The effect of structured diabetes self-management education on type 2 diabetes patients attending a Primary Health Center in Kuwait.

AIM: To evaluate the impact of diabetes self-management education (DSME) on diabetes control measured by glycated hemoglobin (HbA1c) in nationals and expatriates with type 2 diabetes mellitus (T2DM) in Kuwait. METHOD: A total of 291 patients with T2DM (intervention = 150, control = 141) were assessed in a single-center, controlled study to compare the impact of DSME sessions on HbA1c levels as a measure of metabolic control of diabetes mellitus. Measurements of HbA1c were taken at baseline, 6-months, and 12-months. Multiple explorative association tests and regression models were constructed to examine the intervention effects. RESULTS: Patients that received DSME sessions demonstrated better diabetes control with an average reduction of 1.3% (14 mmol/mol) HbA1c over 12-months compared to an average HbA1c increase of 1.1% (12 mmol/mol) in the control group (p < 0.001). Using pairwise comparisons, young, male, and expatriate patients and patients with HbA1c above 7% demonstrated the highest improvements in HbA1c with DSME sessions. In multivariate regressions, DSME intervention was associated with a 1.7% (18 mmol/mol) HbA1c reduction indicating better control of diabetes (p < 0.001). CONCLUSION: DSME sessions were associated with better glycemic control in patients with T2DM over 12 months. This study establishes the effectiveness of DSME sessions for both Kuwaiti nationals and expatriates, which represent a significant portion of the population in Kuwait and the Arabian Gulf region. The favorable impact of DSME suggests a promising cost-effective approach to reduce the risk of complication associationed with diabetes suitable for the unique demographic characteristics in the region.

Genetic variation at the FADS1-FADS2 gene locus influences delta-5 desaturase activity and LC-PUFA proportions after fish oil supplement.

Delta-5 and delta-6 desaturases (D5D and D6D) are key enzymes in endogenous synthesis of long-chain PUFAs. In this sample of healthy subjects (n = 310), genotypes of single nucleotide polymorphisms (SNPs) rs174537, rs174561, and rs3834458 in the FADS1-FADS2 gene cluster were strongly associated with proportions of LC-PUFAs and desaturase activities estimated in plasma and erythrocytes. Minor allele carriage associated with decreased activities of D5D (FADS1) (5.84 × 10(-19) ≤ P ≤ 4.5 × 10(-18)) and D6D (FADS2) (6.05 × 10(-8) ≤ P ≤ 4.20 × 10(-7)) was accompanied by increased substrate and decreased product proportions (0.05 ≤ P ≤ 2.49 × 10(-16)). The significance of haplotype association with D5D activity (P = 2.19 × 10(-17)) was comparable to that of single SNPs, but haplotype association with D6D activity (P = 3.39 × 10(-28)) was much stronger. In a randomized controlled dietary intervention, increasing eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) intake significantly increased D5D (P = 4.0 × 10(-9)) and decreased D6D activity (P = 9.16 × 10(-6)) after doses of 0.45, 0.9, and 1.8 g/day for six months. Interaction of rs174537 genotype with treatment was a determinant of D5D activity estimated in plasma (P = 0.05). In conclusion, different sites at the FADS1-FADS2 locus appear to influence D5D and D6D activity, and rs174537 genotype interacts with dietary EPA+DHA to modulate D5D.