Intensive Patient Education Improves Glycaemic Control in Diabetes Compared to Conventional Education: A Randomised Controlled Trial in a Nigerian Tertiary Care Hospital

Abstract

BackgroundDiabetes is now a global epidemic, but most cases are now in low- and middle-income countries. Diabetes self-management education (DSME) is key to enabling patients to manage their chronic condition and can reduce the occurrence of costly and devastating complications. However, there is limited evidence on the effectiveness of different DSME programmes in resource limited settings.MethodsWe conducted an unblinded, parallel-group, individually-randomised controlled trial at the University of Calabar Teaching Hospital (Nigeria) to evaluate whether an intensive and systematic DSME programme, using structured guidelines, improved glycaemic control compared to the existing ad hoc patient education (clinical practice was unchanged). Eligible patients (≥18 years, HbA1c > 8.5% and physically able to participate) were randomly allocated by permuted block randomisation to participate for six months in either an intensive or conventional education group. The primary outcome was HbA1c (%) at six-months.ResultsWe randomised 59 participants to each group and obtained six-month HbA1c outcomes from 53 and 51 participants in the intensive and conventional education groups, respectively. Intensive group participants had a mean six-month HbA1c (%) of 8.4 (95% CI: 8 to 8.9), while participants in the conventional education group had a mean six-month HbA1c (%) of 10.2 (95% CI: 9.8 to 10.7). The difference was statistically (P < 0.0001) and clinically significant, with intensive group participants having HbA1c outcomes on average -1.8 (95% CI: -2.4 to -1.2) percentage points lower than conventional group participants. Results were robust to adjustment for a range of covariates and multiple imputation of missing outcome data.ConclusionsThis study demonstrates the effectiveness of a structured, guideline-based DSME intervention in a LMIC setting versus a pragmatic comparator. The intervention is potentially replicable at other levels of the Nigerian healthcare system and in other LMICs, where nurses/diabetes educators can run the programme.Trial RegistrationPan African Clinical Trial Registry PACTR20130200047835

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“…weight, blood pressure, lipids, glycaemic control) and reduction in the risk of CV events. [85][86][87][88] Studies assessing the impact of DSME programmes vary in a number of parameters such as methods (e.g. patient empowerment, 38 intensive interventions, 62,77 digital health technology, 40 providers of DSME, duration, intensity and content of education, follow-up intervals and participant characteristics.…”

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“…Long-term glycemic control is one of the strongest clinical-outcome indicators of efficient diabetes management and health outcomes ( 7 ). The very limited research in Africa has provided inconsistent evidence regarding the clinical significance of DSME ( 7 , 20 , 21 , 29 , 47 – 49 ). The current study showed a significant mean HbA1c drop within both intervention and comparison groups.…”

“…However, the very limited research in Africa has resulted in conflicting evidence regarding the effectiveness of DSME on long-term glycemic control and other clinical outcomes. An intensive and structured DSME education given by nurses and physicians for 6 months showed significant reduction in HbA1c among those who received an intervention ( 20 ). However, group-based DSME led by ley health promoters in underserved urban South Africa did not show significant mean difference in HbA1c between groups.…”

Optimal care for systemic sclerosis patients: recommendations from a patient-centered and multidisciplinary mixed-method study and working conference

“…Other studies already showed that current information provision to SSc patients is insufficient in The Netherlands [19,20]. Accessible education improves clinical parameters and therapeutic adherence [21][22][23]. Importantly, it also increases empowerment and strengthens patients' position in decision-making processes [24][25][26].…”