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

Okon Essien; Akaninyene Otu; Victor Umoh; Ofem Enang; Joseph Paul Hicks; John Walley

doi:10.1371/journal.pone.0168835

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 Jan 3;12(1):e0168835. doi: 10.1371/journal.pone.0168835. eCollection 2017.

Authors

Okon Essien¹, Akaninyene Otu¹, Victor Umoh², Ofem Enang¹, Joseph Paul Hicks³, John Walley³

Affiliations

¹ Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria.
² Department of Medicine, University of Uyo, Uyo, Akwa Ibom State, Nigeria.
³ Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.

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.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Blood Glucose / analysis
Chronic Disease
Diabetes Mellitus, Type 1 / blood*
Diabetes Mellitus, Type 2 / blood*
Disease Management
Female
Glycated Hemoglobin / analysis*
Humans
Hyperglycemia / blood
Male
Middle Aged
Nigeria
Patient Education as Topic / methods*
Practice Guidelines as Topic
Regression Analysis
Self Care
Tertiary Care Centers
Treatment Outcome

Substances

Blood Glucose
Glycated Hemoglobin A

Grants and funding

This study received funding from Norvatis Pharmaceuticals and Biofem Pharmaceuticals provided the HbA1c analysers and cartridges. These were received by O Essien on behalf of the research group. However, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.