Abstract
BackgroundThis study aimed to measure the effect of diabetes education using the novel method of “diabetes conversation map (DCM)” as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan.MethodsA parallel arm randomized controlled trial among patients with type 2 diabetes aged 30–60 years, with HbA1c > 7%, diagnosed for at least 5 yrs., was conducted at the national institute of diabetes and endocrinology in Karachi, Pakistan. A total 123 type 2 diabetes patients were randomized into DCM (n = 62) or RC (n = 61). Four weekly diabetes control sessions of 40 min each using the DCM or RC was provided. DMSE was measured using a validated Urdu language DMSE tool at baseline and after three months of the randomization. Change in DMSE and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment was compared.ResultsBaseline characteristics except HbA1c were similar between the two arms. After 3 months of enrollment, there was no change in the DMSE score in the RC arm however, significant increase in DMSE score was noted in the DCM arm (P = < 0.001). The average difference (95% confidence interval) in DMSE score between the DCM and RC arm was 33.7(27.3, 40.0; p = < 0.001) after 3 months of the enrollment. Difference in HbA1c within groups was not significant.ConclusionsDCM significantly improved DMSE among type 2 diabetes patients in a developing country setting like Pakistan. Healthcare workers caring for type 2 diabetes patients need to be trained on DCM to effectively utilize this novel tool for educating diabetes patients.Trial registrationThis trial was prospectively registered. ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018.
Highlights
This study aimed to measure the effect of diabetes education using the novel method of “diabetes conversation map (DCM)” as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan
Pakistan being a low middle income countries (LMIC), experienced an increase from 1.7 million of adult diabetes patients in 1980 to 19.4 million in 2019 and is considered as one of the top 10 countries with highest number of adult population living with diabetes.(1; 2) In 2019, about 4.2 million deaths attributed to diabetes and diabetes related complications occurred globally and almost half (46.2%) of the deaths were among the working age group (< 60 years old) [2, 3]
Among total randomized into the two arms, only 58/ 61(95%) received routine counselling and provided baseline data in the RC arm and only 54/62(87%) received education based on conversation map and provided baseline data in the DCM arm
Summary
This study aimed to measure the effect of diabetes education using the novel method of “diabetes conversation map (DCM)” as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan. The number of adult diabetes cases increased from 108 million in 1980 to 463 million in 2019 and the projections for 2045 is about 700 million [1, 2]. Pakistan being a LMIC, experienced an increase from 1.7 million of adult diabetes patients in 1980 to 19.4 million in 2019 and is considered as one of the top 10 countries with highest number of adult population living with diabetes (diabetes prevalence of ≥12%).(1; 2) In 2019, about 4.2 million deaths attributed to diabetes and diabetes related complications occurred globally and almost half (46.2%) of the deaths (majority from lower middle income countries) were among the working age group (< 60 years old) [2, 3]. Since the life style habits including daily routine are associated with diabetes and its control, people living with diabetes can play an important role in their disease management [5]
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