Tajikistan: "Back to school" for people living with diabetes

For the 60 million people living with diabetes in the WHO European Region, patient education plays a crucial role in their ability to manage the disease. In Tajikistan, where the diabetes morbidity in 2015 was 540 per 100,000, a collection of "diabetes schools" have been established to share vital health information with thousands of people who would otherwise have no way to access it.

The task of diabetes education has generally fallen to primary care physicians. But these family doctors, already overburdened with work, often do not have specific training in the disease. To help support and enhance the education provided by primary care physicians, the national programme for the prevention and treatment of diabetes has founded a total of six diabetes schools since 2012 – one at the republican centre (national level) in Dushanbe and five at the regional level. These schools offer a seven-day training course with specific tracks for type 1 and type 2 diabetes.

The doctors who oversee the schools and manage the trainings participated in a diabetes course held in Uzbekistan, which provided them with deeper knowledge and training on the disease. Key donors and local non-government organizations also support the schools, by: assisting with trainings, providing educational materials for dissemination, and securing equipment, such as computers, for use within the schools. In 2015, approximately 1 000 people attended the training sessions at the republican centre, coming from all around the capital region.

Although 90% of diabetes in the country is type 2, the majority of training attendees have type 1 diabetes. These trainings often include both children with the disease, as well as their caretakers and families. The diabetes school provides an important opportunity for the doctors and nurses to interact not only with the patient, but also with the network of people who will support them in managing the disease. The training for type 1 diabetes stresses the importance of insulin therapy and provides guidance and counseling on how to best adhere to insulin treatment. There is also a strong focus on nutrition and diet, with hands-on interaction with healthy food products and recipes.

The focus for type 2 diabetes patients skews more heavily toward modifiable behavioral risk factors, such as overweight, physical inactivity and unhealthy habits such as tobacco use and alcohol consumption. People with type 2 diabetes also receive counseling on healthy nutrition.

The feedback from participants in the seven-day course has been largely positive. Many patients express their gratitude for the training and counseling they receive from the school, and they thank the doctors for giving them the knowledge and tools to avoid complications from diabetes. Patients who have successfully completed the course say they can see an improvement in their quality of life.

Unfortunately, challenges still persist for the diabetes schools, despite the progress made. Many attendees find it difficult to complete the full seven-day course, and 30-40% of those who begin the training do not fully complete it. Moreover, the quality of trainings at the regional level does not always match that at the national level, and some patients have expressed a wish to have an equivalent level of support in the regions. To improve the quality of support in the regions, doctors from the republican centre travel to the regions and conduct counseling and assist with school operations. The school in Dushanbe is also used as a facility to train doctors from other regions, providing them with the latest updates and information on diabetes care. Additionally, the schools will likely face issues related to financial sustainability in the coming years, which may need to be addressed through requiring a small fee for participation in the trainings, which are currently free.

Despite these challenges, the schools continue to play an important part in the national programme for diabetes prevention and treatment by offering vital, even life-saving, education for people living with diabetes in Tajikistan.