Abstract
Diabetes Mellitus as a one of common non communicable diseases needs to be managed using multidisciplinary and coordinated approach. Incidentally, Clinical practice guidelines along with Continuing Medical Education (CME) would be essential section in this approach. In this regard Iran Diabetes Academy (IDA) affiliated Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) was established in 2017. IDA intended to provide and deliver appropriate source of updated information for all health care providers in field of diabetes prevention, management and rehabilitation.
Introduction
Diabetes Mellitus (DM) would be one of the major global health problems in this century. Accordingly it is estimated the number of people suffering from DM will rise to 642 million in 2040. World Health Organization (WHO) reported that the prevalence of DM in EMRO region will be 11.6% in 2040 [1]. It should be noted that there are not any simple approach to diabetes management and variety interventions would be addressed with multidisciplinary and coordinated approach [2]. So all stakeholders consist of governments, health care providers, diabetic patients and their family, food producers and manufacturers of medicines and technology should be incorporated with each other to improve the quality of life of diabetics. In this regard developing guidelines, protocols, patient and diabetes health care providers’ education could be effective. Hence it is essential to establish the educational centers for diabetes in order to increase the diabetes prevention and management knowledge of both patients and health care providers.
Diabetes policy frameworks in Iran
National Service Framework for Diabetes as an important section of the National Non-communicable Diseases Initiative considers the diverse features of diabetes and focuses on the diabetes management. This document as a national framework involved 6 main goals for diabetes prevention and management which classified into” combating rising prevalence of diabetes and its contributing factors, expanding health insurance coverage, promoting the quality of care offered to patients with diabetes, encouraging diabetic patients for regular periodic clinical examinations, maximizing the number of diabetic patients registered in National Diabetes Register, and full insurance coverage of devices and instruments required by diabetic patients” [3]. Additionally, it covers 23 standards concerning strict rules of clinical service delivery which should be adhered all around the county.
Analysis and statement of problem: Diabetes education
According to the standards of medical care in diabetes, diabetes education should be considered for the staff of long-term care to improve the diabetes management [4]. In this regard, Clinical practice guidelines (CPGs) would be appropriate option to keep updated all health care providers. CME or Continuing Professional Development (CPD) is essential section in this approach [5]. Since CME or CPD are not fully meet the educational demand of health care providers in field of diabetes, holding comprehensive course or vocational course seems to be considered. Therefore, it is essential to prepare a focal point association to have systematic approach to DM Education. The Rochester Academy of Medicine held on 26 June 1899 would be kind of example of professional medical association which local physicians often joined, as well as to be member of national associations [6].
Iranian diabetes academy
Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences was assigned as a WHO Collaborating Center for Research & Education on Management of Osteoporosis and Diabetes since 2007 and has been predesignated in this regard for the period of 2015–2019 [7]. Iran Diabetes Academy (IDA) affiliated EMRI was established in 2017. The Academy committed to improving the health of patients and at risk people in the community and promoting the health care provider through research, education and advocacy. Also, as a leader in diabetes issues, the Academy provides expert evidence at hearings, converses with governmental bodies, collaborates to establish national regulations, and develops position statements on diabetes issues. Furthermore, the Academy will make a platform for both national and international fundraising activities to strengthen research training and educational activities in the field of diabetes.
Diabetes care requirements change significantly over the different life stages of a patient who suffered from it. This means that people with diabetes require diabetes education and adjustment of treatment not only when first diagnosed, but on an on-going basis. The “IDA” through training the well-educated and high-qualified health care provides prominent impression in the patients’ outcomes.
Also, the diabetes clinics function as centers for awareness raising, treatment of diabetes and prevention of complications resulting from diabetes. Training was provided for doctors, nurses, laboratory technicians and receptionists to enable them to manage the clinics in the future. As part of the project, community outreach programs were conducted on a monthly basis. These outreach programs targeted high-risk individuals, such as first-degree relatives of the people with diabetes registered and others with one or more risk factors for diabetes.
The most of the patients with diabetes live in developing countries such as Iran. The complication of diabetes, are major source of patient suffering, disability and societal cost. Despite the high prevalence of diabetes and its complication, the level of care quality and control of diabetes complications is not satisfactory, because, there is no any comprehensive training center in diabetes education and there is no any special program and curriculum to provide well educated specialists such as diabetologiest and podiatrists in diabetes care team in our country.
Evidently, diabetes education, can significantly improve diabetes self-care with a consequent benefit in terms of metabolic outcomes, costs, and quality of life.
Educational programs take time and require specific training, teaching and communication skills. At any time diabetes education became accepted in our country, would not have sufficient qualified diabetes educators to cope with the existing demand. It is therefore imperative that we begin now to develop highly skilled diabetes educators.
According to the evidences, there is a real need for changes and reintroduce in the medical education program in Iran. A move towards a curriculum that engages students and specialist as active participants in a process of lifelong learning would be highly beneficial. As clinically qualified clinicians they will face many challenges in the years ahead, and a modernized curriculum should help them to acquire the necessary knowledge and develop the clinical skills and problem solving abilities they will need.
According to the goals, the multidisciplinary team is to integrate the contributions of different academic disciplines in the diabetes field. The multidisciplinary team member of “Iran Diabetes Academy” include national and international scholars from all area of diabetes discipline and related complications such as members of Iranian Diabetes Network, Iranian Diabetic Foot Network, Italian Barometer of Diabetes Observatory and also other international of EMRI collaboration individuals.
The “Iran Diabetes Academy” provides knowledge and technology for planning and empowering the future of health care provider to delivery appropriate care to patients with diabetes. The mission of this project is to train expert and efficient graduate specialists which provide the opportunity to improve the health and quality of life of community through sharing knowledge of diabetes care with other medical sciences, teaching and applying evidence in various fields of medicine, family and community.
Conclusion
According to conduction health system research methodology, “Iran Diabetes Academy” were established the subspecialty center in order to equity and access to health care through straitening professional education for multidisciplinary health care team. This project will be used for local practice and will help health care providers to behave in the same and standard manner in different areas of our country with different levels of availability to health- care services.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this paper.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, Cavan D, Shaw JE, Makaroff LE. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50. doi: 10.1016/j.diabres.2017.03.024. [DOI] [PubMed] [Google Scholar]
- 2.Organization, W.H., Global report on diabetes. 2016: World Health Organization.
- 3.Noshad S, Afarideh M, Heidari B, Mechanick JI, Esteghamati A. Diabetes care in Iran: where we stand and where we are headed. Ann Glob Health. 2015;81(6):839–850. doi: 10.1016/j.aogh.2015.10.003. [DOI] [PubMed] [Google Scholar]
- 4.Association, A.D. Standards of medical care in diabetes—2018 abridged for primary care providers. Clin Diabetes. 2018;36(1):14–37. doi: 10.2337/cd17-0119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Beckman D, Wardian J, Sauerwein TJ, True MW. Evaluation of an interprofessional continuing professional development course on comprehensive diabetes care: a mixed-methods approach. J Eval Clin Pract. 2019;25(1):148–154. doi: 10.1111/jep.13033. [DOI] [PubMed] [Google Scholar]
- 6.Sturgis, H., et al., Addendum to the Roster of American obstetrical and gynecological societies published in the Jan. 1, 1965, issue of the Journal.
- 7.Nasli-Esfahani E, et al. Iran diabetes research roadmap (IDRR) study: a preliminary study on diabetes research in the world and Iran. J Diabetes Metab Disord. 2017;16(1):9. doi: 10.1186/s40200-017-0291-9. [DOI] [PMC free article] [PubMed] [Google Scholar]