Development of a protocol for behavioural risk factors surveillance among the Iranian type 2 diabetic patients

Abstract

Background: Given the importance and prevalence of type 2 diabetes, close attention to the disease process and its complications is pivotal. Nephrotic disorders, visual disturbances, and disabilities and injuries to the nervous system, are the examples of the disease’s complications. Provision of proper care to patients with type2 diabetes can prevent the development of these complications. Global prevalence of diabetes is about 6.4% and thus it is estimated that more than 280 million people have the disease around the world . The prevalence of diabetes in the Iranian adults (25 to 64 years) is estimated to be 7.7% but only half of these cases have been diagnosed. This study was designed to analyze the nation's health care system in terms of how care in patients with type 2diabetes according to the standards and protocols for care and treatment worldwide. Moreover recognition of behavioral risk factors in patients with type 2 diabetes in Iran and provide a scientific framework for developed a protocol of care of these patients, the main goal of the project is considered. Methods: This study was conducted in four stages. The first three steps are performed based on the results of a review of the literature that are: The first part of the study based on a systematic review of literature to identify current protocols of care for patients with type2 diabetes worldwide. In the second part, program of the care of patients with type2 diabetes in Iran was compared with the structure of a standard protocol which was framed based on the findings of the first stage (gap analysis). In the third section, a systematic review was implemented to identify common reported risk factors among the Iranian people with type 2 diabetes. PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analysis) protocol was used to report the findings of the systematic reviews. But the fourth phase that includes the main section of research is a pilot study to assess the status of a sample of Iranian diabetic patients. Stratified sampling method was used in this cross sectional study to recruit 234 type II diabetic patients from a list of 600 registered patients in the only diabetes clinic of the city of Khoy. Data about the behavioral risk factors and diabetes related complication(s) were collected by a semi structured questionnaire in face to face or telephone interview. Proportions and confidence intervals of the observed difference were calculated to summarize binary variables by the Confidence Interval Analysis (CIA) software version 2.2.0. Results : The main results of this study includes : In the search of diabetes management protocols 8 protocols were identified. Comparison of the Iranian national protocol for control of diabetes with the frame work promoted based on the identified protocols in the first stage indicated insufficiencies and dimensions that need to be revised. Obesity, especially abdominal obesity, is the most important behavioral risk factor for type 2 diabetes. Bases on the findings of the fourth stage of this study, diabetes complications were evident in 67.2% of the patients. Inappropriate dietary pattern, insufficient physical activity and anxiety were reported by 26.5%, 74.8% and 69.7% of the respondents. Most are diagnosed by a physician after referral patients and the most important step after diagnosis was medication and referral to a specialist but behavioral training to the patients or their relatives, there have been very few cases. Quality of life was affected in 94.6% of the respondents but its burden was significantly greater in females (P<0.05, 95% CI of the difference: -0.75 to -0.53). Conclusion: The study findings indicated gaps in our current diabetes management protocol. It was also evident that the diabetic patients in the studied sample were in higher risk of developing diabetes complications. High prevalence of the diabetes complications among the studied patients highlights the health and economic burden of the disease to the country. We suggest an urgent revision in our national diabetes management program.