Diabetes effectively managed by community health workers
MedWire News: Diabetes and hypertension can be effectively managed in middle-income countries through use of primary care systems with trained community healthcare workers and well-established guidelines, shows a study from Iran.
"Despite its success in diabetes prevention and control, the absence of a national program with well-developed guidelines has rendered the Iranian primary healthcare system virtually ineffective in lowering population blood pressure… despite the availability of individual and population-based interventions," say Majid Ezzati (Imperial College London, UK) and colleagues.
They add: "Our results suggest that the primary healthcare system, with a sufficient number of health workers and a program with well-defined guidelines and individual follow-up of patients, can effectively manage chronic disorders such as diabetes."
Using data from the 2005 Non-Communicable Disease Surveillance Survey (NCDSS), the researchers gathered information on fasting plasma glucose (FPG), systolic blood pressure (SBP), body mass index (BMI), medication use, and sociodemographic variables from 65,619 individuals aged 25 years or older.
Data for Behvarz-worker and physician densities were obtained from the 2006 Population and Housing Census and the 2005 Outpatient Care Center Mapping Survey. Using this information, the researchers then investigated the effectiveness of FPG and SBP treatment, and the associations between FPG or SBP and Behvarz-worker density.
Study findings revealed that the prevalence of diabetes, but not hypertension, was significantly higher in urban areas compared with rural areas (8.5 vs 5.6). Overall, the incidence of diabetes and hypertension was significantly higher among women than in men (8.5 vs 6.6 and 20.2 vs 15.8, respectively).
Patients with diabetes or hypertension had received an official diagnosis in 55.8% and 49.2% of cases, respectively. In addition, 39.2% of patients with diabetes and 35.7% of those with hypertension received medication, with higher treatment coverage seen in women than in men (42.6 vs 34.5% for diabetes and 44.1 vs 24.9% for hypertension) and in urban areas compared with rural areas (41.4 vs 33.0% for diabetes and 38.1 vs 31.3% for hypertension).
Diabetes treatment was found to lower FPG by an average 1.34 mmol/L in rural areas, but only by 0.21 mmol/L in urban areas. Individuals with hypertension who lived in urban areas and had received treatment had 3.8 mmHg lower SBP than if they had not received treatment, while the treatment effect was 2.5 mmHg lower SBP in rural areas.
Each additional Behvarz worker per 1000 adults was significantly associated with a 0.09 mmol/L lower average FPG and nonsignificantly associated with a 0.53 mmHg lower SBP.
"Iran's primary care system should expand the number and scope of its primary healthcare worker programs to also address blood pressure and to improve performance in areas with few primary care personnel," conclude the authors in The Lancet.
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By Ingrid Grasmo