Pilot Project Raises Diabetes Awareness in Brazil and India

Miriam E Tucker

December 14, 2015

VANCOUVER, British Columbia — A school-based educational program piloted in Brazil and India has raised awareness about diabetes and diabetes prevention among children, parents, and school staff.

The Kids and Diabetes in Schools (KiDS) project is administered by the International Diabetes Federation and funded by Sanofi Diabetes. Findings from the two-nation pilot study were presented December 3 here at the World Diabetes Congress 2015.

According to the IDF's Diabetes Atlas, 7th edition, also released here at the meeting, Brazil has the fourth-largest population of adults with diabetes in the world, at 14.3 million, and the third-highest number of children with type 1 diabetes, at 30,900.

India is number 2 on both measures, with 69.2 million adults with diabetes and 70,200 kids with type 1 diabetes, respectively. (Data are not collected for type 2 diabetes in children.)

The aim of the KiDS project is to educate people about type 1 and type 2 diabetes, as well as provide healthful lifestyle information to help prevent diabetes among all stakeholders, Denise Reis Franco, MD, education director of ADJ Diabetes Brasil (the Brazilian juvenile diabetes association), told Medscape Medical News in an interview.

"The main purpose was to try to diminish the discrimination against the disease but also stimulate changes in habits, eating better, having more fruits and vegetables, and being more active. We're not only [helping] the persons with diabetes in the school, but we're also trying to prevent the growing epidemic disease that is type 2 diabetes," Dr Franco said.

Project Kits Available in Eight Languages so Far

Materials are available free at www.idf.org/education/kids, with separate information packs for teachers, parents of a child with diabetes, parents of school-aged kids without diabetes, and for children aged 6 to 14 years, with or without diabetes.

Thus far the kits are available in English, Spanish, Portuguese, Hindi, Arabic, Chinese, French, and Russian.

"The KiDS resources are available in several languages to support implementation in many countries. We are looking into formal evaluation in both a Spanish- and French-speaking country as the next stage," David Cavan, MD, IDF director of policy and programmes, told Medscape Medical News.

Dr Cavan added, "Doctors should be aware that a child with diabetes faces many challenges in school and possible stigma and discrimination and exclusion from certain activities. They can use the KiDS resources to support their patients and their parents and teachers."

Diabetes Education Reaches Brazil's Schools

In the pilot program in Brazil, 1-day training in the KiDS program was provided to 9944 students (including 26 with type 1 diabetes), 247 school staff, and 33 parents and caregivers of students with type 1 diabetes in 15 schools, 13 of them in São Paulo and two in the north of the country.

Overall, in Brazil and India, around 1400 teachers and 40,000 students have been trained.

Qualitative interviews were conducted in both countries at 1 and 3 months following the program at 10 schools, with approximately 30 staff members, six parents of children with diabetes, and two parents of children without diabetes interviewed at both time points in Brazil. In India, 20, three, and 15, respectively, were interviewed at 1 month, while subsequent interviews varied in number and timing.

A staff member at a private school in Brazil commented: "You have explained in a few pages and in a very easy language everything we need to know. There weren't technical terms or difficult words. I keep it in my bag so that if I have any doubts I can take it out and read it. It became like a small reference, I think it's easy and at the same time it has proved to be a great support for us."

A parent of a child with diabetes at a Brazilian public school said: "The good thing was that it didn't happen only among the teachers, but the whole school. So, there was more awareness about diet among students, teachers, and nurses."

Meanwhile, a parent of a child without diabetes at a private Indian school commented: "Earlier the diabetic child was not allowed to play and was asked to sit in one place but after reading this book they treat them as a normal child."

"Coming Out" With Regard to Diabetes

Dr Franco said one of her favorite outcomes was an 8-year-old child who told the school director that he had diabetes only after the intervention.

Prior to that, he hadn't felt comfortable telling anyone at school. "He was afraid of being discriminated [against]. I know a lot of patients who don't like to talk to anyone else about diabetes," she said.

There were no major differences between the 1- and 3-month interviews, suggesting retention of the information. "The biggest change related to knowledge....School staff felt more prepared to have a kid with diabetes," Dr Franco stressed.

Following the success of the pilot project, IDF is now working to broaden the program internationally and engage governments to incorporate the program into school curricula.

By November 2015, the pack had been downloaded 7976 times worldwide, 39% in southeast Asia, 34% in Central and South America, 12% in North America, 7% in Europe, 4% in the Middle East/North Africa, 3% in the Western Pacific, and 1% in Africa.

According to Dr Cavan, "Now by working together with governments we can extend the reach of the KiDS project and work to help many more children with diabetes to reach their full potential."

The KiDS project is funded by Sanofi. Dr Franco has participated on advisory panels for Sanofi and Bristol-Myers Squibb; is a board member of Eli Lilly, Sanofi, and Roche Diagnostics; received consulting honoraria from Medtronic; received research support from Sanofi, MannKind, and Eli Lilly; and belongs to speakers' bureaus for Sanofi, AstraZeneca, Medtronic, Eli Lilly, Bristol-Myers Squibb, and Roche Diagnostics. Dr Cavan has no relevant financial relationships.

World Diabetes Congress 2015. Presented December 3, 2015.

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