A successful diabetes education project: educating educators without borders
C. Pieper1, G. Camara2, D. Franco3, G. Duarte3, S. Castiilho3, F. Castelo Branco4, T. Campos3, R. Rezende2, G. Casanova4, T. Reis2, W. Valadares4.
1Brazilian Society of Diabetes, Education, Rio de Janeiro, Brazil.
2Brazilian Society of Diabetes, Education, São Paulo, Brazil.
3Brazilian Society of DiabetesSBD, Education, São Paulo, Brazil.
4Brazilian Society of Diabetes SBD, Education, São Paulo, Brazil.

Background

Brazil is a country with a great territorial extension, 27 states divided into 5 regions with great climatic and population differences. Diabetes already affects about 12 million people, and educational and prevention measures are needed to promote the updating and training health professional in diabetes, including the most distant areas. In these distant regions the population has a large percentage of indigenous ethnicity. They are affected by long periods of drought and heat and by the large distances from medical facilities, sometimes receiving visiting of health teams only by boat.

Aim
The main Project goal was the development and creation of a diabetes program to promote the updating and training of healthcare professional in diabetes from remote areas, so that they become multipliers in their cities and communities.The objective is also the use of diabetes education as a monitoring tool and incentive to self-control and self-care for people with diabetes, serving as a way for prevention of it complications.

Method
The project was developed with a current theoretical program and practical workshops for health professionals (40 hours), who attending in basic health centers. The initial focus was the realization of one program per year, in each capital of three states: Roraima, Amazonas and Paraíba.The first step consisted of the local recognition (previous visit),and the establishment of partnerships for indications of the students and supports, in particular, the Departments of Health. The second stage of the project consisted in: selection of health professional team; development of teaching materials suitable for the reality of the region; choice of location for the realization and organization of the Health Fair scheduled on the 5th day of the course (practical training to be carried out by students); receive and evaluate the curriculum of candidates; choice of location for lectures and practical workshops with audiovisual resources. During the Health Fairs the local population was invited to perform blood glucose test for screening of diabetes and also take the measurement of height, weight and waist circumference. It is calculated BMI and applied the FINDRISC test. They are oriented on 7 Behaviors Self-Care for prevention.The 1st Edition of the project was held in Boa Vista (Roraima) in 2014, the second in Manaus (Amazonas) in 2015, and the Third, in João Pessoa (Paraíba), in 2016.

Results
In the First Edition of the project,in Boavista, 77 health professionals were trained, 66% (51) were nurses and 21% (16) were doctors. Due to the great distances and difficulties of transportation, the majority were from the capital and 18% from other more distant municipalities. During the 3 Health Fairs that were held, with intervals of 3 months, 1252 people were attended and oriented, and 130 reported having diabetes (10,38%). One hundred and five (8,38%) people were at high risk of developing diabetes (FINDRISC questionnaire). 
In the Second Edition, in Manaus, 83 health professionals were trained an also a representative of the Sateré-Mawé indigenous tribe. The chief reported several cases of diabetes (about 10%), some presenting with complications. During the 3 Health Fairs that were held, 820 people were attended, 81 (9,87%) were diagnosed with diabetes and 29.6% were at high risk of developing diabetes (FINDRISC questionnaire). The 3ªThird Health Fairer was held in the city of Manacapuru for local indigenous tribes could participate.
The Third Edition, in João Pessoa, 77 health professionals were trained (73% were nurses and 16% were doctors).The course was attended by professionals from 30 municipalities, including those who attend the local indigenous community of Potiguara. Two Health Fairs were held, and 625 people were attended. Eighty one had diabetes and 24 had a high risk of developing diabetes.
A Program for the training of Community Health Agents (64),was also performed.

Discussion
Education Educators Without Borders Project reached important results in the training of health professionals in the practice of diabetes education. The project has achieved three states in Brazil with large territory whose population is mostly has low income and poor access to health care, especially indigenous and riverside communities. The Project was a milestone for all health professionals who participated in it, as they succeeded in multiplying what they learned with their peers and the population they attend. 
This project was supported by the World Diabetes Foundation.