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Original Research
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
Submitted: 16 February 2018 | Published: 19 November 2018
About the author(s)
Catherine W. Gathu, Department of Family Medicine, The Aga Khan University, KenyaJacob Shabani, Department of Family Medicine, The Aga Khan University, Kenya
Nancy Kunyiha, Department of Medicine, The Aga Khan University, Kenya
Riaz Ratansi, Department of Family Medicine, The Aga Khan University, Dar es Salaam, Tanzania, United Republic of
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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