Diabetes education the Arab world. A call for action

Diabetes education is effective for improving clinical outcomes and quality of life. The barriers to patient education in the Arab World include: Attitude of the administration and policy makers, the negative view of health professionals and patients towards education, lack of curriculum / programs, lack of trained/certified personnel in the field of Therapeutic Patient Education [TPE], economic barriers, misconcepts, environmental and ecological barriers, lack of legislation for food labels, lack of premises for TPE, the absence of a positive role for the patients in their therapeutic choices, unawareness of patients about their rights, lack of time for both the patient and health care providers and high prevalence of illiteracy. Strategic plans should address all these barriers. Content areas that need to be addressed are determined in collaboration with the patient. Any health care professional can provide diabetes education. The lack of trained personnel in the domain of TPE in our region dictates the need to fill this gap by adopting a strategic plan, implemented in successive steps, starting by the formation of a number of Health Care Professionals [HCPs] in short term training. This document is a call for action, inviting all who are concerned with diabetes to establish national diabetes programs in the Arab World, and to start to undertake educational initiatives

Recommendations for management of hyperglycemia in type 2 diabetes in the Arab Countries based on the consensus statement from the American Diabetes Association [ADA] and the European Association for the Study of Diabetes [EASD]

We would like to emphasize that stepwise interventions will help to achieve glycemic goals. Unfortunately there are barriers to effective management of hyperglycemia in type 2 diabetes, particularly in much of the Arab world [38]. We would like to emphasize that antihyperglycemic therapies with the possible exception of TZD should be titrated frequently [at intervals of days to at most weeks] based on glucose levels achieved and tolerability. Most patients can achieve A1C levels less than 7% in a matter of a few months. Suboptimal healthcare systems impede achievement of glycemic goals. Other barriers to effective management include insufficient communication with patients due to limited physician consultation time. This often contributes to inappropriate prescription of medications which patients cannot afford or will not tolerate and contributes to poor adherence. A multidisciplinary team approach to diabetes care - involving diabetologists, primary care providers, diabetes specialist nurses, pharmacists, dieticians and health educators, among others, with the patient at the centre of the team - has been demonstrated to improve both glycemic control and patient quality of life [39]. Equally or arguably more critical to optimizing patient outcomes is adequate treatment of comorbid conditions [e.g. dyslipidemia, hypertension, hypercoagulability] and early complications [e.g. retinopathy, microalbuminuria and the insensate foot]. A team approach with appropriate attention to patient education, motivation and adherence is critical to success, even if the team is just a patient and a primary care provider working together in a context of mutual respect with shared goals, understanding of their individual roles and open communication [40]. We strongly feel that these basic principles should guide every practitioner working with every patient with type 2 diabetes to ensure optimal care in their individual circumstance with an overall aim of reducing the proportion of patients who do not achieve control of diabetes with its asso-ciated omorbidities and complications from current levels of more than 60% [41,42]. Putting into consideration the local concerns mentioned above, our group supports the ADA/EASD consensus algorithm. Our aim is to highlight specific barriers in the Arab world and to adapt these recommendations to be more consistent with local circumstances in our countries