Immediate impact of a diabetes training programme for primary care physicians—An endeavour for national capacity building for diabetes management in India

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Abstract

Aims

India faces a huge burden from diabetes. National capacity for management of diabetes has to be strengthened by improving knowledge of physicians treating diabetes, especially in semi urban and rural areas. A training programme was formulated and conducted at national level, as a step towards this goal.

Methods

Physicians from 6 states of India (n = 3023, M:F 2311:712), aged 30–55 years, with service of ≥3 years, (government n = 1720, private n = 1303, semi urban and rural areas (n = 1581:1442)) were trained in diabetes care in 5-day workshops between March 2004 to December 2006. Impact of training was assessed by pre- and post-training knowledge scores, feedback on usefulness of training modules, prioritizing activities to be introduced in their practice and methods to be used for raising public awareness on diabetes.

Results

The training significantly improved knowledge on treatment, complications, pathophysiology and diagnosis of diabetes (p < 0.001). The participants considered information on preventive aspects of diabetes and foot care as highly educative. Patient education and team-training were considered important in diabetes management. Interest was evinced in raising public awareness about the disease.

Conclusions

Well-planned short training programmes are useful in improving knowledge and in creating enthusiasm to improve diabetes care and awareness.

Introduction

Diabetes is a multi-factorial metabolic disease and chronic hyperglycaemia produces damage or dysfunction of various organs resulting in late onset complications. The primary goal of management of diabetes is to maintain a level of glycaemia as close to normal as possible. Significant improvement in treatment modalities have occurred in the past three decades. Despite the availability of an array of oral drugs and biosynthetic insulin analogues with improved action, the outcome of diabetic treatment remains far from optimal in developed and developing countries [1]. A variety of causes such as non-compliance by patients and or inappropriate prescription by the physicians may be attributed for the failure to reach the treatment goal.

India has the largest number of diabetic subjects and, is likely to remain so, for many years to come [2]. Although there are national guidelines for management of diabetes [3], the outcome of diabetes treatment is reported to be generally poor [4], [5]. A great deal of disparity exists in the knowledge and the practice profile among the physicians treating diabetes in India. Some of the urban areas have speciality centres and the practising physicians have opportunities to update knowledge through continuous medical education. Such facilities are lacking in semi urban or rural areas. As majority of Indians live in rural areas, the facilities for diabetes care are limited and the physicians are not updated regarding the developments in diabetology and its associated disorders.

To reduce the burden of a non-communicable disease like diabetes, preventive measures are as important as optimal management of the disease. Awareness has to be created both among the health care providers as well as among the general population. This can be achieved only by training doctors and paramedical personnel especially in the rural and semi urban areas who have limited access to new information on developments in diabetes care.

Recent studies in India have shown that the burden of diabetes is increasing both in the urban and rural areas [6], [7]. The number of doctors and nurses trained to provide diabetes care does not match the huge number of patients and therefore there is an urgent need for national capacity building for diabetes management. Training of doctors and paramedical personnel throughout India has to be taken up in the crusade against diabetes [8]. There is a shortage of trained personnel to create an awareness and educate the lay public on diabetes.

With the objectives of strengthening the national capacity of diabetes care and providing effective and affordable modes of diabetes management in semi urban and rural areas, we have taken up a diabetes training programme for physicians. Doctors from different regions in India, from public and private sectors were selected for the programme. This report provides the method of training and its short-term impact.

Section snippets

Objectives

The objective of the training programme was to increase the national capacity for management of diabetes by improving the knowledge of doctors on diabetes care and to change their attitude and approach to chronic care of diseases. It was also aimed at creating a cadre of trainers who in turn will disseminate the knowledge and skills to others in medical profession, particularly in semi urban and rural areas.

Preparatory phase and planning

The details of training objectives, selection criteria, training methods, curriculum

Results

A total of 3023 (male 2311:female 712) were trained in 3 years. Among them 1720 and 1303 were from government and private centres, respectively, and 1581 and 1442 were from rural and semi urban areas. Details are shown in Table 1.

Mean cumulative scores obtained in the pre-training and post-training knowledge evaluations were 45% and 60% (p < 0.001). At the baseline, knowledge on diagnosis (35.7%) and complications (31.8%) was low and scores on diabetes monitoring was the highest (53%). Scores

Discussion

The training programme was largely effective in improving knowledge on management and preventive aspects of diabetes among the participants. Feedback from them showed that the programme had created awareness and urge to improve the clinical approach to diabetes. Initiation of patient education to enhance the skills of patients for self management, was considered as a priority requirement. Although team building for diabetes care was considered important, many preferred to train their existing

Conflict of interest

There are no conflicts of interest.

Acknowledgements

The project was fully funded by the World Diabetes Foundation, Denmark. We thank the Foundation, specially Ms. Sanne Frost Helt, Programme Manager for the support and encouragement. We thank members of the Advisory Board and Curriculum Committee for their support and help. We acknowledge the help of Mrs. Mary Simon and Mr. S. Selvam in preparation of the manuscript and Ms. L. Vijaya and A. Bobby for the secretarial assistance.

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