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Ezenwaka CE. A cross-talk between perceptions and reality on insulin therapy among Type-2 diabetes patients in developing countries. Diabetes Res Clin Pract 2022; 192:110114. [PMID: 36208848 DOI: 10.1016/j.diabres.2022.110114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Chidum E Ezenwaka
- The Diabetes and Metabolism Research Group [DMRG], Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago.
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Kumah E, Otchere G, Ankomah SE, Fusheini A, Kokuro C, Aduo-Adjei K, A. Amankwah J. Diabetes self-management education interventions in the WHO African Region: A scoping review. PLoS One 2021; 16:e0256123. [PMID: 34403455 PMCID: PMC8370626 DOI: 10.1371/journal.pone.0256123] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/01/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region. MATERIALS AND METHODS The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis. RESULTS Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. CONCLUSIONS The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.
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Affiliation(s)
- Emmanuel Kumah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Godfred Otchere
- Policy, Planning, Monitoring and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Faculty of Humanities, Center for Medicine and Society, University of Freiburg, Freiburg im Breisgau, Germany
| | - Samuel Egyakwa Ankomah
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, Accra, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Aduo-Adjei
- Center for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Joseph A. Amankwah
- Department of Administration, Ankaase Methodist Hospital, Ankaase, Ghana
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Muchiri JW, Gericke GJ, Rheeder P. Effectiveness of an adapted diabetes nutrition education program on clinical status, dietary behaviors and behavior mediators in adults with type 2 diabetes: a randomized controlled trial. J Diabetes Metab Disord 2021; 20:293-306. [PMID: 34222067 PMCID: PMC8212224 DOI: 10.1007/s40200-021-00744-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE This study evaluated the effectiveness of an adapted social-cognitive theory underpinned diabetes nutrition education program (NEP) on: clinical (HbA1c, BMI, blood lipids, blood pressure) and selected dietary behaviors (starchy foods and energy intake, vegetables and fruit intake) and behavior mediators (knowledge and diabetes management self-efficacy) in patients with type 2 diabetes mellitus (T2DM). METHODS A tertiary hospital outpatient adults (40-70 years) with poorly controlled (HbA1c ≥ 8 %) T2DM were randomized to either intervention group (n = 39: NEP, 7-monthly group education sessions, bi-monthly follow-up sessions, 15-minute individual session, workbook + education materials) or control group (n = 38: education materials only). NEP aimed to improve clinical status through improved dietary behaviors and behavior mediators. Outcomes and changes in diabetes medication were assessed at six and 12 months. Intention-to-treat analysis was conducted. ANCOVA compared the groups (baseline values, age, sex adjustments). RESULTS Forty-eight (62.3 %) participants completed the study. Intervention group compared to the control group had lower (-0.53 %), clinically meaningful HbA1c (primary outcome) at 6 months, albeit not sustained at 12 months. Compared to the control group, the intervention group had significantly lower: (i) systolic blood pressure at six and 12 months (ii) diastolic pressure at 12 months, (iii) energy intake at six-months, (iv) up-titration of insulin at six and 12 months and higher diabetes knowledge scores at six months. CONCLUSIONS NEP had limited effects on HbA1c, targeted dietary behaviors and behavior mediators but showed positive effects on blood pressure. The NEP health cost savings potential supports the need for improving program participation. TRIAL REGISTRATION ClinicalTrials.gov. number NCT03334773; 7 November 2017 retrospectively registered.
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Affiliation(s)
- Jane W. Muchiri
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria, 0001 South Africa
| | - Gerda J. Gericke
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria, 0001 South Africa
| | - Paul Rheeder
- School of Medicine, Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria, 0001 South Africa
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Ezenwaka CE, Onuoha P, Extavour R, Yearwood S. Beliefs of Caribbean type 2 diabetes patients towards insulin therapy and prescription. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00808-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bekele H, Asefa A, Getachew B, Belete AM. Barriers and Strategies to Lifestyle and Dietary Pattern Interventions for Prevention and Management of TYPE-2 Diabetes in Africa, Systematic Review. J Diabetes Res 2020; 2020:7948712. [PMID: 32766315 PMCID: PMC7374199 DOI: 10.1155/2020/7948712] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a major chronic illness in Africa that requires lifelong lifestyle interventions and pharmacological therapy. Lifestyle change is the most important aspect of diabetes care and includes diabetes self-management education and support, medical nutrition therapy, physical activity, smoking cessation counseling, and psychosocial care. PURPOSE The purpose of this project was to review published articles that investigate lifestyle and dietary pattern interventions for diabetes prevention and management in Africa. Barriers to lifestyle interventions and strategies to overcome the barriers are also reviewed in this study. METHODS The article search was conducted in an electronic database search of PubMed, Google Scholar, and Cochrane Library. Studies were included if they were published between 2011 and 2019, if they were conducted in an African country, and were written in the English language. RESULTS Articles reviewed included several that examined the basic lifestyle and dietary pattern changes for all patients diagnosed with type 2 diabetes, on self-care behavior of type 2 diabetes patients, on the cost of diabetes in Africa, and on barriers for adherence to lifestyle and dietary changes in Africa, with strategies to address those barriers. CONCLUSION Lifestyle interventions including regular physical exercise, weight management, and adherence to health care professionals' recommendations on a healthy diet are the cornerstone in the prevention and management of diabetes in Africa. The main barriers to adherence were both systemic (population changes, poor access, western cultural influences, and low-quality healthcare) and personal (poverty and cost, educational status, and perceptions about the disease) in nature. The strategies for the barriers include health education programs, advocacy, and capacity building.
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Affiliation(s)
- Hirut Bekele
- Department of Nursing, Institute of Health Sciences, Bethel University, USA
- Department of Pre-clinical, Institute of Medicine and Health Sciences, Debreberhan University, Ethiopia
| | - Adisu Asefa
- Department of Nursing, Institute of Health Sciences, Bethel University, USA
- Department of Pre-clinical, Institute of Medicine and Health Sciences, Debreberhan University, Ethiopia
| | - Bekalu Getachew
- Department of Pre-clinical, Institute of Medicine and Health Sciences, Debreberhan University, Ethiopia
- Department of Biomedical Science, Institute of Health Sciences, Jimma University, Ethiopia
| | - Abebe Muche Belete
- Department of Pre-clinical, Institute of Medicine and Health Sciences, Debreberhan University, Ethiopia
- Department of Biomedical Science, Institute of Health Sciences, Jimma University, Ethiopia
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Hailu FB, Moen A, Hjortdahl P. Diabetes Self-Management Education (DSME) - Effect on Knowledge, Self-Care Behavior, and Self-Efficacy Among Type 2 Diabetes Patients in Ethiopia: A Controlled Clinical Trial. Diabetes Metab Syndr Obes 2019; 12:2489-2499. [PMID: 31819574 PMCID: PMC6890192 DOI: 10.2147/dmso.s223123] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 11/01/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Diabetes patients must be equipped with the necessary knowledge to confidently undertake appropriate self-care activities. We prepared a diabetes self-management education (DSME) intervention and assessed how it affected patients' self-reported levels of diabetes knowledge, self-care behaviors, and self-efficacy. PATIENTS AND METHODS A before-and-after, two-group intervention study was conducted at Jimma University Medical Centre among adult patients with type 2 diabetes. At baseline, we randomly assigned 116 participants to the DSME intervention and 104 to a comparison group. Six interactive DSME sessions supported by an illustrative handbook and fliers, experience-sharing, and take-home activities were administered to the intervention group by two nurses during a six-month period. Diabetes knowledge, self-care behaviors, and self-efficacy were measured at baseline and at nine months following the commencement of DSME intervention (endpoint) in both groups. RESULTS At the endpoint, data from 78 intervention group participants and 64 comparison group participants were included in final analysis. The difference in the mean Diabetes Knowledge Scale scores before and after the DSME intervention was significantly greater in the intervention group (p = 0.044). The measured self-care behaviors included diet, exercise, glucose self-monitoring, footcare, smoking, alcohol consumption, and khat chewing. The mean number of days per week on which the intervention group participants followed general dietary recommendations increased significantly at the endpoint (p = 0.027). The intervention group followed specific dietary recommendations (p = 0.019) and performed footcare (p = 0.009) for a significantly greater number of days. There were no significant differences within or between the groups in other self-reported diabetes self-care behavior regimens or in diabetes self-efficacy. CONCLUSION Our study found significant improvements in the intervention participants' diabetes knowledge scores and in their adherence to dietary and footcare recommendations. This demonstrates that our DSME intervention may be of clinical importance in developing countries such as Ethiopia. TRIAL REGISTRATION ClinicalTrials.gov, Identifier NCT03185689, retrospectively registered on June 14, 2017: https://clinicaltrials.gov/ct2/show/NCT03185689.
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Affiliation(s)
- Fikadu Balcha Hailu
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- School of Nursing and Midwifery, Jimma University, Jimma, Ethiopia
| | - Anne Moen
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per Hjortdahl
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Muchiri JW, Gericke GJ, Rheeder P. Adapting a diabetes nutrition education programme for adults with type 2 diabetes from a primary to tertiary healthcare setting. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2019. [DOI: 10.1080/16070658.2019.1632127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jane W Muchiri
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - Gerda J Gericke
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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Saha AK, Gunaratnam N, Patil R, Choo M, Bagchi DP, Jhaveri E, Wyckoff J, Bahu G, Balis U, Clyde P, Herman WH. A new model for diabetes-focused capacity building - lessons from Sri Lanka. Clin Diabetes Endocrinol 2018; 4:22. [PMID: 30564437 PMCID: PMC6292123 DOI: 10.1186/s40842-018-0074-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022] Open
Abstract
Sri Lanka is experiencing a rapid increase in the number of people with diabetes mellitus (DM) due to population growth and aging. Physician shortages, outdated technology, and insufficient health education have contributed to the difficulties associated with managing the burden of disease. New models of chronic disease management are needed to address the increasing prevalence of DM. Medical students, business students, and faculty members from the University of Michigan partnered with the Grace Girls’ Home, Trincomalee General Hospital, and Selvanayakapuram Central Hospital to identify and train diabetes-focused medical assistants (MAs) to collect and enter patient data and educate patients about their disease. Return visits to these MAs were encouraged so that patient progress and disease progression could be tracked longitudinally. Data entry was conducted through a cloud-based mechanism, facilitating patient management and descriptive characterization of the population. We implemented this pilot program in June 2016 in coordination with Trincomalee General Hospital and Selvanayakapuram Central Hospital. Over a 12-month period, 93 patients were systematically assessed by the medical assistants. All patients received education and were provided materials after the visit to better inform them about the importance of controlling their disease. Fifteen percent (14/93) of patients returned for follow-up consultation. Trained MAs have the potential to provide support to physicians working in congested health systems in low-resource settings. Public investment in training programs for MAs and greater acceptance by physicians and patients will be essential for handling the growing burden associated with chronic illnesses like DM. Trained MAs may also play a role in improved patient education and awareness regarding diabetes self-management.
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Affiliation(s)
- Anjan K Saha
- 1University of Michigan Medical School, Ann Arbor, MI USA
| | | | - Rashmi Patil
- 1University of Michigan Medical School, Ann Arbor, MI USA
| | - Monica Choo
- 1University of Michigan Medical School, Ann Arbor, MI USA
| | | | - Ekta Jhaveri
- 3The William Davidson Institute, University of Michigan, Ann Arbor, MI USA
| | - Jennifer Wyckoff
- 4Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI USA
| | - Ganeika Bahu
- 5Trincomalee General Hospital, Trincomalee, Sri Lanka
| | - Ulysses Balis
- 6Department of Pathology, Division of Informatics, University of Michigan, Ann Arbor, MI USA
| | - Paul Clyde
- 3The William Davidson Institute, University of Michigan, Ann Arbor, MI USA
| | - William H Herman
- 4Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI USA.,7Michigan Diabetes Research Center, University of Michigan, Ann Arbor, MI USA
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Muchiri JW, Gericke GJ, Rheeder P. Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2018. [DOI: 10.1080/16089677.2018.1541211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- JW Muchiri
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - GJ Gericke
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - P Rheeder
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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Gathu CW, Shabani J, Kunyiha N, Ratansi R. Effect of diabetes self-management education on glycaemic control among type 2 diabetic patients at a family medicine clinic in Kenya: A randomised controlled trial. Afr J Prim Health Care Fam Med 2018; 10:e1-e9. [PMID: 30456964 PMCID: PMC6244221 DOI: 10.4102/phcfm.v10i1.1762] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/26/2018] [Accepted: 08/22/2018] [Indexed: 12/31/2022] Open
Abstract
Background Diabetes self-management education (DSME) is a key component of diabetes care aimed at delaying complications. Unlike usual care, DSME is a more structured educational approach provided by trained, certified diabetes educators (CDE). In Kenya, many diabetic patients are yet to receive this integral component of care. At the family medicine clinic of the Aga Khan University Hospital (AKUH), Nairobi, the case is no different; most patients lack education by CDE. Aim This study sought to assess effects of DSME in comparison to usual diabetes care by family physicians. Setting Family Medicine Clinic, AKUH, Nairobi. Methods Non-blinded randomised clinical trial among sub-optimally controlled (glycated haemoglobin (HbA1c) ≥ 8%) type 2 diabetes patients. The intervention was DSME by CDE plus usual care versus usual care from family physicians. Primary outcome was mean difference in HbA1c after six months of follow-up. Secondary outcomes included blood pressure and body mass index. Results A total of 220 diabetes patients were screened out of which 140 met the eligibility criteria and were randomised. Around 96 patients (69%) completed the study; 55 (79%) in the DSME group and 41 (59%) in the usual care group. The baseline mean age and HbA1c of all patients were 48.8 (standard deviation [SD]: 9.8) years and 9.9% (SD: 1.76%), respectively. After a 6-month follow-up, no significant difference was noted in the primary outcome (HbA1c) between the two groups, with a mean difference of 0.37 (95% confidence interval: -0.45 to 1.19; p = 0.37). DSME also made no remarkable change in any of the secondary outcome measures. Conclusion From this study, short-term biomedical benefits of a structured educational approach seemed to be limited. This suggested that offering a short, intensified education programme might have limited additional benefit above and beyond the family physicians’ comprehensive approach in managing chronic conditions like diabetes.
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Hailu FB, Hjortdahl P, Moen A. Nurse-Led Diabetes Self-Management Education Improves Clinical Parameters in Ethiopia. Front Public Health 2018; 6:302. [PMID: 30406070 PMCID: PMC6206899 DOI: 10.3389/fpubh.2018.00302] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Unlike in developed countries, the clinical effectiveness of diabetes self-management education (DSME) is not well-studied in the African context. Thus, this study sought to determine effects of DSME on clinical outcomes among type 2 diabetic (T2DM) patients in Ethiopia. Methods: Before-and-after controlled study design was employed, with random assignment of 116 T2DM adult patients to a nurse-led DSME group and 104 to a treatment-as-usual (comparison) group. A nurse-led DSME with six sessions supported with illustrative pictures handbooks and fliers was customized to local conditions and delivered by trained nurses over 9 months. Our primary outcome was a change in the proportion of people with target glycated hemoglobin (HbA1c ≤ 7%). We used chi-square test and mixed model analysis. Results: Seventy-eight (67%) and 64 (62%) participants assigned to intervention and comparison, respectively completed the study, and included in the final analysis. Mean HbA1c was significantly reduced by 2.88% within the intervention group and by 2.57% within the comparison group. However, change in the proportion of participants with target HbA1c and end-line mean HbA1c difference between the groups were not significant. Adjusted end-line fasting blood sugar (FBS), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly lower in the intervention group, by 27 ± 9 mg/dL, 12 ± 3, and 8 ± 2 mmHg, respectively. Conclusion: After 9 months of nurse-led DSME, HbA1c was significantly reduced within both groups but there was no significant difference in HbA1c between groups. The intervention also showed some clinically significant effects on blood pressure and FBS. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03185689, retrospectively registered on June 14, 2017 on ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03185689.
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Affiliation(s)
- Fikadu Balcha Hailu
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway.,School of Nursing and Midwifery, Jimma University, Jimma, Ethiopia
| | - Per Hjortdahl
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Anne Moen
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
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Chai S, Yao B, Xu L, Wang D, Sun J, Yuan N, Zhang X, Ji L. The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2. PATIENT EDUCATION AND COUNSELING 2018; 101:1427-1432. [PMID: 29622281 DOI: 10.1016/j.pec.2018.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/13/2018] [Accepted: 03/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus. METHODS Patients were randomly assigned to education group and control group. Education group received professional education and control group received routine outpatient education. RESULTS A total of 118 patients were randomly assigned to two groups (education group, n = 63; control group, n = 55). Compared with control group, the anxiety score (36.00 vs. 42.50, P < 0.05) and depression score (35.50 vs. 44.00, P < 0.05) significantly decreased at the sixth month in education group, respectively. Compared with control group, fasting blood glucose (6.78 mmol/L vs. 7.70 mmol/L, P < 0.00), postprandial blood glucose (7.90 mmol/L vs. 10.58 mmol/L, P < 0.00) and glycosylated haemoglobin A1C level [6.20 (5.80, 6.60)% vs. 6.70 (6.40, 7.30)%, P < 0.01] significantly decreased after the sixth month in education group. CONCLUSION The psychological status and blood glucose of patients with diabetes receiving self-management education were significantly improved. PRACTICE IMPLICATIONS Type 2 diabetes mellitus has been usually linked to increased prevalence and risk of depression and anxiety, which can affect blood glucose levels. Through education, the mood of newly diagnosed patients with diabetes improved, resulting in better blood glucose control.
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Affiliation(s)
- Sanbao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Baoting Yao
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Lin Xu
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Danyang Wang
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Jianbin Sun
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Ning Yuan
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China; Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, 100044, China
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Essien O, Otu A, Umoh V, Enang O, Hicks JP, Walley J. Intensive Patient Education Improves Glycaemic Control in Diabetes Compared to Conventional Education: A Randomised Controlled Trial in a Nigerian Tertiary Care Hospital. PLoS One 2017; 12:e0168835. [PMID: 28045979 PMCID: PMC5207750 DOI: 10.1371/journal.pone.0168835] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 12/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diabetes 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. METHODS We 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. RESULTS We 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. CONCLUSIONS This 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 REGISTRATION Pan African Clinical Trial Registry PACTR20130200047835.
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Affiliation(s)
- Okon Essien
- Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Akaninyene Otu
- Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria
- * E-mail:
| | - Victor Umoh
- Department of Medicine, University of Uyo, Uyo, Akwa Ibom State, Nigeria
| | - Ofem Enang
- Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - John Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Foley E, BeLue R. Identifying Barriers and Enablers in the Dietary Management of Type 2 Diabetes in M'Bour, Senegal. J Transcult Nurs 2016; 28:348-352. [PMID: 27150461 DOI: 10.1177/1043659616649028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to identify cultural enablers and barriers to dietary management of type 2 diabetes in M'Bour, Senegal. This qualitative study used the PEN-3 cultural model to explore diabetes dietary management within a cultural framework. Content analysis identified emergent themes based on the PEN-3 model. Forty-one individuals completed interviews. Themes reflecting ways that culture affects adherence to the diabetic diet included (a) having a different diet or eating separately from the communal family plate creates feelings of social isolation; (b) forgoing the diabetic diet sometimes occurs so that family members have enough food; (c) reducing servings of traditional foods feels like abandoning culture; and (d) women being responsible for preparing food, while men typically manage money for purchasing food yet do not provide input on what food is purchased. Results suggest that educating family units on the dietary management of diabetes may be more effective than individual education.
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Affiliation(s)
- Evan Foley
- 1 The Pennsylvania State University, University Park, PA, USA
| | - Rhonda BeLue
- 1 The Pennsylvania State University, University Park, PA, USA
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Dube L, Van den Broucke S, Dhoore W, Kalweit K, Housiaux M. An Audit of Diabetes Self-Management Education Programs in South Africa. J Public Health Res 2015; 4:581. [PMID: 26753160 PMCID: PMC4693339 DOI: 10.4081/jphr.2015.581] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022] Open
Abstract
Background: Diabetes is a significant contributor to the burden of disease worldwide. Since its treatment requires extensive self-care, self-management education is widely recommended, particularly in resource limited settings. This study aimed to review the current state of policies and implementation of diabetes self-management education (DSME) in South Africa, with a specific focus on cultural appropriateness. Design and Methods: The audit involved a review of policy documents and semi-structured questionnaires with providers and experts in public and private health services. Forty-four respondents were interviewed. Documents were analysed with reference to the International Standards for Diabetes Education from the International Diabetes Federation. Data were entered and analysed in excel to give a description of the DSME programs and ad hoc interventions. Results: Three guidelines for Type 2 diabetes and two for chronic diseases were retrieved, but none were specifically dedicated to DSME. Five structured programs and 22 ad-hoc interventions were identified. DSME is mostly provided by doctors, nurses and dieticians and not consistently linked to other initiatives such as support groups. Health education materials are mainly in English with limited availability. Conclusions: DSME in South Africa is limited in scope, content and consistency, especially in the public services. A National curricula and materials for diabetes education need to be developed and adapted to the socio-economic context, culture and literacy levels of the target populations. It is recommended that DSME would be addressed in national policies and guidelines to guide the development and implementation of standardised programs. Significance for public health Diabetes significantly contributes to the global burden of disease. This burden is especially felt in developing countries, where resources are limited and the health system simultaneously has to deal with communicable and non-communicable diseases. While there is a growing body of literature on the development and implementation of diabetes self-management education, nearly all programs originate from developed countries. Very little is known about the current state of diabetes self-management education in developing countries. By focusing on diabetes self-management education in Southern Africa, the current paper provides policy makers and decision makers in South Africa with information that will help decide on where and how to intervene with regard to diabetes self-management education. The paper also has relevance for decision makers from other developing countries by providing recommendations on diabetes policies and diabetes self-management education.
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Affiliation(s)
- Loveness Dube
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
| | - William Dhoore
- lnstitute of Health and Society, Universite Catholique de Louvain , Brussels, Belgium
| | - Kerry Kalweit
- School of Health Systems and Public Health, University of Pretoria , South Africa
| | - Marie Housiaux
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
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Nwose EU, Oguoma VM, Bwititi PT, Richards RS. Metabolic syndrome and prediabetes in ndokwa community of Nigeria: preliminary study. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:53-8. [PMID: 25789249 PMCID: PMC4358049 DOI: 10.4103/1947-2714.152079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Global prevalence of metabolic syndrome (MS) and diabetes is increasing, but the reference ranges for MS indices have yet to be established for sub-Saharan African countries. As part of the international research collaboration agenda for Prediabetes and Cardiovascular Complications Study (PACCS), a pilot study was conducted in one of the Ndokwa communities of Nigeria in 2013. AIM The study was to obtain preliminary indication of prevalence and reference values of MS in the rural communities of a low-mid income country. MATERIALS AND METHODS Seventy-four volunteer participants were recruited, after public lectures in high schools and churches in the community. Body mass index (BMI), blood pressure and waist circumference (WC), blood glucoselevel, and lipid profile were measured. Percentage prevalence MS was determined using commonest three criteria (Third Adult Treatment Panel (ATP III) 2001, International Diabetes Federation (IDF) 2005, and World Health Organization (WHO) 1999). RESULTS When individual indices of MS are considered separately; the males seem healthier than females. However, the prevalence of high-density lipoprotein (HDL) cholesterol was higher in males than in females. Equal 3% prevalence of MS was seen in both genders using the WHO standard. Other criteria show prevalence of 8% females and 11% males (ATP III), 5% females and 8% males (IDF 2005 European), and 14% females and 17% males (IDF 2005 Ethnic). CONCLUSION The prevalence of MS is higher in males than females; and relative to ATP III 2001 criteria, either the IDF 2005 European may underestimate MS, or the ethnic specific could overestimate the prevalence. Hence, it is important to define the criteria to be used.
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Affiliation(s)
- E U Nwose
- School of Community Health, Charles Sturt University, New South Wales, Australia ; Department of Public and Community Health, Novena University, Delta, Nigeria
| | - V M Oguoma
- School of Psychological and Clinical Sciences, Charles Darwin University, Northern Territory, Australia
| | - P T Bwititi
- School of Biomedical Sciences, Charles Sturt University, New South Wales, Australia
| | - R S Richards
- School of Community Health, Charles Sturt University, New South Wales, Australia
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Nwankwo CU, Ezenwaka CE, Onuoha PC, Agbakoba NR. Implementing diabetes self-management education (DSME) in a Nigerian population: perceptions of practice nurses and dieticians. Arch Physiol Biochem 2015; 121:123-7. [PMID: 26112931 DOI: 10.3109/13813455.2015.1031140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hyperglycaemic complication is the most common cause of hospitalization amongst diabetes patients in Nigeria. Research showed that diabetes self-management education (DSME) assists in controlling hyperglycaemia in diabetes patients. We assessed the opinions of practice nurses and dieticians on implementing DSME in a Nigerian population. 517 nurses and dieticians completed a self-administered questionnaire tool. Results showed that the majority of the participants agreed that DSME in a Nigerian population will assist patients (88.3%) and assist to reduce diabetes complications (91.4%). While only 34% of all participants believed that their establishments were prepared to implement DSME, a large proportion of the participants agreed that their work places do not have enough qualified health personnel (62.4%), educational facilities (65.8%) and economic resources (65.6%) to embark on DSME. These constitute significant barriers for effective DSME and demand that strategic investment in human and material resources for DSME is needed in this population of a developing country.
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Affiliation(s)
- Clementina U Nwankwo
- Faculty of Health Sciences and Technology, Nnamdi Azikiwe University , Nnewi Campus , Nigeria , and
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Dube L, Van den Broucke S, Housiaux M, Dhoore W, Rendall-Mkosi K. Type 2 diabetes self-management education programs in high and low mortality developing countries: a systematic review. DIABETES EDUCATOR 2014; 41:69-85. [PMID: 25392297 DOI: 10.1177/0145721714558305] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Although self-management education is a key factor in the care for diabetes patients, its implementation in developing countries is not well documented. This systematic review considers the published literature on diabetes self-management education in high and low mortality developing countries. The aim is to provide a state of the art of current practices and assess program outcomes, cultural sensitivity, and accessibility to low literate patients. METHODS The Cochrane Library, PubMed, MEDLINE, PsycInfo, and PsycArticles databases were searched for peer-reviewed articles on type 2 diabetes published in English between 2009 and 2013. The World Bank and WHO burden of disease criteria were applied to distinguish between developing countries with high and low mortality. Information was extracted using a validated checklist. RESULTS Three reviews and 23 primary studies were identified, 18 of which were from low mortality developing countries. Studies from high mortality countries were mostly quasi-experimental, those from low mortality countries experimental. Interventions were generally effective on behavior change and patients' glycemic control in the short term (≤9 months). While 57% of the studies mentioned cultural tailoring of interventions, only 17% reported on training of providers, and 39% were designed to be accessible for people with low literacy. CONCLUSIONS The limited studies available suggest that diabetes self-management education programs in developing countries are effective in the short term but must be tailored to conform to the cultural aspects of the target population.
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Affiliation(s)
- Loveness Dube
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - Marie Housiaux
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium (Miss Dube, Prof Van den Broucke, Dr Housiaux)
| | - William Dhoore
- Institute of Health and Society, Université catholique de Louvain, Belgium (Prof Dhoore)
| | - Kirstie Rendall-Mkosi
- School of Health Systems and Public Health, University of Pretoria, South Africa (Dr Rendall-Mkosi)
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Ezenwaka CE, Okoye O, Esonwune C, Onuoha P, Dioka C, Osuji C, Oguejiofor C, Meludu S. High Prevalence of Abdominal Obesity Increases the Risk of the Metabolic Syndrome in Nigerian Type 2 Diabetes Patients: Using the International Diabetes Federation Worldwide Definition. Metab Syndr Relat Disord 2014; 12:277-82. [DOI: 10.1089/met.2013.0139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Chidum E. Ezenwaka
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Osita Okoye
- College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - Chibuike Esonwune
- College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - Philip Onuoha
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Chudi Dioka
- College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - Charles Osuji
- College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | | | - Samuel Meludu
- College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
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Ezenwaka CE, Okoye O, Esonwune C, Dioka C, Onuoha P, Osuji C, Oguejiofor OC, Meludu SC. Is diabetes patients' knowledge of laboratory tests for monitoring blood glucose levels associated with better glycaemic control? Arch Physiol Biochem 2014; 120:86-90. [PMID: 24494805 DOI: 10.3109/13813455.2014.884140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To determine if there is any difference in indices of glycaemic control between type-2 diabetes patients who knew the laboratory tests for monitoring blood glucose and their peers who did not know. METHODS Eighty-nine type-2 diabetes patients were studied after an overnight fast. The patients' bio-data, blood pressure, anthropometric indices and baseline biochemical parameters and glycated haemoglobin A₁c (HbA₁c) were measured. After a breakfast of stewed boiled rice, a 2-hour postprandial blood glucose was measured and a questionnaire administered. RESULTS The patients' mean ± SD HbA1c level was 8.6 ± 2.4% and none of the patients knew about HbA1c test for monitoring glycaemic control. Interestingly, patients who knew about fasting blood glucose test had significantly lower HbA₁c values than their counterparts who did not know (8.1 ± 2.2 vs. 9.1 ± 2.5%, p < 0.05). CONCLUSION Diabetes self-management education incorporating laboratory-based information may assist to prevent poor glycaemic control in developing countries with increasing reports of hyperglycaemic emergencies.
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Affiliation(s)
- C E Ezenwaka
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies , St Augustine , Trinidad & Tobago and
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