Improving wellbeing of people living with diabetes with digital health and therapeutic patient education in Lebanon
To achieve the global diabetes target of 80% of people living with diabetes globally having good control of glycaemia calls for a prompt shift from a narrow focus on the patient in the clinic to a broader view of empowering the whole person beyond.
In this blog we share one MSF initiative prioritizing wellbeing of people living with diabetes (PLWD), the Digital Therapeutic (DTx) project in Lebanon and how the project is being leveraged to further support unmet needs of people living with diabetes in Lebanon which have been amplified by the current armed conflict which is ravaging the country.
Together will colleagues in Lebanon and Switzerland, we have worked with people living with diabetes in Lebanon to develop patient education material for people living with diabetes in Lebanon.
Leveraging digital health for empowered self-management skills
Since 2021 the Médecins Sans Frontières (MSF) Sweden Innovation Unit team, together with MSF medical teams in Lebanon and Switzerland, and people with lived experience of diabetes have been collaborating to develop and launch a digital health tool which includes a package of therapeutic patient education to support empowered wellbeing and self-management skills for people living with Type 1 or Type 2 diabetes and caregivers.
In July 2024, an early version of the mobile application was launched across two clinics in Lebanon, Hermel and Aarsal, for use by a limited cohort of people living with Type 1 or Type 2 diabetes and the caregivers of children living with Type 1. This first mobile application was part of a feasibility assessment aiming to understand the acceptability, relevance and potential of this tool in achieving long-term objectives to improve mental and physical health outcomes and healthcare experiences of people living with diabetes in Hermel and Arsal.
The towns where the intervention was developed and launched are in Northeast Lebanon, Baalbek-Hermel, a governorate with the country’s highest poverty rate according to the World Bank. These towns have seen a significant influx of refugees from the Syrian civil war as of 2011 with Arsal alone hosting approximately 60,000 people still living in tents (UNDP 2018). Hermel more recently has been heavily impacted by Israeli bombardment, with approximately 3,000 people having fled the town by the latest estimations. The individuals living with diabetes in this context or supporting loved ones living with the condition, both Syrian and Lebanese, were facing significant challenges in self-managing their conditions between clinic appointments which this project aimed to address via improved access to support.
The digital health application in its first form offers a range of features, including a library of 12 modules of therapeutic patient education, clinic appointment reminders and notes, and self-monitoring support for blood glucose and physical symptoms and more. Understanding that wellbeing is inextricably linked to a person's quality of life each of the features and resources in this tool were focused on accessibility and empowerment. The project team worked to develop a foundational framework based on behavioral science and collaborated closely with people with lived experience of diabetes to ensure the output could align with these ambitions within the Lebanon context.
Testing the relevance of health innovation in crisis
While the feasibility assessment and data collection phase were concluding in late September, Israeli bombardments in Lebanon significantly escalated, causing mass forced displacement and further disruption to already fragile healthcare services across the country. This escalation demanded reflection on the relevance of the DTx project. Any emergency response naturally demands that medical teams shift their focus toward life-saving activities, this was particularly relevant in this context where many MSF colleagues engaged in the project have become forcibly displaced themselves. However, rather than being distanced from the MSF emergency response, the DTx project was deemed a relevant intervention in supporting people with diabetes to maintain management of their condition and preserve a sense of wellbeing.
“Non-communicable diseases have become an increasing priority in protracted humanitarian crisis settings. Annually 17 million people die from an NCD before age 70 with 86% of these premature deaths occurring in low- and middle-income countries. The ongoing DTx collaboration aligns with the MSF commitment to empower people living in complex humanitarian settings with skills and support to manage their diabetes with dignity. ”
Three key decisions were made by the team to ensure the continued relevance of the DTx project in the immediate humanitarian and medical response and continue to build the project with a view to long term sustainability:
To expedite the development of an offline mode version of the application to allow PLWD without stable internet connection to access the DTx support between clinic appointments;
To develop supplementary therapeutic patient education specific to the emergency context. This aims to support PLWD’s understanding of key details for their condition management including information on insulin storage and diabetes-related self-management skills for wounds;
To create analogue versions of the therapeutic patient education materials allowing for multichannel dissemination to people who may not have access to mobile phones.
Several key stakeholders united to make the activities above possible, crucially, including people with lived experience. One of them was Cyrine Farhat of Positive on Glucose, a local NGO dedicated to supporting people living with diabetes in Lebanon through support groups. Cyrine, who is currently navigating the management of her own condition and wellbeing amidst the latest escalation, has provided meaningful insights to achieve the project milestones including the initial launch and emergency adaptation. The DTx project to date has been guided by this lived experience perspective and a commitment to reinforcing wellbeing as a key part of diabetes condition management. This approach will continue as the dust settles on the current escalation.
“In Lebanon’s current crisis, marked by war and limited access to essential diabetes resources, the MSF DTx app is a crucial lifeline. By supporting self-management through digital tools, this app empowers people living with diabetes (PLWD) to take control of their health even when traditional support systems are stretched thin. Given the difficulties in accessing medications and medical care, a tool like MSF DTx can bridge gaps, fostering resilience and independence for PLWD by providing critical education and self-care strategies remotely.”
Acute response and long-term vision
In 2022, diabetes impacted nearly 830 million adults worldwide - a staggering increase since 1990 and an upward trend that continues today. This rise has hit low-and middle-income countries the hardest, where the resources to manage this complex condition are often limited. Despite the growing number of people affected, many continue to lack the treatment they need with nearly 60% of adults over 30 with diabetes remaining untreated, leaving millions vulnerable to severe health complications, impaired quality of life and premature mortality. Responding to the needs of people living with diabetes is a matter of health equity. These health disparities are unjust and require collective action that includes a focus on bolstering wellbeing, self-efficacy and access to innovations as a part of comprehensive models of care, including for populations enduring conflict.
“The current Lebanon crisis has forced the displacement of more than 1 million people. Fleeing from the war and leaving everything behind, those displaced do not even know if they are going to be able to have access to shelters, food and medications. In this complicated context, where people have limited access to proper resources and education to manage their condition, the DTx project and therapeutic patient education digital materials have helped the MSF team to empower our patients living with diabetes and help improve their ability to manage their condition.”
We cannot wait to get the basics “right” before strengthening health systems through the delivery of high quality and comprehensive diabetes care. As Cyrine says, “in such unstable times, digital therapeutics (DTx) are not just innovative - they are essential. Supporting PLWD with tools for self-management is more than just convenient; it is about preserving lives and wellbeing in a context where every resource counts.” With a focus on building health enabling systems, quality of life and wellbeing can be improved for people living with diabetes, caregivers and communities. Meaningful engagement with key stakeholders, alignment with national strategies, digital health innovations such as the MSF digital therapeutics project, and a focus on therapeutic patient education together offer substantial foundations to achieve this goal.