2. Introduction
• The dramatic increase in newly diagnosed cases of T2D,
particularly in younger people, has resulted into a major
public health concern worldwide and especially in
low and middle-income countries.
• Several studies have demonstrated that prevention
programs can significantly reduce the risk of
developing diabetes.
3. • The development of T2DM is strongly associated with
being overweight, obese or physically inactive. Large
randomized controlled trials have shown that relatively
modest changes in lifestyle can reduce the risk of
progression to T2DM in adults with pre-diabetes by
around 50%.
• Consequently, promoting changes in physical activity
and dietary intake is now recommended in national and
international guidelines as a first line therapy for preventing
T2DM
Introduction
4. • Currently Egypt stands among the top countries
worldwide with the highest diabetic population between
people age 20-74.
• This forms a severe load not only on the health status
of the community but also on the already
compromised health care budget of the country.
• Diabetes prevention - which proved to be successful
and cost effective in many parts of the world - is highly
needed in Egypt.
Egypt and Diabetes
5. • The European “IMAGE” project includes a European
guideline for diabetes prevention together with a practical
toolkit for the implementation of prevention programs.
• In this context, IMAGE developed an adequate education
program for health care professionals to prevent diabetes
as well as the establishment of quality standards.
• “IMAGE EGYPT” is the project designed by Prof. El-Sayed
and Schwarz . It was adapted to the local needs for
prevention of diabetes in Upper Egypt.
IMAGE EGYPT
6. • Previously to the clinical trial for evaluating the prevention
program, Egyptian health care professionals have to be
trained based on the adapted curriculum. After this local
training program (workshop), these so called prevention
managers (PM) the will be able to deliver preventive
intervention.
• The first training program was done in Luxor in 2013 for 10
persons from upper Egypt and is planned to be repeated in
the near future.
Assignment of prevention
managers
7. • The purpose of this study is to evaluate the implementation
of a diabetes prevention program in an underdeveloped
part of Egypt.
• In respect to recommendations from the European IMAGE
project behavioral change methods – transferred by
specifically trained prevention managers - may lead to
improvement in metabolic control, expressed as a
reduction in waist circumference, blood pressure and
HbA1c as primary endpoints.
Rational for clinical trial
8. • Primary objectives
• To determine if a successful implementation of a diabetes
prevention program is associated with improved metabolic control.
• Secondary objectives
• Motivation of subjects to improve healthy lifestyle and change of
quality of life.
• Improvement of metabolic aspects as determined by the waist
circumference, Bp, HB A1c and lipid profile.
Objectives of IMAGE EGYPT Project
10. Preparation phase
• What do you need?
1. Recruitment of working teams.
2. Find out target population in advance.
3. Agreement on strategic alliances.
4. Select suitable permises for intervention program.
5. Finances: Consider your funding needs and your funding sources.
Create a funding plan.
6. Ethics: Apply for necessary permissions and approvals for data
collection (local ethics committee, data protection authorities)
11. Preparation phase
1. Selection and training of the working teams
2. Screening of population to identify people at risk for
development of diabetes in different localities in Upper Egypt.
3. Motivation of high risk population to share in Interventional
program.
4. Preparation of educational material into Arabic and adapt it
to Egyptian social and cultural environment.
12. Screening teams
• Each team received training from the prevention managers
about the aim of the project, methods of screening and
how to apply FINDRISK scoring system.
• Each session was preceded by pre- screening information to
the target population about the risk of type 2 diabetes
mellitus and its complications and possibility of its prevention
to motivate them to participate in the program.
13. Screening
• FINDRISK scoring system
Each session was
preceded by pre-
screening information to
the target population
about Diabetes risk and
possibility of its prevention
to motivate them to
participate in the
program
QUESTION ANSWER SCORE
Age (years) <45
45 - 54
55 - 64
>64
0
2
3
4
Body mass index <25
>25 - 30
>30
0
1
3
Waist circumference (cm) men <94, women <80
men 94 - <102, women 80 - <88
men >102, women > 88
0
3
4
Do you usually have at least 30 minutes
of physical activity at work and/or during
leisure time (including normal daily activity)?
Yes
No
0
2
How often do you eat vegetables, fruit or
berries?
Every day
Not every day
0
1
Have you ever taken medication for high
blood pressure on regular basis?
No
Yes
0
2
Have you ever been found to have high
blood glucose (e.g. in a health examination,
during an illness, during pregnancy)
No
Yes
0
5
Have any of the members of your immediate
family or other relatives been diagnosed
with diabetes (type 1 or type 2)?
No
Yes: grandparent, aunt,
uncle or first cousin
Yes: parent, brother, sister, or own child
0
3
5
TOTAL SCORE:
<7: low risk
7-11: slightly elevated risk
12-14: moderate risk
15-20: high risk
>20: very high risk
14. Scoring results
• Using the FINDRISK scoring system. Type 2 Diabetes- high risk (T2D_HR) is
defined as a score >14 points in the FINDRISC questionnaire. Persons
with a very high score (20 and higher) have a high probability of
suffering from undiagnosed diabetes; exclusion of diabetes with an
oral glucose test was recommended.
• Subjects with a high FINDRISC score (>14) are the target group and
has an opportunity to participate in the intervention program
• Persons who have low score or moderate risk score received general
information about healthy diet and exercise benefits during screening.
15. Preparation of educational sessions
• Power-point presentations were prepared in Arabic, together with the
materials needed for booklets, brochures, letters, and SMS as well as
the questionnaires that were used during the workshops in every
session.
• The materials were adapted from the prevention module and
culturally adjusted according to population’s needs.
• An agreement should be obtained from certain lab. to perform pre-
and post- intervention laboratory investigations for all intervention and
control groups.
• In the original plan, 4 sessions are required:
16. Educational Tools
1. Simplified power point presentations in Arabic.
2. Simple printed questionnaires, papers and pens.
3. Simple brochures.
4. Boards, pens.
5. Some healthy foods or drinks.
6. Discussions, brain storming…
19. Implementation phase
Educational sessions
• We introduced 2 funny people; Halima and Masud. They plan to do
exactly the same thing you are going to do during our journey to
change lifestyle to enjoy the upcoming years
20. Implementation phase
first educational sessions
Objectives:
Motivation of persons to change their life style.
Power point presentation; contents:
• Why we choose this group for attending these sessions?
• A simplified account on type 2 diabetes, its risk factors and complications.
• How can we avoid diabetes by change in life style?
• Figuring out your personal importance and expectations in respect to a
behavior change
• Thinking about your self-confidence to change habits
21. First educational session
Training questionnaires and discussions about:
• what would you like to do?
• what are your own causes to change your life style?
• Do you think it possible?
• How much it is important for you to change your life style?
• What is your level of confidence that you can change?
• What are your own points of strength and weakness?
Main Message
It’s not difficult but let’s start together; It’s never to late, any minor
change is beneficial.
22. Second session
Objectives:
Motivate subjects to increase their physical activity.
How to Increase your level of physical activity without becoming an
athlete?
• Thinking about your willingness to become more physically active
• know key messages about the range of physical activity
• Setting your goals to create a successful action plan
• Preparing coping strategies and monitoring your progress
Message
You don’t need to be an athlete, but just move as much as you can.
How to be physically active?
23. Third session
Objectives:
Motivate subjects to change their eating habits.
How to make healthier food choices and enjoy eating?
• Thinking about your willingness to adapt your eating and drinking
patterns
• know key messages about healthier food choices
• Setting SMART goats to create a successful action plan
• Preparing coping strategies and monitoring your progress
Message
• Most of the available food can be eat in a healthy manner; just
change methods of cooking, serving and balance amounts.
24. Fourth session
Objectives
Maintenance and relapse managements.
• What did you do? Are there any obstacles or relapses you
encountered? How can we face it?
How to cope with risk situations and relapses?
• Revise your action plans
• Thinking about coping strategies and checking if they are working
• Looking for social support especially for the time after the course
Message
Give yourself sufficient time to adapt the new behavior, if you fail try
again, prepare alternative plans, let others help you. Try to have
measurable goals.
25. Contineous communication
and support
• A page was created on Facebook and the attendants were invited to
follow it.
• Telephone calls and
SMS messages.
• Frequents visits
27. Clinical Trial for the Evaluation of a
Diabetes Prevention Program in
Upper Egypt
Eman A. Sabet & Amanl Khalifa
Under supervision of
Prof. Adel A. El-Sayed
28. What did we learned from the
first implementation trial
• We should choose groups who are easily accessible to
communicate with.
• If possible , better to choose a time outside the work time.
• We have to create more attractive methods during sessions.
• We should listen well to our clients and we should have
answers and solutions foe their problems.
• We may share them active sessions about physical activities
and healthy cooking.
• Others …..???
