Delphi consensus validation of an integrated climate sensitive diabetes management model for climate vulnerable health systems in Iran

Abstract

Abstract Type 2 diabetes mellitus (T2DM) is rising rapidly in Iran, where climate-related hazards such as heatwaves, sand and dust storms, and disruptions to food and medicine supply chains challenge continuity and quality of care. We sought to validate a climate-sensitive, health system-oriented management model for T2DM using a Delphi consensus process. Eighteen experts in diabetes, noncommunicable diseases and health systems rated 51 statements derived from the preliminary Integrated Iranian Climate-Sensitive Diabetes Management Model (ICDMM), mapped onto six domains aligned with WHO health system building blocks. Items were scored on a binary agree/disagree scale, with a ≥ 70% agreement threshold for consensus. In round 1, agreement ranged from 61.1% to 100.0%; 46 statements met the threshold and five were revised. In round 2 all revised items achieved ≥ 80% agreement, and ultimately all 51 statements reached consensus. The validated ICDMM comprises six domains and 51 components spanning climate-informed governance, resilient and equitable service delivery, workforce preparedness, digital and early-warning information systems, climate-resilient supply chains, and equity-oriented climate-sensitive financing. The ICDMM offers a disease-specific framework for operationalising climate-resilient health system principles for T2DM in a climate-vulnerable middle-income setting and now requires implementation and evaluation in real-world practice.