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

Autor: Lamptey R; Polyclinic/ Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana. r.lamptey@umcutrecht.nl.; Department of Community Health, University of Ghana Medical School, Accra, Ghana. r.lamptey@umcutrecht.nl.; Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. r.lamptey@umcutrecht.nl.; Korle Bu Teaching Hospital, Guggisberg avenue, Accra, Ghana. r.lamptey@umcutrecht.nl., Amoakoh-Coleman M; Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.; Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana., Barker MM; Diabetes Research Centre, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Centre, Leicester, UK., Iddi S; Department of Statistics and Actuarial Science, University of Ghana, Legon, Ghana., Hadjiconstantinou M; Diabetes Research Centre, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Centre, Leicester, UK., Davies M; Diabetes Research Centre, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Centre, Leicester, UK.; Diabetes Research Centre, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Centre, Leicester, UK., Darko D; Family Medicine Department, Nyaho Medical Center, Accra, Ghana.; Department of Physician Assistantship Studies, Central University, Prampram, Ghana., Agyepong I; Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana., Acheampong F; Office of Research, Korle Bu Teaching Hospital, Accra, Ghana., Commey M; Non-Communicable Diseases Control Programme, Ghana Health Service, Accra, Ghana., Yawson A; Department of Community Health, University of Ghana Medical School, Accra, Ghana.; Divison of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Ghana, Accra, Ghana., Grobbee DE; Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Adjei GO; Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana.; Office of Research Innovation and Development, University of Ghana, Legon, Ghana., Klipstein-Grobusch K; Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2023 Feb 24; Vol. 23 (1), pp. 199. Date of Electronic Publication: 2023 Feb 24.
DOI: 10.1186/s12913-023-09188-y
Abstrakt: 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 1:1 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 identifier:NCT04780425, retrospectively registered on 03/03/2021.
Results: Recruitment: 22 nd until 29 th 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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