Impact of a multidisciplinary intervention for diabetes in Eritrea.
BACKGROUND
When hemoglobin A1c (HbA1c) testing was made available to diabetic patients in the nation of Eritrea, the majority of values were markedly increased. As a result, a multidisciplinary clinical education program was instituted in Eritrea and the rate of HbA1c testing was increased to monitor progress.


METHODS
In February 2003, a cooperative diabetes project was initiated in Eritrea to train diabetes educators, enhance physician education, create patient-teaching materials, and promote glucose monitoring. Two additional visits were made in 2003 and 2004. HbA1c values from January 2003 to November 2004 (n = 3606) were reviewed to assess diabetic control for the population and for a subset of individual patients (n = 350). A cohort of 209 diabetic persons were evaluated for demographics, treatment, and prevalence of complications.


RESULTS
The cohort of 209 patients was 34% female and had a mean (SD) age of 50.5 (15.5) years and diabetes duration of 8.6 (6.3) years. Prevalence of hypertension was 37% and proteinuria 6%. For diabetes treatment, 59% received insulin therapy, 35% received oral agents, and 6% received nonpharmacologic treatment. HbA1c values improved significantly between the 1st 6 months of 2003 (median 10.9%) and the last 6 months of 2004 (median 8.5%; P <0.001). Individual patients in whom 2 HbA1c values were measured > or =3 months apart showed a significant mean decrease of 0.5% (P <0.001).


CONCLUSIONS
Our experience suggests that the combination of sustainable upgraded laboratory services and training in clinical management leads to sustainable improvement in diabetes care in developing countries.
Windus
David W
DW
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Ladenson
Jack H
JH
Merrins
Cindy K
CK
Seyoum
Melles
M
Windus
Debra
D
Morin
Susan
S
Tewelde
Beyene
B
Parvin
Curtis A
CA
Scott
Mitchell G
MG
Goldfeder
Jason
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D004496:Education, Continuing / Q000458:organization & administration; D019017:Eritrea; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000458:organization & administration; D015995:Prevalence; D016730:Program Development
D006442:Glycated Hemoglobin