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Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.
Lamptey, Roberta; Amoakoh-Coleman, Mary; Barker, Mary Moffett; Iddi, Samuel; Hadjiconstantinou, Michelle; Davies, Melanie; Darko, Daniel; Agyepong, Irene; Acheampong, Franklyn; Commey, Mary; Yawson, Alfred; Grobbee, Diederick E; Adjei, George Obeng; Klipstein-Grobusch, Kerstin.
  • Lamptey R; Polyclinic/ Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana. r.lamptey@umcutrecht.nl.
  • Amoakoh-Coleman M; Department of Community Health, University of Ghana Medical School, Accra, Ghana. r.lamptey@umcutrecht.nl.
  • Barker MM; Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. r.lamptey@umcutrecht.nl.
  • Iddi S; Korle Bu Teaching Hospital, Guggisberg avenue, Accra, Ghana. r.lamptey@umcutrecht.nl.
  • Hadjiconstantinou M; Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
  • Davies M; Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
  • Darko D; Diabetes Research Centre, University of Leicester, Leicester, UK.
  • Agyepong I; NIHR Leicester Biomedical Research Centre, Leicester, UK.
  • Acheampong F; Department of Statistics and Actuarial Science, University of Ghana, Legon, Ghana.
  • Commey M; Diabetes Research Centre, University of Leicester, Leicester, UK.
  • Yawson A; NIHR Leicester Biomedical Research Centre, Leicester, UK.
  • Grobbee DE; Diabetes Research Centre, University of Leicester, Leicester, UK.
  • Adjei GO; NIHR Leicester Biomedical Research Centre, Leicester, UK.
  • Klipstein-Grobusch K; Diabetes Research Centre, University of Leicester, Leicester, UK.
BMC Health Serv Res ; 23(1): 199, 2023 Feb 24.
Article in English | MEDLINE | ID: covidwho-2267885
ABSTRACT

BACKGROUND:

In high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive.

AIM:

To compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings.

DESIGN:

Single-blind randomised parallel comparator controlled multi-centre trial. Adults (> 18 years) with type 2 diabetes from two hospitals in urban Ghana were randomised 11 to usual care only, or usual care plus a structured diabetes self-management education program. Randomisation codes were computer-generated, and allotment concealed in opaque numbered envelopes. The intervention effect was assessed with linear mixed models. MAIN

OUTCOME:

Change in HbA1c after 3-month follow-up. Primary analysis involved all participants. CLINICALTRIAL gov identifierNCT04780425, retrospectively registered on 03/03/2021.

RESULTS:

Recruitment 22nd until 29th January 2021. We randomised 206 participants (69% female, median age 58 years [IQR 49-64], baseline HbA1c median 64 mmol/mol [IQR 45-88 mmol/mol],7.9%[IQR 6.4-10.2]). Primary outcome data was available for 79 and 80 participants in the intervention and control groups, respectively. Reasons for loss to follow-up were death (n = 1), stroke(n = 1) and unreachable or unavailable (n = 47). A reduction in HbA1c was found in both groups; -9 mmol/mol [95% CI -13 to -5 mmol/mol], -0·9% [95% CI -1·2% to -0·51%] in the intervention group and -3 mmol/mol [95% CI -6 to 1 mmol/mol], -0·3% [95% CI -0·6% to 0.0%] in the control group. The intervention effect was 1 mmol/mol [95%CI-5 TO 8 p = 0.726]; 0.1% [95% CI -0.5, 0.7], p = 0·724], adjusted for site, age, and duration of diabetes. No significant harms were observed.

CONCLUSION:

In low-resource settings, diabetes self-management education might not be associated with glycaemic control. Clinician's expectations from diabetes self-management education must therefore be guarded.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetes Mellitus, Type 2 / Self-Management Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: BMC Health Serv Res Journal subject: Health Services Research Year: 2023 Document Type: Article Affiliation country: S12913-023-09188-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetes Mellitus, Type 2 / Self-Management Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: BMC Health Serv Res Journal subject: Health Services Research Year: 2023 Document Type: Article Affiliation country: S12913-023-09188-y