Facilitators guide to the

International Diabetes Federation

DIABETES
EDUCATION
MODULES
2ND EDITION 2011
IDF is committed to supporting the development of a global health workforce that is prepared
to meet the needs of the growing numbers of people with diabetes. To advance this aim, IDF
has developed tools that enable countries to provide diabetes education to health
professionals. IDF has also published a position statement on Diabetes Education (See
Appendix 1).

The IDF Diabetes Education Modules are intended to be used in conjunction with the
International Curriculum for Diabetes Health Professional Education.1 The Curriculum contains
extensive objectives, suggestions for faculty, activities and an evaluation process for each
module. In addition, some sample case studies and sample group-work activities are provided
at the end of the document.

PURPOSE OF THE MODULES

The purpose of the modules is to provide content material to support the IDF Curriculum and
provide a standardized, evidenced-based set of slides that can be used for health professional
education. The modules could also be used for self-study, integrated into an existing
programme or used on their own. It is not intended that every programme should use every
module; modules should be selected to suit the objectives of the programme and the needs of
the audience.

IDF encourages faculty and participants of a diabetes education programme to join the IDF
International Diabetes Education Network for Health Professionals. They can access this
network on the IDF website at www.idf.org. This forum provides an opportunity for health
professionals to engage in discussion events with international experts, ask questions and solve
problems with other colleagues, and share best practices. It is a stimulating and valuable
follow-up to any diabetes education programme.

TARGET AUDIENCE
The primary target for the modules is non-physician health professionals. They can, however,
be adapted for other groups, such as family physicians or medical or other health professional
students. When planning the programme, the facilitator needs to know the make-up of the
audience and their prior level of knowledge about diabetes care and management. The
activities and problem solving should be appropriate for the target group.
COPYRIGHT
The Modules are the intellectual property of the International Diabetes Federation. They can be
used under the following copyright regulation:

International Diabetes Federation. All rights reserved. No part of this publication may
be reproduced or transmitted in any form or by any means without the written prior
permission of the International Diabetes Federation (IDF).

Requests to reproduce or translate IDF Diabetes Education Modules should be addressed to:

IDF Communications
166 Chausse de La Hulpe
B-1170 Brussels
Belgium
by fax to +32-2-5385114
or by e-mail to modules@idf.org

When you use the modules, you should register your email address and use the evaluation
form that is provided on the CD to evaluate the modules. When the evaluation forms are
complete, please send them to modules@idf.org.

ROLE OF FACULTY

Preparing a group teaching session requires good planning in advance of the session to provide
a positive learning environment. Effective educational sessions are designed to engage learners
and offer them an opportunity to participate actively by applying information to their daily lives
and situations.2

CONSIDERATIONS FOR FACILITATING A WORKSHOP2

Assess the need for a programme in your area

What other diabetes programmes have been offered in the area?
Have the health professionals in your area had opportunities for education?
Are they requesting more or different education?
Are the facilities where they work supportive of an education programme?
 Will the participants be able to get time off work to attend?
Once the participants have increased knowledge and new skills, will they be able to
use them?

Prepare for the workshop

Become familiar with the content in each of the modules you intend to use. Try to
anticipate the questions people might have; if you are not sure about something,
look it up before you get into the classroom.
Add relevant local data to the modules and ensure the material is correct for the
Guidelines or practice in the relevant country.
Determine the faculty for the programme and have a meeting to ensure you all
know which topics other people will be addressing. Work as a supportive team and
be sure not to contradict each other in your sessions.
Determine whether the suggested activities are suited to your audience. In some
cases, you may prefer to develop alternative activities that are specific to your target
group. One way of doing this is to talk to or meet with representatives of the group.
Ask those who are going to participate to work with you in ensuring the activities
allow for immediate application of information in a way that is relevant and
practical.
Some modules contain short activities. You should also develop group work, such as
case studies, role play or problem-solving situations, to follow most of the modules,
giving the participants time to apply the information in the module.
Review the allocation of time for each activity. Participants may need 20 minutes to
work through a case study and then 10 minutes for each group to give feedback to
the larger group.
Prepare an outline for the programme that gives time, topic, objectives and name of
faculty. Be sure the time allotted to each topic is adequate and agreed to by the
faculty. See examples below.
Assemble the required teaching materials. Obtain the required number of handouts
and teaching materials. Produce copies of the PowerPoint slides as handouts with
three slides per page.
Prepare tent cards or nametags for each participant.

Organize the facility

Check the room in which the workshop will be offered. If you are going to use slides
or overheads they need to be positioned so that participants can see the screen
comfortably.
Decide where you will stand. Do you like to walk around when teaching? Do you
need to be close to the audiovisual equipment so you can advance slides? Do you
want to sit?
 Check that all AV equipment is working and you have all the extension cords you
need.
Ensure that lighting and heating are appropriate.
The set-up of the room will affect the type of interaction you achieve between the
participants. Think carefully about what kind of participation you want in your
session before arranging the seating pattern. If you want all people to be able to see
and interact with each other, a circle or a u-shape might be best; if you want people
to work together in small groups, tables with four to six participants at each might
be best.

Ensure that the room is conducive to learning

Provide a welcoming environment, Have a flip chart at the door with Welcome
to . on it. This lets people know they are in the right place and that you are glad
they are there.
Provide good signage to ensure that participants can find the location of the
workshop easily.
Check the temperature in the room. Remember that it will warm up when all the
people are in the room. Know where the temperature control is and how to use it
before the session starts.
Check the lighting. If you are using audiovisuals, how many lights should be left on
so that the screen can be best seen? Should the curtains be drawn? Do not turn off
all the lights.
Determine whether you need a microphone. If the room and group are small, you
probably will not need one, but if you have a big group, use a microphone. This can
also help save the facilitators voice when doing a long session. You may speak
loudly but sometimes your voice may drop at the end of sentences and without a
microphone, words are lost. In a large group (20 or more), it is a good idea to have a
microphone that can be passed among participants when they speak so that
everyone can hear what is being said.

Facilitate the workshop

Introduce yourself and the others who will facilitate the workshop. Simple
introductions are enough; there is no need to read a complete CV.
Explain any emergency regulations for the facility, such as the locations of exits,
stairs etc.
Point out the location of washrooms.
Highlight the agenda, including scheduled breaks so that people know what is
coming and how long they are likely to be sitting. Knowing this adds to the
participants feeling of being secure and comfortable in the session.
Explain the purpose or goals of the workshop.
 Explain that participation can enrich the learning experience and encourage people
to ask questions as these arise. Encourage discussion. Explain that general discussion
is part of the learning process and that you hope they will all participate.
Begin the session with an icebreaker. An icebreaker should be short and get people
involved. If you ask each person to state their name and say why they are here, you
run the risk of someone giving their whole life history. To shorten it, you could ask
participants to pair off with someone they did not previously know and spend a few
minutes finding out something about each other. Then go around and ask each
person to tell one thing about the new acquaintance. If you have a large group this
will take too long, instead ask each table (six to eight people) to introduce
themselves to each other. They can meet the people from the other tables at the
breaks.
Provide opportunities for the participants to apply the information during the
programme, such as problem solving and role play.

Assess the learning needs of participants

If you have not assessed learning needs prior to the workshop, you should do a quick
assessment at the beginning. It is important to assess the priorities of the participants.
Here are two options:

Ask participants to finish this sentence:

This session or workshop will be helpful to me if

Identify how participants hope to benefit from the session and write responses on a flip
chart. Incorporate your findings as the session unfolds. At the end of the session, review
the comments; point out how the session has met specific needs. If the learning needs
of an individual are clearly beyond the scope or the intent of the session, refer her or
him to other resources or provide follow-up at a later time.

Post a flip chart and markers close to the entrance for the session. At the top of the
blank page, write: What do you want to gain from this session? Review the needs prior
to beginning the session and identify how the session can meet these goals.

Wrapping up
Be sure to leave time in your programme to summarize. Do this by asking questions
on the material that has been discussed. Highlight key points on summary slides or flip
charts. Also, try to recap with a story or example that reviews the discussion.
Always give people the opportunity to ask questions and tell them how to reach you
or someone else if doubts or queries arise after the session.
Evaluation
Use the evaluation form provided by IDF on the CD or the website to evaluate the
programme, along with an evaluation that reflects your objectives.
Evaluate facultys experience using the modules with the form provided by IDF on
the CD or on the website.
Collect all evaluations from the participants and the faculty and return them to IDF.
Either mail them to Education Modules, 166 Chausse de La Hulpe, B-1170 Brussels,
Belgium, or scan and email them to modules@idf.org.

References

1. 1. International Diabetes Association. International Curriculum for Diabetes Health Professional Education. IDF.
Brussels, 2008.
2. 2. Belton AB, Simpson N. The How to of Patient Education. 2nd ed. RJ + Associates. Streetsville, 2010.
Appendix 1

POSITION STATEMENT SELF-MANAGEMENT EDUCATION

Diabetes self-management education: a right for all

January 2011

The epidemic of diabetes continues to increase at an alarming rate throughout the world.
Diabetes is a complex, chronic condition that requires both high-quality clinical care and
effective self-management. In addition, prevention efforts for type 2 diabetes largely advocate
lifestyle changes in order to reach and maintain a healthy weight and level of physical activity.
As a result, diabetes self-management education and on-going support are significant
contributors to metabolic and psychological outcomes among people with diabetes and those
who are at risk of diabetes.

As the world prevalence of diabetes increases, efforts to promote diabetes self-management

education are critical to reducing the human and economic burden of diabetes. A collaborative
effort among people with diabetes and those at risk of diabetes, governments and health
services, healthcare professionals and the general public is needed.

Therefore, the International Diabetes Federation (IDF) believes diabetes self-management

education is a critically important, fundamental and integral component of diabetes prevention
and care and should be available and accessible to everyone.

The goal of IDF, through the work of its Consultative Section on Diabetes Education (DECS) is to
address these and other issues by developing and implementing strategies that facilitate
equitable access to high quality diabetes self-management education and support.

The purpose of diabetes self-management education (DSME) and diabetes self-management

support (DSMS) is to prepare those affected by diabetes to make informed decisions, cope with
the demands of living daily with a complex chronic disease, and make changes in their
behaviour that support their self-management efforts and improve outcomes. The ultimate
goal is to reduce the burden of diabetes on individuals, families, communities and healthcare
systems, and, by supporting good health, prevent or delay the onset of diabetes related long-
term complications.6

Although awareness of the value of education has improved, similar barriers to access to DSME
exist in both developed and developing countries. The primary barrier to access to education is
shortage of qualified diabetes educators.7 Additional barriers include lack of financial
reimbursement or support for education, and inability for people with diabetes to get time
away from work to receive education. There are inadequate resources to provide education to
people with diabetes and those at risk of diabetes and to train health professional, lay and peer
educators. Governments need to invest in education to support primary and secondary
prevention and reduce health expenditure in the future.

At individual level, it is the position of IDF that:

All people with diabetes and those at risk of diabetes, no matter where they live, have
the right to learn about diabetes, how it can be prevented, how it can be managed
effectively and how to access educational and clinical resources.
High-quality education includes assessing, planning, implementing, using behaviour
change strategies and evaluating the outcomes of DSME.
Diabetes self-management education that integrates the clinical, behavioural and
psychosocial aspects of diabetes self-management should be available and sustained.
The public must be made aware of the need to recognize diabetes early and how to
prevent diabetes and the serious health consequences of diabetes.

At healthcare setting and professional levels, it is the position of IDF that:

All healthcare providers have an education role when caring for people with diabetes
and should facilitate access to diabetes self-management education and on-going
support.
Diabetes education is best provided by an integrated interdisciplinary team including, at
a minimum, the person with diabetes, a nurse, a dietitian and physician who are skilled
in diabetes prevention and management as well as educational, behavioural and
psychosocial strategies. Other team members (such as family members, pharmacists,
behavioural scientists) can be included as needed.
Effective educational, behavioural and psychosocial strategies should be included in
health professional education programmes and postgraduate curricula. It should also be
included in continuing education programmes about diabetes and implemented based
on the IDF International Curriculum for Health Professional Education.

At national level, it is the position of IDF that:

For the prevention and treatment of diabetes to be successful through educational

initiatives, governments and local, national and international health associations must promote
opportunities to enhance education, provide financial support, and facilitate access to and
public awareness of diabetes self-management education.

Health Ministries need to integrate a comprehensive diabetes self-management

education plan into their National Diabetes Programmes, understanding the population-
level of risk and public health implications of the diabetes epidemic to their countries.
Health Ministries at all levels need to recognize the importance of diabetes self-
management education being acknowledged, promulgated, funded and delivered
according to the IDF International Standards for Diabetes Education.
 Governments need to develop rigorous accreditation systems for diabetes education
and training, complemented by regulatory frameworks developed in cooperation with
health workers and their professional organizations.
Health ministries need to strengthen the capacity of primary care to respond to the
diabetes epidemic and improve access to diabetes self-management education.

References

3. Chodosh J, Morton SC, Mojica W, et al. Meta-analysis: chronic disease self-management programs for older adults.
Ann Intern Med 2005; 143: 427-38.
4. Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane
Database Syst Rev 2009; 1: CD005268.
5. Duncan I, Birkmeyer C, Coughlin S, et al. Assessing the value of diabetes education. Diabetes Educ 2009; 35: 752-60.
6. Hawthorne K, Robles Y, Cannings-John R, Edwards A. Culturally appropriate health education for type 2 diabetes
mellitus in ethnic minority groups. Cochrane Database Syst Rev 2008; 3: CD006424.
nd
7. International Diabetes Federation. International Curriculum for Diabetes Health Professional Education, 2 ed. IDF.
Brussels, 2008.
rd
8. International Diabetes Federation. International Standards for Diabetes Education, 3 ed. IDF. Brussels, 2009.
th
9. International Diabetes Federation. Diabetes Atlas, 4 ed. IDF. Brussels, 2009.
10. Norris SL, Lau J, Smith SJ, et al. Self-management education for adults with type 2 diabetes: A meta-analysis on the
effect on glycemic control. Diabetes Care 2002; 25: 1159-71.
11. Renders CM, Valk GD, Griffin SJ, et al. Interventions to improve the management of diabetes in primary care,
outpatient, and community settings: a systematic review. Diabetes Care 2001; 24: 1821-33.
12. Skovlund SE, Peyrot M; International DAWN Advisory Panel. The Diabetes Attitudes, Wishes, and Needs (DAWN)
program: a new approach to improving outcomes of diabetes care. Diabetes Spectrum 2005; 18: 136-42.
 Appendix 2

Example: Outline of diabetes educator course 3 days

DAY 1
0830-0900 Registration Faculty

0830-0900 Introductions 1. Explain the outcomes expected from this programme

Getting to know you 2. Warm-up exercise
Outline of the course
0930-1030 Teaching and Learning 1. Participants assess their own communication skills and those of
principles others
2. Discuss the principles of adult education
Module 1-2 3. Discuss the principles of process of education assessment,
planning, implementation, evaluation
4. Discuss evaluation of learning on an individual and group basis
5. Apply the principles in the group work throughout the week to
come
1030-1045 Break

1045-1115 Helping people to 1. Discuss myths and beliefs specific to region

change behaviours 2. Discuss the psychosocial needs of the person and family
3. Discuss approaches and strategies for helping people to change
Module 1-2 4. Give a conceptual overview of change models
1115-1230 Role play To include:
Teaching process, behaviour change strategy and good
communication skills
1230-1330 Lunch

1330-1500 Nutrition therapy 1. Discuss principles for good nutrition, recognizing the different
cultural practices in the country
Sections of Modules 2-2, 2. Discuss how to build flexibility into a diabetes meal plan
2-3, 2-4 3. Discuss the benefits of weight loss in relation to the cultural
beliefs surrounding weight loss
4. Comment on need for different approaches for type 1 diabetes
and type 2 diabetes
5. Discuss strategies for coping with festivals, celebrations and
other special occasions
1500-1630 Nutrition small-group 1. Plan days meals based on good nutrition principles
work 2. Determine the CHO content of the days meals
3. Through a case study, assist a patient to make adjustments to a
standard meal plan to suit his lifestyle
4. Discuss impact of food on blood glucose levels
5. Present plans to the group (practice teaching)
 DAY 2
0830-0845 Welcome and Faculty
housekeeping
0845-915 Type 1 diabetes / type 1. Describe in basic terms the pathogenesis of type 1 diabetes and type
2 diabetes: 2 diabetes
What is the 2. Describe the results of insulin deficiency on carbohydrate, lipid an
difference? protein metabolism
3. Discuss the characteristics of the metabolic syndrome and its
Module 2-1 importance
4. Discuss prevention strategies for type 2 diabetes
0915-1015 Physical activity and 1. Discuss the health benefits of physical activity
clinical monitoring 2. Discuss the role of physical activity in the prevention of diabetes
3. State the recommended amount of activity for most people with
Modules 2-5, 2-6 diabetes
4. Discuss precautions that should be considered prior to undertaking
physical activity
5. Discuss the benefits of self-monitoring of blood glucose
6. State target values for blood glucose, lipids, blood pressure and
urinary albumin for people with diabetes
7. Discuss the value of HbA1c
8. Discuss the value of urinary ketone and glucose testing
1015-1030 Break

1030-1200 Type 2 diabetes 1. Give an overview of the mechanism of action of glucose-lowering

medications
2. Discuss strategies to help people take their medication as prescribed
Module 3-1 3. Discuss the suggested progression of medication use in people with
type 2 diabetes
4. Discuss several issues specific to the older adult with regards to using
medication
1200-1300 Case studies 1. Type 2 failing on oral agents, moving to insulin

1300-1400 Lunch

1400-1530 Insulin 1. Discuss factors to be considered when individualizing insulin therapy

2. State the different types of insulin and their action times
Module 3-2 3. Discuss the advantages and disadvantages of different common
insulin regimens
4. Discuss different methods of insulin delivery
5. Discuss interpretation of blood glucose results using pattern
management techniques
1530-1630 Case studies on 1. Describe factors that put people at risk of hypoglycaemia
hypoglycaemia and 2. Describe the signs and symptoms of hypoglycaemia
sick-day management 3. Discuss the actions of the counter-regulatory hormones
4. Describe treatment and follow-up management for people
experiencing a hypoglycaemic episode
5. Discuss prevention measures for those at risk of hypoglycaemia
6. Discuss the definition and incidence of diabetic ketoacidosis (DKA)
and hyperosmolar hyperglycaemic syndrome (HHS)
7. Discuss the signs and symptoms and treatment of DKA and HHS
8. Discuss the importance of and strategies for the management of
illness in people with diabetes
 DAY 3
0830-0845 Welcome and Faculty
housekeeping
0845-0945 Macrovascular disease 1. Describe the importance of coronary heart disease in people
with diabetes
2. Discuss target levels for lipids and treatment of dyslipidaemia
Module 5-1 3. Discuss target levels for blood pressure and management
strategies for hypertension
0945-1045 Case studies Small group work with macrovascular disease cases

1045-1100 Break

1100-1130 Retinopathy 1. Define retinopathy

2. Discuss the risk factors for retinopathy
Module 5-2 3. Describe preventive strategies for retinopathy
4. Explain the benefits and possible side effects of laser
treatment to a person with diabetes
1130-1215 Nephropathy 1. Discuss the risk factors for chronic kidney disease (CKD)
2. Discuss the progression of CKD
Module 5-3 3. Describe the screening measures and target levels for
microalbuminuria
4. Discuss management strategies for CKD
5. State caution to be recognized with use of certain
medications
1215-1315 Lunch

1315-1415 Renal case studies 1. Type 1 with nephropathy

2. Type 2 with microalbuminuria
1415-1545 Peripheral neuropathy, 1. Differentiate between peripheral neuropathy and peripheral
peripheral vascular vascular disease (PVD)
disease and practical 2. Discuss risk factors for peripheral neuropathy and PVD
foot care 3. Discuss screening methods for both peripheral neuropathy
and PVD
Modules 5-4a, 5-4b, 5-4c 4. Describe some of the clinical manifestations of peripheral
neuropathy and PVD
5. Discuss the presentation of four different types of ulcers
6. Discuss management strategies for neuropathic and
ischaemic ulcers
7. Discuss the importance of treating foot infections promptly
8. Discuss stratification of foot care services
9. Educate people with diabetes about daily preventative care of
their feet
10. Recognize common problems people with diabetes may
experience
11. Discuss the types of shoes and socks appropriate for people
with diabetes
1545-1600 Closure and certificates
 Example: Outline of programme focus on complications 3 days

DAY 1
Time Topic Objectives Faculty

0830-0900 Introduction
Outline of course
0900-1000 Where are you now? Local feedback on role of the health professional in complication
assessment, types of complications they see, cultural barriers, etc.
1000-1030 Break
1030-1130 Communication skills 1. Discuss the importance of good communication skills
2. Differentiate between a clear message and one open to
misinterpretation
3. Discuss techniques for delivering different types of messages
1130-1230 Role play Practise telling a newly diagnosed person with type 1 diabetes
about complications

1230-1330 Lunch
1330-1445 Pathophysiology of 1. Describe simply the formation and function of advanced
complications glycated end products
2. Describe briefly the polyol pathway
3. Describe the formation and significance of protein kinase c
4. Describe the significance of oxidative stress
1445-1600 Macrovascular disease 1. Describe the importance of coronary heart disease in people
with diabetes
Short break 2. Recommend screening tests and frequency to patients as
in this talk Module 5-1 appropriate in different countries
if needed 3. Discuss preventative strategies with patients
4. Describe macrovascular risk in people with diabetes
5. Discuss the results of pivotal clinical trials
6. Discuss target levels for lipids and treatment of dyslipidaemia
7. Discuss target levels for blood pressure and management
strategies for hypertension
 DAY 2
Time Topic Objectives Speaker

0900-1015 Small-group work Case studies on macrovascular disease

1015-1045 Break

1045-1145 Nephropathy 1. Discuss the risk factors for chronic kidney disease (CKD)
2. Discuss the progression of CKD
Module 5 - 3 3. Describe the screening measures and target levels for
microalbuminuria
4. Discuss management strategies for CKD
5. State caution to be recognized with use of certain
medications
1145-1300 Nephropathy case Type 1 with nephropathy
studies Type 2 with microalbuminuria
1300-1400 Lunch

1400-1445 Retinopathy 1. Define retinopathy

2. Discuss the risk factors for retinopathy
3. Describe preventive strategies for retinopathy
Module 5-2 4. Explain the benefits and possible side effects of laser
treatment to a person with diabetes
1445-1600 Role play Practise telling a person with a long duration of diabetes that they
now have mild retinopathy and microalbuminuria
Role play incorporating the following:
a. psychological impact of diabetes on quality of life
b. strategies for assisting patients to accept the diagnosis of
complications and make changes recommended for managing
diabetes
c. involvement of family in the management of diabetes
d. cultural differences in the acceptance and management of
diabetes
 DAY 3
Time Topic Objectives Speaker

0900-1000 Autonomic neuropathy 1. Describe gastroparesis, signs, symptoms, and management

2. Discuss treatment options of erectile dysfunction
3. Describe autonomic neuropathy and how it affects the
cardiovascular system, i.e. arrhythmia, postural hypotension,
silent MI
4. Describe cranial nerve involvement
1000-1030 Break

1030-1145 Small-group work 1. Case studies on autonomic neuropathy

1145-1300 Hands-on foot care 1. Screen a foot for signs of high-risk neuropathy and peripheral
vascular disease
2. Discuss stratification of care according to risk status
3. Discuss good foot care practices in the high-risk individual
4. Recognize problems, triage and refer to appropriate
healthcare professional
5. Discuss first-aid techniques for foot problems
1300-1400 Lunch

1400-1430 What can healthcare

professionals do about
complications?

1400-1530 Small-group work Develop a flow sheet for screening and assessment of
complications for your daily clinical practice
1530 Closure