Date of Award

12-7-2015

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Jacob Shabani

Second Supervisor/Advisor

Riaz Ratansi

Third Supervisor/Advisor

Nancy Kunyiha

Department

Family Medicine (East Africa)

Abstract

Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored.

Objective: To compare the effect of a structured Diabetes Self-Management Education programme to usual care, in type 2 diabetic patients managed at the family medicine clinic, Aga Khan University Hospital, Nairobi (AKUHN).

Methods: This was an open label randomized clinical trial carried out at the outpatient family medicine clinic of the Aga Khan University Hospital, Nairobi. One hundred and forty type 2 diabetic patients were recruited, 70 patients randomly allocated to either group using a computer generated sequence. DSME was applied in the intervention arm by Certified Diabetic Educators (CDE) while the control group received usual care from the family medicine doctor. The primary outcome, glycated hemoglobin (HBA1c) was used to determine the mean difference in blood glucose control after 6 months of follow up. Secondary biomedical outcomes included blood pressure, body weight, height and BMI. Data was analyzed using the per protocol analysis. STATA version 12 software was used. Difference in means of the outcome variables was compared using the student t-test.

Results: A total of 96 patients (69%) completed the study, 55 in the DSME group and 41 in the usual care group. The mean (± SD) age of all the patients at baseline was 48.8 (± 9.8) years with a mean (± SD) HBA1c of 9.9% (± 1.76). After 6 months of follow up, no significant difference was noted in the primary outcome (HBA1c) between both groups, with a mean difference of 0.37 (95% CI - 0.45 to 1.19; P = 0.37). DSME also made no remarkable change in any of the secondary outcome measures.

Conclusion: Overall, DSME did not show significant improvements in the primary or secondary biomedical outcomes. This may suggest that a well-trained family physician offering diabetes education may be just as good as a DSME trained educator. Further studies are however required to support this finding, particularly in primary care settings within the African context.

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