title: Impact of a multidisciplinary intervention for diabetes in Eritrea.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Windus
authors.forename: Jack H
authors.initials: JH
authors.lastname: Ladenson
authors.forename: Cindy K
authors.initials: CK
authors.lastname: Merrins
authors.forename: Melles
authors.initials: M
authors.lastname: Seyoum
authors.forename: Debra
authors.initials: D
authors.lastname: Windus
authors.forename: Susan
authors.initials: S
authors.lastname: Morin
authors.forename: Beyene
authors.initials: B
authors.lastname: Tewelde
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Parvin
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Scott
authors.forename: Jason
authors.initials: J
authors.lastname: Goldfeder
mesh_terms: 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
chemical_list: D006442:Glycated Hemoglobin