Diabetes self-management education exposure and glycated haemoglobin levels among Marshallese participants in a randomized controlled study.

Abstract

A randomized control trial (RCT) of diabetes self-management education (DSME), undertaken by a community-based participatory research (CBPR) partnership between the University of Arkansas for Medical Sciences (UAMS) and the Marshallese community in Arkansas. The RCT examined the effect of hours of intervention exposure, with the hypothesis that increased exposure is one reason the Adapted-Family DSME was found to be more effective than the Standard DSME. Some 221 Marshallese with type 2 diabetes were randomized to an Adapted-Family DSME group (in-home setting) (n=110) or a Standard DMSE group (community setting) (n=111). The Adapted-Family DSME included 10h of education that covered the core self-care elements recommended by the American Diabetes Association (ADA) and American Association of Diabetes Educators' (AADE) recommendations. The Standard DSME included 10h of intervention with all ADA and AADE core elements. The number of hours of intervention exposure in the Adapted-Family DSME arm (mean=8.0; median=10.0) was significantly higher than the number of hours of intervention received in the Standard DSME arm (mean=1.5; median=0.0). As hypothesized, higher exposure was associated with a significant reduction in HbA1c in a model including only study arm and exposure (P=0.01), and in a model including study arm, exposure, and all demographic variables (P=0.046). This finding is consistent with previous reviews that showed increased exposure to DSME produced improved glycaemic control and ≥10h of DSME produces clinically meaningful reductions in HbA1c .