and interviews: knowledge, attitudes and behaviour "Three-day Food Diary" and physical activity” Weight, waist circumference were measured Pedometer to act as incentive for walking

8. RESULTS (N= 94) Gender: females (73%) Age: 47% (40-45 y) and 25% (>55 y ) COB: Turkey (45%) Iraq (39%) Lebanon (12%) Obesity: 50% (BMI=30+)

9. Knowledge of risk of diabetes? 54.8% said yes post intervention compared to 29.8% pre-intervention (p=.069).

10. Why do you think you are at risk factors of DM? 59.6 58.5 38.3 45.7 54.3 40.4 56.4 28.7 8.5 72.3 71.3 48.9 64.9 60.6 48.9 68.1 51.1 11.8 0 10 20 30 40 50 60 70 80 Overweight Family member Blood pressure Cholesterol Little Exercise Fast Food Stress Smoking Other % PRE POST

11. 39.1 60.9 20.4 79.6 0 10 20 30 40 50 60 70 80 % No Yes No 39.120.4 Yes 60.979.6 PREPOST Have you done anything to lower risk during last 3 months (P<0.001)

12. Lifestyle changes after program 89% in food preparation 79% dietary intake 82% shopping 81% feeling of well being 79% physical activity 69% body weight

13. Mean walking time last week pre and post intervention ExercisePrePostP-value Walking1802580.007 Moderate2492690.722 Vigorous1611850.85

14. Weight and Waist Weight (kg): significant reduction in weight [mean weight pre=78.1, post=77.3; Z score=-3.415 (P=0.001) Waist circumference (cm): mean pre=99.5cm, post =96.5 Z=-2.569 (P=0.010)

15. Effectiveness of the program using 10-points scale 68% gave 9 or 10 points 18% gave 7 or 8 points 2% gave 5 points (undecided) 2% gave 3 or 4 points

16. What are the main reasons for not taking any actions to lower your risks? ReasonsPrePostp-value No time to cook 37.2%20%0.004 Like to eat fast food 24.5%11.1%0.029

17. What did you like? 77% appreciated the information 69% the skills learned 63% the support provided 95% learned healthy eating skills 70% maintaining healthy weight 75% how to loose weight 73% value regular exercise 48% information access and 42% attitudinal change

18. Source of diabetes knowledge Doctors (92%) Television (70%) Friends (54%) Nurses (35%) Brochures (35%) Family (36%) Internet (29%) Ethnic media (29%).

19. Comparison with other studies

20. Meta-analysis of 11 RCTs in CALD: 1. Improved HbA1c 3m after intervention 2. Weight Mean Difference -0.3% at 3m and 0.6% at 6m 3. Knowledge scores improved at 3m 4. Healthy life style improvement at 3m Hawthorne K, Robles Y, Cannings-John R, Edwards S. Culturally appropriate health education for type 2 diabetes in ethnic minority groups. Cochrane Database of Systematic Revies 2008 (3)

21. Limited intervention Administered by trained peers equipped with culturally appropriate education Native language Significant improvement in: knowledge and attitudes limited changes in lifestyle behaviour The changes were maintained three months after the intervention. Conclusions

22. The peer-led DPP was effective in improving knowledge and changeing behaviour The program could be replicated in other CALD Conclusions

23. Diabetes Research Initiatives in Sharjah, UAE Nabil Sulaiman nsulaiman@sharjah.ac.ae n.sulaiman@unimelb.edu.au Diabetes Supercourse, Alexandria 12 Jan 2009

24. Sharjah Diabetes Study  Background  Why the study  Methods  Preliminary results  Conclusions  Recommendations

25. Environmental and behavioral changes New dietary habits (what and how we eat), Lack of physical activity, Overweight/ obesity, and Stresses of urbanization and working condition will lead to further rise of CVD and diabetes, and their risk factors.

26. Summary Diabetes is a major and complex health problem worldwide. Prevalence in UAE (24% & IGT18%) is the 2nd highest in the world Onset of the disease in the GCC is early in late 20s With early Dx and appropriate Mgt diabetics can live better and longer

27. Sharjah Diabetes Study N. Sulaiman, Dh. Al Badri, N. Sajwani, S. Saleh, D. Young

30. 1 Nabil Sulaiman, 2 Dhafir Al Badry, 2 Najla Sajwany, 1 Amal Hussein, 1 Saba Saleh, 2 Doris Young ( 1 Department of Family and Community Medicine, University of Sharjah, 2 Ministry of Health UAE, 3 Department of General Practice, University of Melbourne) The study design is a cross sectional baseline survey of patients with diabetes attending Primary Medical Care Centers in Sharjah during 2007/08. Data Collection 1.Research Assistant attended diabetes mini clinics at Riffa and Asit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals: 2.Patients were invited to participate 3.Patients were interviewed using structured questionnaires 4.Their data were extracted from medical records 5.Data cleaning and analysis was performed using SPSS Background  Diabetes is a major and complex health problem worldwide.  Diabetes prevalence in UAE is the 2 nd highest in the world, reaching about 24% in UAE nationals.  The prevalence of pre diabetes is reported to be about 18%.  With early identification and appropriate management, people with diabetes can live better and longer This project was funded by the University of Sharjah. For information please contact Dr Nabil Sulaiman, HOD Family and Community Medicine, The University of Sharjah E-mail: nsulaiman@sharjah.ac.ae or n.sulaiman@unimelb.edu.aunsulaiman@sharjah.ac.ae n.sulaiman@unimelb.edu.au Aim To improve diabetes management, control and quality of life of patients with diabetes in UAE Objectives 1. Establish an electronic database for diabetic patients in Sharjah 2. Audit their medical records to identify gaps in management. 3. Pilot test known EB intervention to investigate their appropriateness to Sharjah 4. Determine barriers and facilitators to the implementation of the intervention METHODOLOGY Diabetes Control Indicators  body weight and waist circumference from medical records  knowledge and attitudes towards healthy eating using physical activity questionnaire and  Biochemical indicators such as AbA1c and cholesterol, lipids, blood glucose and urine test PRELIMINARY RESULTS  Participants: 347 diabetic patients were interviewed and their medical records were cheeked  Gender: 65.4% (n= 227) females and 34.6% (n=120) males  Nationality: UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, others 10% including Palestine, Lebanon, Yemen, Iraq, Poland, Syria, Iran and Sudan.  Marital Status: 8.9% single, 87.9% married, divorced 1.4% and 1.4% widowed.  Consanguineous Marriage: 16.4% (n=57)  Occupation: : 47.3% housewife, 28.2% clerks, 6.3% students, 0.6%retired.  Family History: 23.1% (N=80) had a positive family history of diabetes.  Smoking: 3.2% (n=11) current smokers, 3.2% (n=11), ex-smokers, never smoked 93.1% (n=323). CONCLUSIONS 1.Diabetes Mellitus is common problem in primary medical centers in Sharjah. 2.There is gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity. 3.Diabetes control in Sharjah measured by HbA1c could be improved compared with international guidelines. 4.Measures to improve control may include employing Diabetes Nurse Educators to assist doctors at the medical centers to train patients as well as CME courses for doctors working at the centers.

31. Sharjah Diabetes Study Aim To improve diabetes management, control and quality of life of patients with diabetes in UAE

32. Sharjah Diabetes Study Objectives Identify gaps in diabetes management Determine barriers and facilitators to implementation of known interventions Pilot test known EB intervention in Sharjah

33. Study Design Cross sectional baseline survey of patients with diabetes attending Primary Medical Centers in Sharjah during 2007/08.

34. Data Collection Research Assistant attended diabetes mini clinics at Riffa and Wasit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals: Patients were invited to participate and interviewed using questionnaires Their data were extracted from medical records Data cleaning and analysis was performed using SPSS

35. Diabetes Control Indicators Medical Records: Biochemical indicators such as HbA1c and cholesterol, lipids, blood glucose and urine test Weight and waist circumference Patients questionnaire: Knowledge and attitudes healthy eating physical activity

36. Preliminary Results Sample: 347 patients Gender: 65.4% females Mean age 53.2 (14.6) BMI 29.8 (5.9)

37. Nationality UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, Others: 10% (Palestine, Lebanon, Yemen, Iraq, Syria, Iran and Sudan)

38. Diabetes in Families

39. Marital Status 87.9% married 8.9% single 2.8 divorced/widowed Consanguineous Marriage: 16.4% (n=57)

40. Gender difference

41. HbA1c: 78% of patients has HbA1c (>7%) BP: 57% have high BP

42. Management Methods

43. Complications (83) 26 (Eye glaucoma, laser surgery) 74 (feet ulcer, loss of sensation) 2 (Kidney: protein urea or albumin urea) 4 (loss of toe/ foot) 6 (angina, heart attack)

44. Self monitoring

45. Self Management I can exercise several times a week (25% strongly agree) I can not exercise unless I feel like exercising (28% strongly agree) I can recognize when my blood sugar is too high (27% strongly agree)

46. Self Management I can do what was recommended to prevent low blood sugar (24% SA) I can figure out what self treatment when blood sugar gets high (29% SA) I can fit my diabetes self treatment routine into my usual lifestyle (26% SA)

47. CONCLUSIONS Diabetes Mellitus is common problem in primary medical centers in Sharjah. High levels of obesity Low physical activity Gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity.

48. Recommendations Diabetes management in Sharjah could be improved compared with international guidelines Measures to improve control: Diabetes Nurse Educators Patient’s self management education Peer-led or peer-support models CME for doctors at PHC centers

49. Thank You