DIABFRAIL - LATAM: Scaling-up of and evidence-based intervention programme in older people with Diabetes and Frailty in Latin America

Background

The EU-funded DIABFRAIL-LATAM project gathered a multidisciplinary team of academics, researchers and healthcare professionals to improve the quality of life and functional status of elderly diagnosed with diabetes. With high prevalence in ageing populations, diabetes is associated with medical comorbidity, functional loss and frailty, and visual and lower limb disability. The project built on results of three EU-funded projects (MIDFRAIL, FRAILOMIC and VIVIFRAIL) to scale up a multimodal intervention among elderly with diabetes in four Latin-American countries (Chile, Colombia, Mexico and Peru).

Aims

To scale-up a multi-modal intervention in subjects with type 2 diabetes Mellitus aged ≥ 65 years who are frail or pre-frail in terms of physical function and quality of life in comparison with usual clinical practice and to evaluate, in comparison with usual clinical practice, the effectiveness of a multi-modal intervention on any of the following outcome measures:

Changes in trajectories of frailty status
Incidence rate of symptomatic hypoglycaemia and hypoglycaemic coma.
Incidence rate of hospital admission.
Incidence rate of permanent institutionalization.
Carer burden.
Laboratory biomarkers of prognostic value for response to intervention.

Project plan

The project embraced three main parts: 1) a validation study (an open Randomized Clinical Trial) that mimicked the intervention to be transferred and that was shown to be effective and with a good cost-effective relationship; 2) a feasibility study that included an economic analysis, adherence assessment and an analysis of the barriers and key factor of success; and 3) a proper scaling up process using a methodology based on the recommendations of the WHO (“WHO ExpandNet model”) and the European Union (“Maturity Model” and “11 success factors” suggested by the Expert Group on Health Systems Performance Assessment) that took place not only in the five countries participating in the validation of the intervention, but also in another four countries, under the auspices of the Pan-American Health Organization and the cooperation of the local governments. DIABFRAIL-LATAM has the potential to be scaled up to many other countries in Latin America and the Caribbean.

In addition to the multidisciplinary team of academic partners, research partners, clinical partners, public health partners and citizen organizations, several local, national and international stakeholders, including governmental organizations and NGOs provided support in the several care settings. The intervention included education and exercise programmes and its success was measured by changes in physical function and quality of life.

Impact

The DIABFRAIL-LATAM project has shown that engaging with older patients with diabetes can increase their awareness of the need for care of their disease and the importance of maintaining physical function in later life. PAHO is advocating for DIABFRAIL-LATAM to be implemented along with other evidence-based programs within the Integrated Care for Older People (ICOPE) strategy.

Publications and output

You may visit the project website for more information.