Community Based Diabetes Prevention and Management Program
According to the International Diabetes federation, "Currently there are 370 million indigenous people worldwide, representing 5% of the world's population. While the percentage of indigenous peoples is low, the burden of diabetes on indigenous peoples is undeniable. 50% of indigenous adults over 35 years of age have type 2 diabetes."
Diabetes is reaching an epidemic stage among Aboriginal people. It is estimated that approximately 48% of the First Nations population above 45 years old in Canada have diabetes. Aboriginal children are also now being diagnosed with Type 2 diabetes, a condition that in the past occurred mainly in older persons. Through community initiatives, based on traditional holistic and western medicine integrated approaches, building trust, and respect of peoples cultures and traditions; diabetes can be prevented and managed.
Empowerment through knowledge and ownership of the challenge is what Diabetes and My Nation is about. A model developed by Diabetes Task Force Solutions , the program was implemented at the Haisla First Nation.
Diabetes Task Force Solutions is a team of professional healthcare providers, and patients with considerable business expertise, to ensure that our solutions are evidence based, comprehensive, cost effective, and sustainable. DTFS has worked with a group of First Nations elders with vast experience in the fields of health management, residential schools, education, and First Nations healthcare providers to customize and implement Diabetes and My Nation.
Improve the health outcomes of the Aboriginal people living with diabetes and other chronic diseases through a holistic approach that integrates traditional healing and traditional learning methods, with modern medicine and advanced technology.
Diabetes and My Nation initiative is a community based health management program to achieve evidence based outcomes for the prevention and management of diabetes (Type 2 diabetes Mellitus – T2DM) in First Nations communities. It applies culturally appropriate and holistic methods, and includes all age groups including youths but not infants in the community.
The program has evolved through the contribution of a First Nation leader, a strategy developer, (both of whom have Type 2 diabetes) and a diabetes specialist, with extensive consultation with community members, First Nations healthcare professionals, and healthcare professionals from both federal and provincial programs with actual experience working with First Nations communities.
The program consists of six integrated components: Awareness and Motivation, Education, Management and Monitoring, Treatment, Prevention, and Diabetes Management Software. Diabetes Nurse Educators play an integral part in the implementation of the program as the main point of contact for monitoring patients and coordinating treatment activities. This provides intimate motivational access to healthcare which permits alternative and cost effective approaches to all aspects of diabetes management.
Since each First Nation is different from other Nations in term of level or readiness, resources, and relations with the healthcare system, the implementation of the various components of the initiative has a degree of flexibility to allow adjustments in each community. The goal and objectives, however, are the same for all communities.
Among the major challenges facing remote community is access to healthcare, particularly diabetes specialists. We developed the Virtual Diabetes Centre to provide local community nurses with a user friendly diabetes clinic visit forms allows nurses to interview patients and record medical data that generates professional reports for virtual access by healthcare providers from anywhere and recommend treatments based on current and historical medical records.
Virtual Diabetes Center's Diabetes Case Management enables immediate transfer of this information to consultants in Endocrinology and Ophthalmology. As a result, complete recommendations for changes in therapy are provided “on line,” via a secure system to the primary care physicians. For more information please visit the Virtual Diabetes Centre website.
Managing chronic diseases such as diabetes requires a comprehensive approach that addresses all aspects from motivation to education, screening, monitoring, treatment, and adoption of healthy lifestyle. It also requires the infrastructure support from the healthcare team and services to funding and information technology. These requirements applies to each individual with diabetes on the micro level and also to any community based initiative on the macro level. Overall all of these activities must address the culture and level of readiness to receive and apply these programs on the individual and community levels. Community based programs must also addresses prevention and management, including all age groups. Although it sounds like a massive task, the key is integrating these activities within existing programs.
Diabetes and My Nation model consists of different integrated programs, these programs evolved through the interaction with different communities and individuals; these programs could apply as is to a specific community or modified to meet that community settings from available resources to culture.
Managing and preventing chronic diseases is not a short term initiative, it is long term, there is no cure for diabetes, individual with diabetes need support and monitoring for the rest of their life, also the programs they adopt has to evolve as they age; therefore, it is preferred that any program to be self sustained by the individual and/or communities.
The diabetes awareness and screening gathering is a community event to share traditional food and activities, share knowledge about diabetes from healthcare professionals and community members, and provide community members an opportunity to test if they have or at risk of developing diabetes.
These gatherings are held at each of the First Nations communities where community members shared traditional food, dancing and singing. They also shared knowledge about diabetes and how to prevent and manage it, applying traditional healing and modern medicine. These events presented opportunities for local healthcare providers and local services for building bridges with the communities. Screening for diabetes was carried out by a certified healthcare professional from healthcare authorities and/or local pharmacies and healthcare workers. At the end of the awareness gathering, community members were invited to join the Circle of Diabetes Self-Management, physical activity and nutrition programs, and diabetes educational activities.
Screening is carried out by certified healthcare workers for the following: Blood Sugar, Blood Pressure, A1c (if Blood Sugar level is over 11.1 mmol/L or the person has Type 2 diabetes), Weight, Height, and Waist Circumference.
A program for youth in the 14 – 20 age groups, promotes diabetes prevention through learning about their culture. In this case, this was accomplished by participating with the community in carving a canoe. They also participate in “Learn and Share” program; the youth under the supervision of community elders gather traditional food and learn about their culture and how it could prevent diabetes, they also prepare the food for their families and also share it with community elders (food security program).
Youth will produce a video to document the process and also customizing their “Diabetes and My Nation” DVD by including their traditional healing practices. They will learn about diabetes and how to prevent and manage it, take a pledge to avoid drugs, alcohol, and un-healthy food and drink; they will also participate in a traditional physical activity such as dancing, fishing, and/or hunting. Youth are also encouraged to join homework club if it is available at their community.
Haisla's youth program logo designed by Cassidy
Learn and Share - Haisla Youth 2009
Haisla First Nation - Canoe
Through consultation with the elders and youth of a number of First Nations, a number of traditional and non-traditional physical activities were started. Any of these activities must be associated with diabetes education, screening, and monitoring. Among these programs are:
Diabetes and My Nation Basketball Tournament
To ensure the success of any health management initiative it has to be integrated within an established framework. The Expanded Chronic Care Model identifies essential elements in a system that strives for enhanced chronic care management. Diabetes and My Nation team worked with the Haisla First Nation to implement the Expanded Chronic Care Model, (theoretical model) as part of their overall health program. As a result, the Haisla First Nation health program was select on one of the 8 best practices in Canada in 2008 by the First Nations and Inuit Health Branch, Health Canada.
These Expanded Chronic Care Model elements include:
Diabetes and My Nation utilizes the Chronic Diseases Management (“CDM”) Tool Kit to provides access to client data for timely care, reminders, and feedback for patients and providers
Diabetes and My Nation developed a simple database of people who were screen for diabetes and hypertension during the Diabetes Awareness and Screening Gathering to identifies relevant subpopulations for proactive care
The local diabetes nurse shares the information with local family physicians and designated diabetes specialist to coordinate care
The CDM Tool Kit and the database are used to monitor quality improvement efforts in practice and care systems; validate new integrated programs/services; measure broad based outcomes on health and well-being, as well as, clinical outcomes
The diabetes nurse is working with the Ministry of Health on required modification of the CDM Tool Kit to meet the requirements of Diabetes and My Nation
VPM key allows remote access to nurse educator’s home computer work station and northern health lab data base thus providing up to date and timely reporting of information to clients & reduces self management time
Diabetes is not only a medical problem. It is a socio-economic challenge to the community. A successful diabetes prevention and management program must integrate all aspects that affect the person with diabetes, from motivation to social support with constant monitoring by the health care professionals. It is not only the responsibility of health authorities; it is the responsibility of all stakeholders, from families, community leaders, educational authorities, sports and healthy living groups and industries. Empowerment of patients through culturally appropriate education, supporting the communities through establishing an infrastructure of trained healthcare providers and healthcare system, and developing long-term strategies are the key components to the comprehensive diabetes prevention and management program.
Diabetes and My Nation team would like acknowledge the First Nation and Inuit Health Branch for funding the pilot project of this model, Vancouver Coastal, Interior, Vancouver Island, North Health Authorities, and BC Ministry of Sports and Healthy Living and ActNow BC for their support. Also Merck Frosst Canada, GSK, LifeScan, and Shopper Drug Mart were among the supporter of the initial stages of the program. Siemens Canada donated 4 DCA 2000 analyzers to the communities. Special thanks to the Sliammon First Nation; and the Haisla First Nation and Haisla people, and their Chief and Council and the Health Department, Social Department and School; and all other First Nations in BC and members of the community, and volunteers who have participated in the pilot project of Diabetes and My Nation.
Working together to improve diabetes care