National program for diabetes control & prevention in Iran
To prevent and control diabetes and its complications in an early phase, Iran implemented the National Program for Diabetes Control and Prevention. This program was developed and implemented for the purposes of screening ‘individuals at risk’, and pregnant women. Individuals at risk consist of all people over 30 years old who have at least one risk factor as positive family history of diabetes, hypertension, overweight or obesity. Presently, the National Program for Diabetes Control and Prevention has been integrated into the national health system of Iran since 2004. The first stage of the program was implemented in rural areas of Iran and since then two rounds of screening have been held to cover non-covered portions of the country.
In this study, 41 medical universities located within 30 provinces in Iran were responsible for providing health care services to the population of interest, among them 11universities were selected randomly. Among the diabetic patients, diagnosed in national program of diabetes in these universities, 1,423 type 2 diabetic patients were selected randomly proportional to the size of diagnosed diabetic patients in each selected university and followed from 2010 until 2011.
In the first step, patients were divided in two groups; 1-Patients who received any care in past 12 months by family physicians; and 2- Patients who did not receive any visits from a family physician. Then, we divided those patients who received care according to the numbers of medical visits during the first year following a diagnosis with diabetes. Since in the National Program for Diabetes Control and Prevention each GP has to visit diabetic patients four times per year, the patients were grouped depending on receiving one to three physician visits during the first year and those who were visited four or more times by their family general physicians. For each patient a questionnaire was completed.
For those patients who received care, we compared the fasting blood sugar (FBS), HbA1c, Body Mass Index (BMI), systolic and diastolic blood pressure, and mean arterial pressure in these two groups of patients at the time of screening and after one year of diagnosis with diabetes.
Data on age, height, and weight were collected by the questionnaire during the medical examination. BMI was calculated by dividing body weight in kilogram by the square of body height in meters and used to define subjects as normal (BMI below 25), overweight (BMI from 25 to 30), or obese (BMI above 30). Within one week after filling out the questionnaire, all patients were referred to the laboratory for measuring HbA1c and FBS. All tests were performed in the same laboratory and the chromatography method was used to measure HbA1c.
All descriptive data are given as mean ± standard deviation, and as percentages when appropriate.
Analysis of covariance was done using general linear model, comparing three groups of diabetic patients to test difference in HbA1c adjusted for age, sex, BMI, and mean arterial pressure. Bonferoni post hoc test was applied to determine significant differences between specific groups on these variables. To compare the differences between variables in the time of diagnosis and 1 year after that, the paired t-test has been used.
The independent t-test was applied for comparison of FBS, BMI, and arterial pressure in two groups of patients; the patients who received appropriate care (at least 4 visits by GPs) and patients with no medical care. The statistical analyses were carried out with SPSS version 18.