Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.
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. MAINOUTCOME:
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.Keywords
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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