Effect of Group Patient Education on Glycemic Control Among People Living with Type 2 Diabetes in Vietnam: A Randomized Controlled Single-Center Trial

Abstract

Introduction In low- to middle-income countries such as Vietnam, urgent measures are required to prevent and control type 2 diabetes and its complications. This study measured the effect of a 3-month patient education and self-management intervention in a low-resource setting on diabetes knowledge and levels of blood glucose control. Methods This was a single-center randomized controlled study among adult outpatients with type 2 diabetes. Patients were randomly assigned to 3-month community intervention consisting of group education for type 2 diabetes knowledge, diet, exercise in combination with usual diabetes care, or to usual diabetes care alone (control). Diabetes knowledge was measured with a modified Michigan University Diabetes Knowledge Test (MDKT). Other study outcomes included change in mean HbA1c, fasting blood glucose (FBG), and systolic blood pressure (SBP). Results A total of 364 patients were randomized, 182 to the intervention group and 182 to control. The two groups were similar regarding main baseline characteristics. The male/female ratio was 45.1%/54.9% and mean age was 62.2 ± 9.3 years. Approximately half the patients (48.1%) were overweight and 15.7% were obese, mean baseline HbA1c was 8.21 ± 1.92%, and only 29.9% of participants had a baseline HbA1c < 7.0%. At baseline, diabetes knowledge was “very poor” or “poor” in 63.7% of patients. After a 3-month follow-up, the proportion achieving the target MDKT score increased from 37.4% to 81.3% in the intervention group and from 35.2% to 51.7% in the control (between-group difference P < 0.001). The estimate (SD) of the difference between intervention and control groups was − 1.63 (2.16), 95% CI − 2.07 to − 1.18. Mean changes from baseline HbA1c were − 0.54 ± 1.41% and − 0.18 ± 1.33% in the intervention and control groups, respectively ( P = 0.012). Among those with poor glycemic control (HbA1c ≥ 7%) at baseline, mean changes at 3 months were − 0.80 ± 1.52% vs 0.41 ± 1.47%, respectively, ( P = 0.013). Statistically significant decreases in FBG and SBP were also observed in the intervention group at 3 months, but not in the control group. Multivariate analysis revealed the variables with the strongest influence on blood glucose control at 3 months were study group, baseline MDKT score, diabetes duration, and baseline HbA1c (all P ≤ 0.05). Conclusion Provision of a structured educational program to Vietnamese people living with type 2 diabetes is effective at improving disease knowledge and is associated with better glycemic control. Larger and longer-term studies are now warranted to confirm these findings. Trial Registration This trial was retrospectively registered on 27 May 2020 through the https://clinicaltrials.gov site with the following identifier: NCT04403841 Su...

Avaliação do programa comportamental em diabetes mellitus tipo 2: ensaio clínico randomizado

“…Os modelos dos programas pautados nos aspectos psicossociais, comportamentais e clínicos auxiliam as pessoas com DM2 a tomarem decisões informadas sobre sua condição, melhorando sua autoeficácia por meio da mudança de comportamento. Além disso, participar de grupos educativos com pessoas bem-sucedidas no controle do diabetes pode desempenhar um papel importante no incentivo e motivação dos pacientes para o desenvolvimento da autoeficácia 7,9 . Contudo, associar sessões presenciais com acompanhamento via intervenção telefônica pode resultar no aumento da autoeficácia das pessoas com DM2 e redução dos níveis glicêmicos, favorecendo o controle da condição 4 .…”

“…Os programas comportamentais em DM2 podem combinar diferentes estratégias metodológicas, como a educação em grupo e a intervenção telefônica, a fim de contribuir para controle da condição crônica. A educação em grupo caracteriza-se como um espaço de troca de experiências entre as pessoas com a mesma condição crônica 8,9 . Observa-se a contribuição na identificação de problemas e sentimentos, compreensão das limitações, enfrentamento dos problemas, aumento da confiança e autonomia para tomada de decisões informadas, visando à adoção de comportamentos saudáveis e aquisição de atitudes para o autocuidado 10 .…”

The impact of health literacy interventions on glycemic control and self‐management outcomes among type 2 diabetes mellitus: A systematic review

“…Five of them were conducted in developed countries including 2 in the United States, 27,28 2 in England, 29,30 1 in Sweden, 31 and 10 in developing countries including 4 in Brazil, [32][33][34][35] 3 in China, [36][37][38] 1 in Ethiopia, 39 1 in Nigeria, 40 and 1 in Vietnam 41 (see Figure 3). Three studies were conducted in hospital settings 36,37,41 and the rest were conducted in outpatient clinics, diabetes clinics, primary health care, or community health centers (see Table 1). From selected articles three were three-arm RCTs 28,33,34 and the rest were twoarm RCTs.…”

“…Interventions varied in terms of the type of intervention programs, duration of program, follow-up period, and intervention providers. Intervention time varied from 3 months 27,28,36,38,40,41 to 12 months. [33][34][35] The long follow-up period of 12 months was performed in four studies, 31,33,34,38 and 6-month follow-up was performed in five studies.…”

“…29,30,32,36,37 In eight studies, interventions were delivered by a nurse, 28,31,32,[34][35][36]39,40 in two studies interventions were delivered by a diabetes educator, 37,38 in two studies interventions were delivered by a community worker, 29,30 in one study the intervention was delivered by a support professional, 33 in one study the intervention was delivered a peer educator, 27 and in one study the intervention was delivered by a medical doctor. 41 The most common method of intervention delivery was group education. 27,[29][30][31][37][38][39][40][41] In three studies, a combination of group and individual education, 28,32,36 group education and telephone calls, 34 and group education and home visits 33 were used.…”