Effectiveness and sustainability of a structured group-based educational program (MEDIHEALTH) in improving medication adherence among Malay patients with underlying type 2 diabetes mellitus in Sarawak State of Malaysia: study protocol of a randomized controlled trial

Effectiveness of a pharmacist-led, community group-based education programme in enhancing diabetes management: A multicentre randomised control trial

Aims

This study presents a protocol for the Pharmacy Integrated Community Care (PICC) program, meticulously designed to enhance Hemoglobin A1c (HbA1c) levels and augment knowledge about diabetes mellitus (DM) among individuals diagnosed with Type 2 Diabetes Mellitus (T2DM) in the Sarawak State of Malaysia.

Methods

From 1 May to December 31, 2023, a prospective, multicenter, parallel-design randomised controlled trial will be conducted with two groups, each consisting of 47 participants. The intervention group will receive a structured, four-session group-based program guided by experienced pharmacists, focusing on medication adherence and diabetes management. The control group will follow the standard Diabetes Mellitus Adherence Clinic program. The primary outcomes of this study encompass enhancements in knowledge regarding diabetes medication management and adherence, followed by subsequent changes in HbA1c levels.

Conclusions

The successful implementation of the PICC program holds promise for enhancing health outcomes in the T2DM population, potentially leading to more effective diabetes management initiatives and better health practices in the community.

Trial registration clinicaltrialsgov identifier

NCT05106231.

Assessing the Efficacy of Contextualized Group Counseling Education in Asia: A Mixed Methods Study

Many experiential learning teaching models are developed in Western cultures, with their efficacy not tested in non-Western cultures, especially in counseling education. This study examined the learning experiences of students (n = 52) enrolled in a culturally contextualized experiential teaching method implemented across a 3-year period in a Malaysian university Masters-level group counseling course. The course changes included group demonstrations by lecturers and peers, live group participation and observation, group dynamics map drawing and debriefing, paired group proposal writing and presentation, and group note- taking. This study adopted a mixed method approach with a short survey consisting of both standardized scales and open-ended questions, administered at the beginning and end of each 12-week semester. Archival data on students' evaluation was also retrieved from the year before the intervention, to compare with the 3 years of intervention. Results showed a statistically significant improvement in students' perceived group leadership skills and leadership characteristics at the end of the course. Students' overall satisfaction with the course quality also improved significantly from the year prior to the implementation of the new teaching method. Qualitative coding identified three major themes-active learning classroom that led to confidence in group counseling knowledge and skills; experiential activities in the tutorial sessions, with opportunities to carry out their proposed group activities; and formative feedback given throughout the semester during tutorial settings contributing to the higher course satisfaction rate. To conclude, we discuss the implications of contextualized experiential learning for higher education counseling pedagogy in the Asian region.

Supplementary information

The online version contains supplementary material available at 10.1007/s10447-022-09471-3.

Machine Learning Approaches to Predict Risks of Diabetic Complications and Poor Glycemic Control in Nonadherent Type 2 Diabetes

Purpose: The objective of this study was to evaluate the efficacy of machine learning algorithms in predicting risks of complications and poor glycemic control in nonadherent type 2 diabetes (T2D). Materials and Methods: This study was a real-world study of the complications and blood glucose prognosis of nonadherent T2D patients. Data of inpatients in Sichuan Provincial People's Hospital from January 2010 to December 2015 were collected. The T2D patients who had neither been monitored for glycosylated hemoglobin A nor had changed their hyperglycemia treatment regimens within the last 12 months were the object of this study. Seven types of machine learning algorithms were used to develop 18 prediction models. The predictive performance was mainly assessed using the area under the curve of the testing set. Results: Of 800 T2D patients, 165 (20.6%) met the inclusion criteria, of which 129 (78.2%) had poor glycemic control (defined as glycosylated hemoglobin A ≥7%). The highest area under the curves of the testing set for diabetic nephropathy, diabetic peripheral neuropathy, diabetic angiopathy, diabetic eye disease, and glycosylated hemoglobin A were 0.902 ± 0.040, 0.859 ± 0.050, 0.889 ± 0.059, 0.832 ± 0.086, and 0.825 ± 0.092, respectively. Conclusion: Both univariate analysis and machine learning methods reached the same conclusion. The duration of T2D and the duration of unadjusted hypoglycemic treatment were the key risk factors of diabetic complications, and the number of hypoglycemic drugs was the key risk factor of glycemic control of nonadherent T2D. This was the first study to use machine learning algorithms to explore the potential adverse outcomes of nonadherent T2D. The performances of the final prediction models we developed were acceptable; our prediction performances outperformed most other previous studies in most evaluation measures. Those models have potential clinical applicability in improving T2D care.

Effectiveness of a pharmacist-led structured group-based intervention in improving medication adherence and glycaemic control among type 2 diabetes mellitus patients: A randomized controlled trial

BACKGROUND

A pharmacist-led structured group-based intervention (MEDIHEALTH) was formulated to improve medication adherence among Malay type 2 diabetes mellitus (T2DM) patients in the Malaysian state of Sarawak.

OBJECTIVES

The objective of this study was to examine the effectiveness of MEDIHEALTH and its mechanism of impact for improving medication adherence and the glycated haemoglobin (HbA1c) level.

METHODS

A two group and parallel randomised controlled trial with a twelve months follow-up period was conducted at two primary health clinics in Malaysia that were surrounded by Malay communities. Malay T2DM patients whose HbA1c was >7% and total score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was <26 were recruited and parallelly randomised to the MEDIHEALTH or usual care (control) groups. The extended theory of planned behaviour was employed to test the mechanism of impact. Repeated measure analysis of variance was used to assess the difference in the estimated marginal mean of the SEAMS scores and HbA1c level between the intervention and control groups at different times.

RESULTS

A total of 142 participants were recruited and randomised; three from the intervention group and eight from the control group withdrew before receiving any treatment. Hence, 68 participants in the intervention group and 63 in the control group were included for analyses. The MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p < 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at one, three, six and twelve months post-intervention (p < 0.001). These improvements were mediated by enhancements in perceived behavioural control and knowledge about medications.

CONCLUSIONS

The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients.