Dataset Information

Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.

ABSTRACT:

Background

In high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive.

Aim

To compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings.

Research design and methods

Design

Single-blind randomised parallel comparator controlled multi-centre trial. Adults (> 18 years) with type 2 diabetes from two hospitals in urban Ghana were randomised 1:1 to usual care only, or usual care plus a structured diabetes self-management education program. Randomisation codes were computer-generated, and allotment concealed in opaque numbered envelopes. The intervention effect was assessed with linear mixed models.

Main outcome

Change in HbA1c after 3-month follow-up. Primary analysis involved all participants.

Clinicaltrial

gov identifier:NCT04780425, retrospectively registered on 03/03/2021.

Results

Recruitment: 22^nd until 29^th January 2021. We randomised 206 participants (69% female, median age 58 years [IQR: 49-64], baseline HbA1c median 64 mmol/mol [IQR: 45-88 mmol/mol],7.9%[IQR: 6.4-10.2]). Primary outcome data was available for 79 and 80 participants in the intervention and control groups, respectively. Reasons for loss to follow-up were death (n = 1), stroke(n = 1) and unreachable or unavailable (n = 47). A reduction in HbA1c was found in both groups; -9 mmol/mol [95% CI: -13 to -5 mmol/mol], -0·9% [95% CI: -1·2% to -0·51%] in the intervention group and -3 mmol/mol [95% CI -6 to 1 mmol/mol], -0·3% [95% CI: -0·6% to 0.0%] in the control group. The intervention effect was 1 mmol/mol [95%CI:-5 TO 8 p = 0.726]; 0.1% [95% CI: -0.5, 0.7], p = 0·724], adjusted for site, age, and duration of diabetes. No significant harms were observed.

Conclusion

In low-resource settings, diabetes self-management education might not be associated with glycaemic control. Clinician's expectations from diabetes self-management education must therefore be guarded.

SUBMITTER: Lamptey R

PROVIDER: S-EPMC9957611 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.

Lamptey Roberta R Amoakoh-Coleman Mary M Barker Mary Moffett MM Iddi Samuel S Hadjiconstantinou Michelle M Davies Melanie M Darko Daniel D Agyepong Irene I Acheampong Franklyn F Commey Mary M Yawson Alfred A Grobbee Diederick E DE Adjei George Obeng GO Klipstein-Grobusch Kerstin K

BMC health services research 20230224 1

<h4>Background</h4>In high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive.<h4>Aim</h4>To compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings.<h4>Research design and methods</h4><h4>Design</h4>Single-blind randomised parallel comparator controlled multi-centre trial. Adults (> 18 years) with type 2 ...[more]

PMID: 36829179

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Project description:IntroductionA journal club (JC) is a commonly used medical educational tool. Videoconferencing technology can facilitate the delivery of JCs, however, there remains no evidence on the role of web-based virtual JCs in promoting the acquisition and retention of medical knowledge. The Web-Ed trial aims to evaluate the educational benefits, feasibility and acceptability of web-based virtual JCs compared with traditional face-to-face ones.Methods and analysisWeb-Ed is a multicentre pragmatic parallel-group randomised trial across teaching hospitals within the UK National Health Service (NHS). We will enrol qualified doctors or medical students who are >18 years old, proficient in English and able to use online videoconferencing software. Block randomisation will be used to allocate participants in 1:1 ratio to either intervention group. Both groups will be presented with the same educational material and follow a standardised JC structure hosted by nominated moderators and medical faculty members.The primary outcome is the difference in participants' knowledge acquisition and retention 7 days after the JCs evaluated using standardised multiple-choice questions. We will report secondarily on the feasibility and acceptability of the JCs using Likert scale questionnaires. Assuming a 30% drop-out rate, we aim to enrol 75 participants to detect a 20% improvement in knowledge acquisition at 80% power and 5% significance. We will report using mean difference or risk ratio with 95% CIs and assess significance using parametric/non-parametric testing. Where relevant, we will adjust for predetermined characteristics (age, grade of training and session duration) using multivariate regression analyses.Ethics and disseminationWeb-Ed was designed by doctors in training to address their learning needs and evaluate the preferred mode of learning. The trial results will be published in peer-reviewed journals and presented at relevant scientific conferences. The trial has been approved by the NHS Health Regulation Authority (21/HRA/3361).Trial registration numberISRCTN18036769.

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Dataset Information

Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.

Background

Aim

Research design and methods

Design

Main outcome

Clinicaltrial

Results

Conclusion

Publications

Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.

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