Effects of a lifestyle education program on glycemic control among patients with diabetes at Kigali University Hospital, Rwanda: A randomized controlled trial

Amendezo, Etienne; Timothy, David Walker; Karamuka, Vincent; Robinson, Brian D.; Kavabushi, Patrick; Ntirenganya, Cyprien; Uwiragiye, Joseph; Mukantagwabira, Donatille; Bisimwa, Jeanne; Marie, Henriette Uwintwali; Umulisa, Henriette; Niyomwungeri, Scholastique; Ndayambaje, Bernard; Dusabejambo, Vincent; Bavuma, Charlotte

doi:10.1016/j.diabres.2017.02.001

Cited by 30 publications

(58 citation statements)

References 22 publications

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“…The pooled results indicate no statistically significant difference in outcomes of mean difference (MD) −0.82 [95% CI: −1.71, 0.08] ( P = .07) with moderate heterogeneity in the effects of the interventions ( I 2 = 50%; Figure S7, Appendix ). Two studies reported weight, one with statistical significance, 24 and the other without 35 …”

Section: Resultsmentioning

confidence: 99%

“…To our knowledge, no review has been conducted so far in SSA. Positive effects recorded in some interventions 20,21 have been highly variable from one intervention to another, [22][23][24] and even not statistically significant in others. [25][26][27] This variability of interventions based on patient empowerment makes it difficult to assess their effectiveness, thereby limiting their usefulness in the decision-making process for the improvement of the quality of health care without a measurement of their effect sizes.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of interventions based on patient empowerment in the control of type 2 diabetes in sub‐Saharan Africa: A review of randomized controlled trials

Mogueo

Oga‐Omenka

Hatem

et al. 2020

Endocrino Diabet & Metabol

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Background It is estimated that 1.6 million deaths worldwide were directly caused by diabetes in 2016, and the burden of diabetes has been increasing rapidly in low‐ and middle‐income countries. This study reviews existing interventions based on patient empowerment and their effectiveness in controlling diabetes in sub‐Saharan Africa. Method PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO and Global Health were searched through August 2018, for randomized controlled trials of educational interventions on adherence to the medication plan and lifestyle changes among adults aged 18 years and over with type 2 diabetes. Random‐effects meta‐analysis was used. Results Eleven publications from nine studies involving 2743 participants met the inclusion criteria. The duration of interventions with group education and individual education ranged from 3 to 12 months. For six studies comprising 1549 participants with meta‐analysable data on glycaemic control (HbA1c), there were statistically significant differences between intervention and control groups: mean difference was −0.57 [95% confidence interval (CI) −0.75, −0.40] (P < .00001, I2 = 27%). Seven studies with meta‐analysable data on blood pressure showed statistically significant differences between groups in favour of interventions. Subgroup analyses on glycaemic control showed that long‐term interventions were more effective than short‐term interventions and lifestyle interventions were more effective than diabetes self‐management education. Conclusion This review supports the findings that interventions based on patient empowerment may improve glycaemia (HbA1c) and blood pressure in patients with diabetes. The long‐term and lifestyle interventions appear to be the most effective interventions for glycaemic control.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions based on patient empowerment in the control of type 2 diabetes in sub‐Saharan Africa: A review of randomized controlled trials

Mogueo

Oga‐Omenka

Hatem

et al. 2020

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

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“…The prevalence of T2DM in recent population studies in East Africa, has ranged from 1.4% to 12.0%, with studies reporting over 50% previously undiagnosed cases of T2DM. Such patients are likely to present late with acute or long-term complications of T2DM and needing insulin therapy [ 3 – 9 ]. Therefore, within East Africa, there may be many patients requiring insulin therapy and assistance from health care providers in the management of the insulin therapy.…”

Section: Introductionmentioning

confidence: 99%

EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management

et al. 2019

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To date, insulin therapy remains the cornerstone of diabetes management; but the art of injecting insulin is still poorly understood in many health facilities. To address this gap, the Forum for Injection Technique and Therapy Expert Recommendations (FITTER) published recommendations on injection technique after a workshop held in Rome, Italy in 2015. These recommendations are generally applicable to the majority of patients on insulin therapy, athough they do not explore alternative details that may be suitable for low- and middle-income countries. The East Africa Diabetes Study Group sought to address this gap, and furthermore to seek consensus on some of the contextual issues pertaining to insulin therapy within the East African region, specifically focusing on scarcity of resources and its adverse effect on the quality of care. A meeting of health care professionals, experts in diabetes management and patients using insulin, was convened in Kigali, Rwanda on 11 March 2018, and the following recommendations were made: (1) insulin should be transported safely, without undue shaking and exposure to high (> 32 °C) temperature environments. (2) Insulin should not be transported below 0 °C. (3) If insulin is to be stored at home for over 2 months, it should be stored at the recommended temperature of 2–8 °C. (4) Appropriate instructions should be given to patients while dispensing insulin. (5) Insulin in use should be kept at room temperature and should never be kept immersed under water. Immersing insulin under water after the vial has been pierced carries a high risk of contamination, leading to loss of potency and likelihood of causing injection abscesses. (6) The shortest available needles (4 mm for pen and 6 mm for insulin syringe) should be preferred for all patients. (7) In routine care, intramuscular injections should be avoided, especially with long-acting insulins, as it may result in severe hypoglycaemia. (8) The practice of slanting the needle excessively should be avoided as it results in sub-epidermal injection of insulin which leads to poor absorption and may cause “tattooing” of the skin and scarring. (9) In patients presenting in a wasted state, with “paper-like skin”, injections should, if possible, be initiated with pen injection devices, so as to utilise the 4-mm needle without lifting a skin fold (pinching the skin); otherwise lifting of a skin fold is required, if longer needles are utilised. (10) Reuse of needles and syringes is not recommended. However, as the reuse of syringes and needles is practiced for various reasons, and by many patients, individuals should not be given alarming messages; and usage should be limited to discarding when injections become more painful; but at any rate not to exceed reusing a needle more than 5 times. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0574-x) contains supplementary material, which is available to authorized users.

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“…A century later, diabetes is no longer rare, but is still fatal. Presentation of T2DM in East Africa is still characterized by acute complications superimposed on late chronic complications of diabetes, resulting mainly from delay in accessing health care [ 36 ]. Recent added challenges in the management of diabetes include comorbidity with HIV, tuberculosis, malaria, and depression.…”

Section: Glycemic Control In Diabetesmentioning

confidence: 99%

EADSG Guidelines: Insulin Therapy in Diabetes

et al. 2018

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Executive Summary and Recommendations A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A).Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A).Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin. Two or three premixed insulin injections per day may be used (A).The target glycated hemoglobin A1c (HbA1c) for all children with T1DM, including preschool children, is recommended to be < 7.5% (< 58 mmol/mol). The target is chosen aiming at minimizing hyperglycemia, severe hypoglycemia, hypoglycemic unawareness, and reducing the likelihood of development of long-term complications (B).For patients prone to glycemic variability, glycemic control is best evaluated by a combination of results with self-monitoring of blood glucose (SMBG) (B).Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus (T2DM) include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy (B).In T2DM patients, with regards to achieving glycemic goals, insulin is considered alone or in combination with oral agents when HbA1c is ≥ 7.5% (≥ 58 mmol/mol); and is essential for treatment in those with HbA1c ≥ 10% (≥ 86 mmol/mol), when diet, physical activity, and other antihyperglycemic agents have been optimally used (B).The preferred method of insulin initiation in T2DM is to begin by adding a long-acting (basal) insulin or once-daily premixed/co-formulation insulin or twice-daily premixed insulin, alone or in combination with glucagon-like peptide-1 receptor agonist (GLP-1 RA) or in combination with other oral antidiabetic drugs (OADs) (B).If the desired glucose targets are not met, rapid-acting or short-acting (bolus or prandial) insulin can be added at mealtime to control the expected postprandial raise in glucose. An insulin regimen should be adopted and individualized but should, to the extent possible, closely resemble a natural physiologic state and avoid, to the extent possible, wide fluctuating glucose levels (C).Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient’s care plan. Fasting plasma glucose (FPG) values should be used to titrate basal insulin, whereas both FPG and postprandial glucose (PPG) values should be used to titrate mealtime insulin (B).Metformin combined with insulin is associated with decreased weight gain, lower insulin dose, and less hypoglycemia when compared with insulin alone (C).Oral medications should not be abruptly discontinued when starting insulin therapy because of the risk of rebound hyperglycemia (D).Analogue insulin is as effective as human insulin but is a...

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Effects of a lifestyle education program on glycemic control among patients with diabetes at Kigali University Hospital, Rwanda: A randomized controlled trial

Cited by 30 publications

References 22 publications

Effectiveness of interventions based on patient empowerment in the control of type 2 diabetes in sub‐Saharan Africa: A review of randomized controlled trials

Effectiveness of interventions based on patient empowerment in the control of type 2 diabetes in sub‐Saharan Africa: A review of randomized controlled trials

EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management

EADSG Guidelines: Insulin Therapy in Diabetes

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