Diabetes
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2nd
Diabetes Mellitus
Maribel U. Cruz, M.D.
Session Objectives 1. To discuss the epidemiology of DM 2. To discuss the National Diabetes Prevention & Control Plan a. Vision/ Mission/ Goal/ Objectives b. Policies c. Strategies d. Levels of Program Intervention e. Different components of Program Implementation Epidemiology • • • • • •
Worldwide approximately 135 million people were afflicted in 1995 Number is expected to rise to 300 million in the year 2025 In 2000, the Prevalence rate for DM was 5.1% and IGT 8.1% Women had a higher prevalence than men The frequency of DM & IGT in urban and rural areas are about the same Prevalence increases w/ age, with a rise observed in the 50 yr. old age group
DM is a serious disease Leading cause of new cases of blindness 2x higher risk for heart attack & stroke 75% of deaths are due to atherosclerosis 5x more prone to gangrene 50% of non-traumatic amputation occur in people with diabetes 17x more prone to renal disease 25% of new cases of ESRD are among diabetic patients Leading Causes of Mortality Number and Rate / 100,000 Population Philippines, 1997
Subject: FCM 3 Topic: DIABETES Lecturer: Dra. Maribel U. Cruz Shifting /Date: November 12, 2008 Trans group: Ces.Kix.Pau.May
NUMBER
RATE
1. Diseases of the Heart
CAUSES
49,962
69.8
2. Diseases of the Vascular System
38,693
54.1
3. Pneumonia
30,811
43.1
4. Accidents
28,563
39.9
5. Malignant Neoplasm
26,842
37.5
6. Tuberculosis, all forms
23,056
32.2
7. COPD
11,807
16.5
8. Other diseases of the Resp. System
6,961
9.7
9. Diabetes Mellitus
6,749
9.4
10. Nephritis, Nephrotic syndrome
6,704
9.4
Leading Causes of Mortality Number and Rate / 100,000 Population Philippines, 2000 CAUSES
NUMBER
RATE
1. Diseases of the Heart
60,417
79.1
2. Diseases of the Vascular system
48,271
63.2
3. Malignant Neoplasm
36,414
47.7
4. Pneumonia
32,637
42.7
5. Accidents
32,355
42.4
6. Tuberculosis, all forms
27,559
36.1
7. COPD & allied conditions
15,904
20.8
8. Conditions fr. Perinatal period
15,098
19.8
9. Diabetes Mellitus
10,747
14.1
10. Nephritis, Nephritic syndrome, Nephrosis
7,963
10.4
Leading Causes of Mortality Number and Rate / 100,000 Population Philippines, 2002 CAUSES
NUMBER
RATE
1. Heart diseases
70, 138
88.2
2. Vascular system diseases
49,519
62.3
3. Malignant Neoplasm
38,821
48.8
4. Pneumonia
34,218
43
5. Accidents
33,617
42.3
6. Tuberculosis, all forms
28,507
35.9
7. COPD & allied conditions
19,320
24.3
8. Conditions fr. perinatal period
14,209
17.9
9. Diabetes Mellitus
13,922
17.5
9,192
11.6
10. Nephritis, Nephritic syndrome, Nephrosis
The National Diabetes Prevention and Control Program Situationer The National Diabetes Prevention and Control Plan for the years 1999-2010 is a 12-year program of action MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI
Subject: Topic: Page 2 of 6
Major thrusts of the Program: 1. Promoting lifestyles that deter the development of Diabetes among individuals and risk reduction 2. Training & promotion of self-care and community mobilization for known diabetics Risk Factors Non-Modifiable Risk Factors 1. Family History 2. Age 3. Sex 4. Race Modifiable Risk Factors 1. Diet 2. Body Weight 3. Smoking 4. Alcohol 5. Sedentary lifestyle 6. Birth weight 7. Migration Risk Factors • Previous history of IFG / IGT • Poor obstetrical history in women • Hypertension • Dyslipidemia • Coronary Artery disease • Cerebrovascular accidents Situationer Diabetes prevention & control activities shall be established in the ff. venues: 1. Communities 2. Hospitals 3. Schools 4. Workplaces • DOH shall coordinate closely with different inter-sectoral partners in the implementation & management of the program Vision A Filipino Nation empowered to prevent Diabetes & its complications in themselves, in their families and in their communities by year 2010 and thereafter Mission Take advantage of and create opportunities to establish Diabetes awareness, information, education & medical and allied services within the reach of each and every Filipino Goal
Reduce the health and social impact of Diabetes among Filipinos by: • Making at least 90% of Filipinos aware of what Diabetes is by the year 2004 through 2010 and thereafter • Reducing the rate of increase of prevalence of Diabetes to 5% per year starting 2004 to 2010 Objectives The program shall ensure that the following objectives are met: 1. The development of strategies & programs including awareness campaigns & the continuing education of health personnel and concerned individuals to prevent DM and its complications 2. The adoption of cost-effective & appropriate screening methods for the detection of DM & its early and pre-symptomatic stages Objectives 3. The investigation into the epidemiology , etiology, diagnosis, treatment, prevention & control of DM 4. The evaluation of measures employed including drug & diet therapies in the control of DM 5. The establishment of mechanisms to reduce the socio-economic impact of DM on affected individuals and families Objectives 6. The granting of incentives & support for organizations of affected individuals and families 7. The establishment of coordinated health systems, w/c shall involve clinicians , researchers, allied health professionals, community-based health workers & lay volunteers for dealing w/ DM and its complications Objectives 8. The participation of LGUs alongside concerned gov’t. agencies & NGOs in the implementation of programs on DM prevention and control 9. The periodic review of research needs & potential in the control of DM 10. The systemic utilization of public & private resources to achieve the objectives enumerated above: and 11. The recommendations of the Commission for legislation Policies 1. Program resources & energies shall be focused on the Primordial & Primary levels of prevention
Subject: Topic: Page 3 of 6
2. The program shall primarily focus on the age group of 0 – 21 years. o Secondary targets are adolescents & adults not yet suffering from DM o Tertiary targets are those known to have DM 3. Self-care, self-reliance & co-responsibility for the health of one’s family and community shall be among the values to be promoted 4. Medical & other health services by the program shall involve the active participation of families & communities 5. The DOH shall work closely with all levels in the education department and develop active linkage with agencies involved in communication sciences and behavior modification 6. Major program strategies & approaches shall have built-in measures of effectiveness & efficiency & shall be monitored & evaluated at strategic periods of time so that adjustments can be made in favor of achieving program goals 7. It shall be the priority of the National Diabetes Commission , its succeeding & advisory bodies and the DOH to identify and source out funding for the program 8. The program shall ensure that its implementers & partners shall develop active linkage , provide technical inputs or participate in legislative & social marketing activities of sectors related to or affecting health Strategies I. Phasing-in of Implementation The 12-year program shall be phased into three: 1. Preparing the groundwork – first 3 years 2. Weakening the bastions of Diabetes – next 3 yrs. 3. Controlling Diabetes & assimilating healthy lifestyles into the Filipino culture- last 6 years Each phase shall be concluded by an evaluation & re-planning activity The achievement of the end goals or outcomes for each stage will indicate the beginning of the next phase Phases of the NDPCP A. PREPARATORY PHASE ( 1999-2001) Major Activities : Create & increase public awareness on DM ; identify, organize & mobilize partners; source funds; intensify studies and researches
Other Activities : Train health workers;
design multilevel school curricula; initiate legislative agenda; establish networks Expected Outcome: Information, resources & active supporters for the program are adequately available
B. INTENSIVE PHASE ( 2002 – 2004 ) Major Activities : Counter initiatives and influences favoring development of DM; promote healthy lifestyles; provide full-scale logistics support; implement school curricula Other Activities: Implement services at the community, schools, workplace and hospitals ; support expansion of Diabetes consortia ; monitor and continue training Expected Outcome: Influence of factors favoring Diabetes & its complications is weakened C. MAINTENANCE PHASE ( 2005 – 2010 ) Major Activities : Sustain, improve and update pertinent communication strategies; upgrade health services & networks for diabetics; upgrade educational materials Other Activities : Monitor & evaluate ; strengthen specialty facilities, institutionalize training; design succeeding program plans Expected Outcome: Filipinos adopt healthy lifestyles & are able to access diabetes related services II Strategic Clustering A group of centrally managed program components shall be planned, administered &/or implemented by the DOH in coordination w/ its partners who are organized into strategic clusters Each cluster shall respond to one or two special concerns or objectives of the program The activities shall complement & support direct program services intended for the community, school, hospital & workplace Major • • • • • •
Clusters Management Advisory Cluster Legislative Action Cluster Research & Information Cluster Resource Mobilization Cluster Public Information Cluster Formal Education Cluster
Subject: Topic: Page 4 of 6
• •
Social Mobilization cluster Clinical Diagnosis & Case Management Cluster
Management Advisory Cluster • Program administration • Steer and coordinate all program clusters • Formulate program policies & standards
•
• •
Assist the Clinical Diagnosis & Case Management Cluster to identify the standards of health care to diabetics and their families Provide technical & logistics assistance to service delivery units Facilitates monitoring & evaluation of the program
Research and Information Cluster • Research and development
•
•
It shall have representatives from the DOH the Institute for Studies on Diabetes Foundation & the Phil. Council for Health Research & Development Priority areas for research include : • Epidemiology of Diabetes • Prevalence of known risk factors • Diagnosis & management of Diabetes
Legislative Action Cluster • Legislative agenda and function • Identifying program goals on behavioral & policy changes that require the force of law • Formulate legislative agenda & plan of action to mobilize lobby groups to support their proposed bills or oppose laws that are detrimental to health • Priority areas for legislation include : • Tax exemption for the importation of oral anti-diabetic drugs, insulin & monitoring devices • Controls the importation , manufacture & sale of tobacco and alcohol Formal Education Cluster • Education and training program • Formulate & institutionalize the Diabetes curricula fit for the different levels of education • Design training modules for the different categories of health workers • The Diabetes curricula shall include value re-orientation in favor of healthy lifestyles • Works in coordination with the cluster in charge of public information
•
CME shall be designed for all program implementers in the public & private sector
Public Information Cluster • Mass communication & public information • Disseminate life-saving information on the prevention of diabetes & its complications • Develop a long-term, data-based communication & public information plan specific for children, their caretakers and infuencers Social Mobilization Cluster • Responsible for identifying & developing organizations that shall support direct program services , legislative and educational agenda, information plan and material resource mobilization • Community level – families shall be the nucleus of action • At schools – teachers, faculty & children coming from families at risk of developing Diabetes • Workplace & Hospitals – core group is composed of Diabetics & members of families at risk Resource Mobilization Cluster • Resource development & management • Ensures that resources are adequate, available, distributed where they are needed The National Diabetes Act of 1996 provides for: Granting of incentives & support for organizations of affected individuals and families Systemic utilization of public & private resources to achieve the objectives of the program Levels of Program Intervention The NDPCP shall intervene at all levels of disease prevention: Primordial, Primary, Secondary and Tertiary Primordial : (-) risk, (-) disease Primary : (+) risk, (-) disease Secondary : (+) risk, (+) disease Tertiary : (+) disease, (+) complication Primordial Prevention Focuses intervention on all Filipinos regardless of predisposition of the disease Program activities shall aim to : 1. Assist Filipinos in developing , maintaining or shifting to healthy lifestyles
Subject: Topic: Page 5 of 6
2. Dissuade them from acquiring or keeping unhealthy habits Primordial Prevention • Information campaign for the general population • Most interventions for primordial prevention shall be packaged for the consumption of children and their caregivers • Targeting of scientifically-packaged information to the major influencers of health behavior in the Filipino society • Mass media & interpersonal communications shall be used to convey appropriate information to specific influence groups Primary Prevention • Preventing the development of DM among those at risk of developing the disease • High risk individuals can be clustered into families • Interventions shall focus on families rather than on individuals • Screening of risk factors, education and counseling, diet or behavior modification techniques, laboratory work-up shall be focused on the family Secondary Prevention • Involves early detection & prompt treatment of DM to prevent complications • It is important that the program contributes to the disability-free life years of the diabetes case • The first step is to identify diabetes cases • Requires screening for the diabetes risk factors among families and individuals at the barangay level followed by referral & confirmation of the diagnosis at higher levels of care • A special health service package shall be provided for confirmed diabetics & members of their families w/c shall include: clinical, dietary & psychological counseling support group organization family therapy medical services laboratory monitoring Tertiary Prevention • Involves preventing further disability providing access to rehabilitation services • Effective networking among hospitals, of clinics with hospitals & among specialists in the different fields of medicine is essential
Components of Program Implementation The NDPCP recommends and supports the implementation of a standard package of services specific to 4 different venues: 1. Community-based program 2. Hospital-based program 3. School-based program 4. Workplace-based program A. Community-Based Program Base: RHU-BHS network Shall work for a strong linkage between gov’t. & non-gov’t. health facilities at the community level Partners : DOH, DILG, LGUs Focus : primordial & primary prevention Client : family and the community as a whole Minimum package of services : • Public information & health education • Advocacy & social mobilization for healthy lifestyle & healthy foods • Physical fitness & exercise programs • Screening for risks, signs & symptoms of diabetes • Medical,self-care, dietary & psycho-social counseling • Referral of suspected diabetes cases to higher levels of care, follow-up of referrals • Support for organization of diabetes patients, their families & diabetic support groups B. Hospital-Based Program Primary level hospitals have a package of services similar to the community-based program Secondary & Tertiary level hospitals shall deliver higher levels of care to those at risk or suffering from diabetes Partners : DOH, private hospitals, NGOs Focus : Secondary & tertiary prevention Client : patients and their families Support the community, school and workplace based components of the program Minimum service package: • Screening of walk-in patients • Medical & dietary counseling • Referral of cases for community based activities or to other specialized services • Follow-up of referred cases • Early diagnosis & laboratory monitoring
Subject: Topic: Page 6 of 6
•
Management of the complications of diabetes
C. School-Based Program Schools are encouraged to carry out various forms of diabetes prevention & control measures All levels of education shall be involved in the program Partners : DOH, DECS, Association of private schools, PTA, student groups Focus: Primordial & primary prevention Client : school, community, family & studentpatients shall work closely with the community & hospital-based systems Minimum package of services: • Health education • Exercise & sports programs • Healthy food promotion • Screening & identification of diabetics • Clinic services • Referral • Organization of diabetic students,faculty & staff D. Program for the Workplace All workplaces shall be recommended & motivated to provide diabetes prevention & control services to their staff Partners: DOH, DOLE, privately run, occupational health groups, leading corporations and labor organizations Focus : Primordial, primary & secondary Client : Employees, family For industries with less than 100 employees: • Health education • Exercise & sports program • Stress management • Risk assessment • Referral For those with 100 employees or more: • Health education • Exercise & sports program • Screening for risks • Self-care and diet counseling • Clinic services • Referral to hospitals or to the community Summary 1. Epidemiology of DM 2. National Diabetes Prevention & Control Plan for the years 1999-2010 a. Vision/ Mission/ Goal/ Objectives b. Policies c. Strategies
d. Levels of Program Intervention e. Different components of Program Implementation
Diabetes Mellitus
Maribel U. Cruz, M.D.
Session Objectives 1. To discuss the epidemiology of DM 2. To discuss the National Diabetes Prevention & Control Plan a. Vision/ Mission/ Goal/ Objectives b. Policies c. Strategies d. Levels of Program Intervention e. Different components of Program Implementation Epidemiology • • • • • •
Worldwide approximately 135 million people were afflicted in 1995 Number is expected to rise to 300 million in the year 2025 In 2000, the Prevalence rate for DM was 5.1% and IGT 8.1% Women had a higher prevalence than men The frequency of DM & IGT in urban and rural areas are about the same Prevalence increases w/ age, with a rise observed in the 50 yr. old age group
DM is a serious disease Leading cause of new cases of blindness 2x higher risk for heart attack & stroke 75% of deaths are due to atherosclerosis 5x more prone to gangrene 50% of non-traumatic amputation occur in people with diabetes 17x more prone to renal disease 25% of new cases of ESRD are among diabetic patients Leading Causes of Mortality Number and Rate / 100,000 Population Philippines, 1997
Subject: FCM 3 Topic: DIABETES Lecturer: Dra. Maribel U. Cruz Shifting /Date: November 12, 2008 Trans group: Ces.Kix.Pau.May
NUMBER
RATE
1. Diseases of the Heart
CAUSES
49,962
69.8
2. Diseases of the Vascular System
38,693
54.1
3. Pneumonia
30,811
43.1
4. Accidents
28,563
39.9
5. Malignant Neoplasm
26,842
37.5
6. Tuberculosis, all forms
23,056
32.2
7. COPD
11,807
16.5
8. Other diseases of the Resp. System
6,961
9.7
9. Diabetes Mellitus
6,749
9.4
10. Nephritis, Nephrotic syndrome
6,704
9.4
Leading Causes of Mortality Number and Rate / 100,000 Population Philippines, 2000 CAUSES
NUMBER
RATE
1. Diseases of the Heart
60,417
79.1
2. Diseases of the Vascular system
48,271
63.2
3. Malignant Neoplasm
36,414
47.7
4. Pneumonia
32,637
42.7
5. Accidents
32,355
42.4
6. Tuberculosis, all forms
27,559
36.1
7. COPD & allied conditions
15,904
20.8
8. Conditions fr. Perinatal period
15,098
19.8
9. Diabetes Mellitus
10,747
14.1
10. Nephritis, Nephritic syndrome, Nephrosis
7,963
10.4
Leading Causes of Mortality Number and Rate / 100,000 Population Philippines, 2002 CAUSES
NUMBER
RATE
1. Heart diseases
70, 138
88.2
2. Vascular system diseases
49,519
62.3
3. Malignant Neoplasm
38,821
48.8
4. Pneumonia
34,218
43
5. Accidents
33,617
42.3
6. Tuberculosis, all forms
28,507
35.9
7. COPD & allied conditions
19,320
24.3
8. Conditions fr. perinatal period
14,209
17.9
9. Diabetes Mellitus
13,922
17.5
9,192
11.6
10. Nephritis, Nephritic syndrome, Nephrosis
The National Diabetes Prevention and Control Program Situationer The National Diabetes Prevention and Control Plan for the years 1999-2010 is a 12-year program of action MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI
Subject: Topic: Page 2 of 6
Major thrusts of the Program: 1. Promoting lifestyles that deter the development of Diabetes among individuals and risk reduction 2. Training & promotion of self-care and community mobilization for known diabetics Risk Factors Non-Modifiable Risk Factors 1. Family History 2. Age 3. Sex 4. Race Modifiable Risk Factors 1. Diet 2. Body Weight 3. Smoking 4. Alcohol 5. Sedentary lifestyle 6. Birth weight 7. Migration Risk Factors • Previous history of IFG / IGT • Poor obstetrical history in women • Hypertension • Dyslipidemia • Coronary Artery disease • Cerebrovascular accidents Situationer Diabetes prevention & control activities shall be established in the ff. venues: 1. Communities 2. Hospitals 3. Schools 4. Workplaces • DOH shall coordinate closely with different inter-sectoral partners in the implementation & management of the program Vision A Filipino Nation empowered to prevent Diabetes & its complications in themselves, in their families and in their communities by year 2010 and thereafter Mission Take advantage of and create opportunities to establish Diabetes awareness, information, education & medical and allied services within the reach of each and every Filipino Goal
Reduce the health and social impact of Diabetes among Filipinos by: • Making at least 90% of Filipinos aware of what Diabetes is by the year 2004 through 2010 and thereafter • Reducing the rate of increase of prevalence of Diabetes to 5% per year starting 2004 to 2010 Objectives The program shall ensure that the following objectives are met: 1. The development of strategies & programs including awareness campaigns & the continuing education of health personnel and concerned individuals to prevent DM and its complications 2. The adoption of cost-effective & appropriate screening methods for the detection of DM & its early and pre-symptomatic stages Objectives 3. The investigation into the epidemiology , etiology, diagnosis, treatment, prevention & control of DM 4. The evaluation of measures employed including drug & diet therapies in the control of DM 5. The establishment of mechanisms to reduce the socio-economic impact of DM on affected individuals and families Objectives 6. The granting of incentives & support for organizations of affected individuals and families 7. The establishment of coordinated health systems, w/c shall involve clinicians , researchers, allied health professionals, community-based health workers & lay volunteers for dealing w/ DM and its complications Objectives 8. The participation of LGUs alongside concerned gov’t. agencies & NGOs in the implementation of programs on DM prevention and control 9. The periodic review of research needs & potential in the control of DM 10. The systemic utilization of public & private resources to achieve the objectives enumerated above: and 11. The recommendations of the Commission for legislation Policies 1. Program resources & energies shall be focused on the Primordial & Primary levels of prevention
Subject: Topic: Page 3 of 6
2. The program shall primarily focus on the age group of 0 – 21 years. o Secondary targets are adolescents & adults not yet suffering from DM o Tertiary targets are those known to have DM 3. Self-care, self-reliance & co-responsibility for the health of one’s family and community shall be among the values to be promoted 4. Medical & other health services by the program shall involve the active participation of families & communities 5. The DOH shall work closely with all levels in the education department and develop active linkage with agencies involved in communication sciences and behavior modification 6. Major program strategies & approaches shall have built-in measures of effectiveness & efficiency & shall be monitored & evaluated at strategic periods of time so that adjustments can be made in favor of achieving program goals 7. It shall be the priority of the National Diabetes Commission , its succeeding & advisory bodies and the DOH to identify and source out funding for the program 8. The program shall ensure that its implementers & partners shall develop active linkage , provide technical inputs or participate in legislative & social marketing activities of sectors related to or affecting health Strategies I. Phasing-in of Implementation The 12-year program shall be phased into three: 1. Preparing the groundwork – first 3 years 2. Weakening the bastions of Diabetes – next 3 yrs. 3. Controlling Diabetes & assimilating healthy lifestyles into the Filipino culture- last 6 years Each phase shall be concluded by an evaluation & re-planning activity The achievement of the end goals or outcomes for each stage will indicate the beginning of the next phase Phases of the NDPCP A. PREPARATORY PHASE ( 1999-2001) Major Activities : Create & increase public awareness on DM ; identify, organize & mobilize partners; source funds; intensify studies and researches
Other Activities : Train health workers;
design multilevel school curricula; initiate legislative agenda; establish networks Expected Outcome: Information, resources & active supporters for the program are adequately available
B. INTENSIVE PHASE ( 2002 – 2004 ) Major Activities : Counter initiatives and influences favoring development of DM; promote healthy lifestyles; provide full-scale logistics support; implement school curricula Other Activities: Implement services at the community, schools, workplace and hospitals ; support expansion of Diabetes consortia ; monitor and continue training Expected Outcome: Influence of factors favoring Diabetes & its complications is weakened C. MAINTENANCE PHASE ( 2005 – 2010 ) Major Activities : Sustain, improve and update pertinent communication strategies; upgrade health services & networks for diabetics; upgrade educational materials Other Activities : Monitor & evaluate ; strengthen specialty facilities, institutionalize training; design succeeding program plans Expected Outcome: Filipinos adopt healthy lifestyles & are able to access diabetes related services II Strategic Clustering A group of centrally managed program components shall be planned, administered &/or implemented by the DOH in coordination w/ its partners who are organized into strategic clusters Each cluster shall respond to one or two special concerns or objectives of the program The activities shall complement & support direct program services intended for the community, school, hospital & workplace Major • • • • • •
Clusters Management Advisory Cluster Legislative Action Cluster Research & Information Cluster Resource Mobilization Cluster Public Information Cluster Formal Education Cluster
Subject: Topic: Page 4 of 6
• •
Social Mobilization cluster Clinical Diagnosis & Case Management Cluster
Management Advisory Cluster • Program administration • Steer and coordinate all program clusters • Formulate program policies & standards
•
• •
Assist the Clinical Diagnosis & Case Management Cluster to identify the standards of health care to diabetics and their families Provide technical & logistics assistance to service delivery units Facilitates monitoring & evaluation of the program
Research and Information Cluster • Research and development
•
•
It shall have representatives from the DOH the Institute for Studies on Diabetes Foundation & the Phil. Council for Health Research & Development Priority areas for research include : • Epidemiology of Diabetes • Prevalence of known risk factors • Diagnosis & management of Diabetes
Legislative Action Cluster • Legislative agenda and function • Identifying program goals on behavioral & policy changes that require the force of law • Formulate legislative agenda & plan of action to mobilize lobby groups to support their proposed bills or oppose laws that are detrimental to health • Priority areas for legislation include : • Tax exemption for the importation of oral anti-diabetic drugs, insulin & monitoring devices • Controls the importation , manufacture & sale of tobacco and alcohol Formal Education Cluster • Education and training program • Formulate & institutionalize the Diabetes curricula fit for the different levels of education • Design training modules for the different categories of health workers • The Diabetes curricula shall include value re-orientation in favor of healthy lifestyles • Works in coordination with the cluster in charge of public information
•
CME shall be designed for all program implementers in the public & private sector
Public Information Cluster • Mass communication & public information • Disseminate life-saving information on the prevention of diabetes & its complications • Develop a long-term, data-based communication & public information plan specific for children, their caretakers and infuencers Social Mobilization Cluster • Responsible for identifying & developing organizations that shall support direct program services , legislative and educational agenda, information plan and material resource mobilization • Community level – families shall be the nucleus of action • At schools – teachers, faculty & children coming from families at risk of developing Diabetes • Workplace & Hospitals – core group is composed of Diabetics & members of families at risk Resource Mobilization Cluster • Resource development & management • Ensures that resources are adequate, available, distributed where they are needed The National Diabetes Act of 1996 provides for: Granting of incentives & support for organizations of affected individuals and families Systemic utilization of public & private resources to achieve the objectives of the program Levels of Program Intervention The NDPCP shall intervene at all levels of disease prevention: Primordial, Primary, Secondary and Tertiary Primordial : (-) risk, (-) disease Primary : (+) risk, (-) disease Secondary : (+) risk, (+) disease Tertiary : (+) disease, (+) complication Primordial Prevention Focuses intervention on all Filipinos regardless of predisposition of the disease Program activities shall aim to : 1. Assist Filipinos in developing , maintaining or shifting to healthy lifestyles
Subject: Topic: Page 5 of 6
2. Dissuade them from acquiring or keeping unhealthy habits Primordial Prevention • Information campaign for the general population • Most interventions for primordial prevention shall be packaged for the consumption of children and their caregivers • Targeting of scientifically-packaged information to the major influencers of health behavior in the Filipino society • Mass media & interpersonal communications shall be used to convey appropriate information to specific influence groups Primary Prevention • Preventing the development of DM among those at risk of developing the disease • High risk individuals can be clustered into families • Interventions shall focus on families rather than on individuals • Screening of risk factors, education and counseling, diet or behavior modification techniques, laboratory work-up shall be focused on the family Secondary Prevention • Involves early detection & prompt treatment of DM to prevent complications • It is important that the program contributes to the disability-free life years of the diabetes case • The first step is to identify diabetes cases • Requires screening for the diabetes risk factors among families and individuals at the barangay level followed by referral & confirmation of the diagnosis at higher levels of care • A special health service package shall be provided for confirmed diabetics & members of their families w/c shall include: clinical, dietary & psychological counseling support group organization family therapy medical services laboratory monitoring Tertiary Prevention • Involves preventing further disability providing access to rehabilitation services • Effective networking among hospitals, of clinics with hospitals & among specialists in the different fields of medicine is essential
Components of Program Implementation The NDPCP recommends and supports the implementation of a standard package of services specific to 4 different venues: 1. Community-based program 2. Hospital-based program 3. School-based program 4. Workplace-based program A. Community-Based Program Base: RHU-BHS network Shall work for a strong linkage between gov’t. & non-gov’t. health facilities at the community level Partners : DOH, DILG, LGUs Focus : primordial & primary prevention Client : family and the community as a whole Minimum package of services : • Public information & health education • Advocacy & social mobilization for healthy lifestyle & healthy foods • Physical fitness & exercise programs • Screening for risks, signs & symptoms of diabetes • Medical,self-care, dietary & psycho-social counseling • Referral of suspected diabetes cases to higher levels of care, follow-up of referrals • Support for organization of diabetes patients, their families & diabetic support groups B. Hospital-Based Program Primary level hospitals have a package of services similar to the community-based program Secondary & Tertiary level hospitals shall deliver higher levels of care to those at risk or suffering from diabetes Partners : DOH, private hospitals, NGOs Focus : Secondary & tertiary prevention Client : patients and their families Support the community, school and workplace based components of the program Minimum service package: • Screening of walk-in patients • Medical & dietary counseling • Referral of cases for community based activities or to other specialized services • Follow-up of referred cases • Early diagnosis & laboratory monitoring
Subject: Topic: Page 6 of 6
•
Management of the complications of diabetes
C. School-Based Program Schools are encouraged to carry out various forms of diabetes prevention & control measures All levels of education shall be involved in the program Partners : DOH, DECS, Association of private schools, PTA, student groups Focus: Primordial & primary prevention Client : school, community, family & studentpatients shall work closely with the community & hospital-based systems Minimum package of services: • Health education • Exercise & sports programs • Healthy food promotion • Screening & identification of diabetics • Clinic services • Referral • Organization of diabetic students,faculty & staff D. Program for the Workplace All workplaces shall be recommended & motivated to provide diabetes prevention & control services to their staff Partners: DOH, DOLE, privately run, occupational health groups, leading corporations and labor organizations Focus : Primordial, primary & secondary Client : Employees, family For industries with less than 100 employees: • Health education • Exercise & sports program • Stress management • Risk assessment • Referral For those with 100 employees or more: • Health education • Exercise & sports program • Screening for risks • Self-care and diet counseling • Clinic services • Referral to hospitals or to the community Summary 1. Epidemiology of DM 2. National Diabetes Prevention & Control Plan for the years 1999-2010 a. Vision/ Mission/ Goal/ Objectives b. Policies c. Strategies
d. Levels of Program Intervention e. Different components of Program Implementation
