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Education for Life: Managing Diabetes

Region: Caucasus, Georgia
Author: Centre of Information and Education in Diabetes, Dr. Rimma Shaginyan, Diabetologist-Educator
Consortium Member: Horizonti
Status: Completed - Final Report Budget: $3872 Collected: $3872 Needs: $0
Result: This program educated Georgian diabetics in foot care, lifestyle management, and blood sugar monitoring; one of the goals is to reduce lower-extremity amputations among this population.
Donors: Stanley Music, Natia Gvatua Music, with funds matched by the Tri-State United Way Fund, via Merck Pharmaceutical Employee Contributions plan [November 1999]
Comment: Such preventive medical programs raise the quality of human life and health. Individuals are empowered to take control of this aspect of their lives; health professionals are able to see improvement in the population they care for.

Problem Statement:
Diabetes is the most common chronic disease (above 250,000 patients in Georgia) and the most important cause of premature death and preventable illness and disability. Foot care remains the main cause of hospitalization among diabetic patients in Georgia. Our data of evaluating the quality of diabetes care suggests that foot inspection was found only in 12% of patients. It is estimated that 50-70% of all amputations in diabetes population is 15 times greater than that of the general population.

The USA spends about $500 million/year on diabetic foot problems (not including hospitalization). Though there are no yet official data of foot care in Georgia, our cost calculation of the same problem in Georgia was in preceding year approximately $1200 per patient. Intensive out patient education and quality care programs reduced the number of lower extremity amputations by 49% and savings were estimated to be $ 437,500/year (American Diabetes Association, USA).

Accomplishments to Date:
Although diabetes is still a major issue, the Center has been able to make some progress with limited funds. The success of our previous training programs is shown in our patients' improved ability to manage their own diabetes care, changes in their life styles, flexible diet and willingness to follow appropriate sugar lowering therapy. Our programs have lead to remarkable reductions in foot complications as well as saved costs of controlling diabetes.

Objectives:

• To initiate a Foot Care screening program for diabetic patients;
• To develop a structured group education program;
• To assess the data of care for people with diabetes in order to reveal patients at high risk of foot complications;
• To evaluate the effectiveness of integrating education and screening programs for further organization of the foot care system in Georgia.

Expected Outcomes of This Project:

• Reduction in number of foot amputations among Georgian diabetics;
• Development and expansion of diabetes education programs;
• Introduction of medical (screening) practices into diabetes-related foot complications;
• Reduction of costs of treating diabetes;
• Improved ability to identify high priority needs in quality of diabetic foot care;
• Improved compliance of patients with appropriate diabetes and follow-up of foot care.

2. Months Two - Four:
Training and screening programs.

3. Month Five:
Evaluation procedures, assessment and discussions of the results. Final working and financial reports.

The Proposed Methodology:

1. Training courses for Type 1 and 2 diabetic patients, carried out with 5-8 people in the group on a regular basis:
   
   1. Initial 5-day course, covering basic topics of diabetes, diet control, nutrition and sugar lowering therapy;
      
   2. Intermediate 3-day retreats 6 months later focusing on the benefits of tight control of diabetes, including foot, eye and skin care.
      
   3. Advanced "strengthening" 3-day course 2-3 years later to offer the instructions in the specific topics of late complications and options for improving metabolic control. Metabolic and self monitoring of blood glucose will be assessed by visual test strips Betachek. Estimated total number of patients in the program - 100 persons.

2. Screening Program
   1. To complete the questionnaire of North West Diabetes Foot Care Study (100 patients' data)
      
   2. To compile data from Foot Care Community Screening Form (100 patients' data)

3. Evaluation proceedure and assessment of the results.

Budget

1.Materials
Test strips "Betachek" for checking glucose control 60 packs x$25	$1500
Lancets 1 pack (200 units) x$40	$ 40
Penjet 2 units x $10	$ 20
2. Screening Costs
Printing of screening form for 500 patients	$ 200
Printing of Foot Care Study questionnaire for 500 patients	$ 100
3. Other
Paper	$ 100
Cartridge for Copier 3Sharp -Z 202 1 unit	$ 110
Cartridge for printer 3Desjet - 6902 2 units x 35	$ 70
Stationery	$ 70
4. Personnel salary for 5 months
Diabetologist–Educator	$ 300
Diabetologist–Educator	$ 300
Podiatrist (Diabetic Foot Specialist)	$ 250
Patient-educator	$ 230
Patient-educator	$ 230
VF Administrative Cost (10%)	$ 352
Total	$3,872