Effects of a culturally tailored, family-support, community-based self-management education and support programme on clinical outcomes amongst adults with type 2 diabetes in Western Ethiopia: A pilot randomised controlled trial.

Abstract

To examine the preliminary effects of a culturally tailored, family-supported, community-based diabetes self-management education and support (DSMES) programme for Ethiopian people with type 2 diabetes on glycosylated haemoglobulin (HbA1c), blood pressure, body mass index and lipid profiles. A two-arm pilot randomised controlled trial (RCT) was conducted involving 76 patient-caregiver dyads from Western Ethiopia, which were randomly allocated to the intervention arm to receive 12 hours of DSMES intervention guided by social cognitive theory on top of usual care, or to the control group, which received usual care. Whilst HbA1c was a primary outcome, the blood pressure, body mass index and lipid profiles were secondary outcomes. Primary outcome was the change in HbA1c between baseline and 2-month follow-up between the groups. Generalised estimating equations was used to test the preliminary effect of the DSMES programme on the outcomes at baseline, post-intervention and at 2-month follow-up for secondary outcomes. Cohen's d was used to estimate the between-group effect sizes of the intervention. The DSMES produced significant improvement in HbA1c with large effect size (β = -1.667, p < 0.001, d = -0.81) and triglycerides with medium effect size (d = -0.50). HbA1c in the intervention group was decreased by 12 mmol/mol (1.1%). Although non-significant, the DSMES also had small to moderate effects (d = -0.123 to 0.34) on blood pressure, body mass index, total cholesterol, low-density and high-density lipoproteins when compared with usual care. A culturally tailored, social-cognitive theory guided, family-supported, community based DSME programme could have a benefit on HbA1c and triglycerides. A full RCT is warranted to test the effectiveness of the DSMES programme.