Extended Abstract
1. Objectives
ging is a physiological process with no direct impact on diseases. However, in this period, the passage of time, environmental factors, and an unhealthy lifestyle, negatively impact the prevalence of diseases, especially chronic ones. One of such conditions is type 2 diabetes, which has a huge burden on older people, families and the country’s health system [1]. Diabetes requires long-term medical care, self-management education, and support to prevent acute complications and reduce the risk of long-term complications [2]. The National Program for Prevention and Control of Diabetes (NPPCD) in Iran with the goal of reducing economic costs, disabilities, premature deaths caused by diabetes, and its complications is in progress; however, investigating the effects of this program have been overlooked. Therefore, this study attempted to assess the effect of NPPCD on the Knowledge, attitude, and practice of aged type 2 diabetes patients.
2. Methods and Materials
This was a cross-sectional study with a Pre-test-Post-test design. It was conducted after approval by the Research Ethics Committee of University of Social Welfare and Rehabilitation Sciences (code: USWR.REC.1395.296) and coordination with the Health Center No.2 of Isfahan affiliated to the health care centers with diabetes care unit in Isfahan City, Iran. The study population consisted of aged type 2 diabetes patients who first joined the NPPCD from July 22, 2016, to March 19, 2017 (with any previous history of diabetes, regardless of their diabetes being controlled or not). In total, 100 Samples were selected based on convenience sampling technique. The inclusion criteria were the age of ≥60, willingness to file diabetes, no acute illness, and the ability to communicate with others. The exclusion criteria were an unwillingness to continue to receive care and treatment, acute problems occurring for the patient during the study, and training sessions nonattendance for more than 2 consecutive times. Given that all diabetics were able to join the program and due to the ethical considerations, it was difficult to select a control group. Therefore, by selecting a matched pairs design, each sample was considered as self-control, and the intervention variables were controlled by this design. The surveying tool was a two-part questionnaire; the first part comprised a demographic form (12 items) and the second part consisted of a 25-item knowledge, attitude and practice assessment inventory [3]; 10 items explored knowledge, 5 items attitude, and 10 items practice assessment. Patients’ information was collected before and three months after entering the program.
3. Results
Of 100 samples (age range: 60-84 years), 41% were male and 59% female; 42% retired and 5% employed (all men); majority of them (44%) aged 60-64 years and only 3% were in the age group of 80-84 years; also 88% were living with their wife, and 12% living alone. Furthermore, 47% were illiterate, 11% had elementary school education, 6% middle school education; 21% high school education and 15% had higher educational degrees. In addition, 77% had a diabetes history of 0-10 years and 9% of 20-29 years; 55% had hypertension, 44% were overweight, 28% had obesity, 53% abdominal obesity, 71% blood lipid disorders, and 66% reported a history of diabetes in their first-degree relatives.

Because the data related to knowledge and attitude assessment had no normal distribution, the Wilcoxon test was used. The obtained results revealed that the mean score of knowledge increased from 7 at Pre-test (before entering the program) to 10 at Post-test (3 months after entering the program), and this increase was statistically significant (P<0.001, z=-7.61). The mean score of attitude also increased from 8 to 10 and this increase was also statistically significant (P<0.001, z=-6.84) (Table 1). The size of NPPCD effect on the knowledge and attitude of samples using formula (1) was obtained equal to 0.76 and 0.68, respectively which indicates its high effect.
Formula (1)

The data related to practice assessment had normal distribution; thus, Paired Samples t-test was employed. The Pre-test and Post-test Mean±SD scores of practice were 35.60±6.38 and 41.91±5.23, respectively. This indicates that the practice of participants after entering the program was higher than before and improved significantly (t=-11.95, P<0.001) (Table 2). The size of NPPCD effect on the practice of subjects using formula (2) was obtained as 0.77; i.e. the program had a 77% impact on the patients’ practice, which is high.
Formula (2)

4. Conclusion
The NPPCD had a positive impact on the knowledge, attitude and practice levels of diabetics in a comprehensive manner. The study samples were aged adults with diabetes; therefore, some of them, especially women, were dependent on their children and set up their referral and follow-up times according to the working hours of their children. Therefore, it is recommended that in educational and interventional programs, in addition to training diabetic patients, their caregivers and families be trained regarding diabetes and the importance of pursuing treatment in preventing disease complications. Further studies in other cities in the country are also recommended.

Ethical Considerations
Compliance with ethical guidelines
The study was conducted after approval by the Research Ethics Committee of University of Social Welfare and Rehabilitation Sciences (code: USWR.REC.1395.296) and coordination with the Health Center No. 2 of Isfahan affiliated to the health care centers with diabetes care unit in Isfahan City, Iran.
Funding
The present paper was extracted from the MA thesis of the first author, Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences.
Authors contributions
All authors contributed in preparing this article.
Conflict of interest
The authors declared no conflict of interest.
Acknowledgments 
Hereby, we acknowledge all professors of Tehran University of Welfare and Rehabilitation Sciences, officials of the Department of Research of the University of Social Welfare and Rehabilitation Sciences, Dthe Health Center No. 2 of Isfahan affiliated to the health care centers with diabetes care unit in Isfahan City, Dr. Zahra Torabi, officials and staff.