Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali.

Xavier Debussche,Maryvette Balcou-Debussche,Hélène Delisle,Stéphane Besançon,Laetitia Huiart,Cyril Ferdynus,Assa T Sidibe,Noël C Barengo

doi:10.1371/journal.pone.0191262

Abstract

ObjectivesOur objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country (Mali).MethodsWe conducted an open-label randomised controlled trial. A total of 151 adults (76% women, mean age 52.5) with type 2 diabetes (HbA1c≥8%), treated in the diabetes consultation units of two secondary health centres in Bamako, were allocated to peer-led structured patient education (n = 76) or conventional care alone (n = 75). The intervention group received 1 year of culturally tailored structured patient education (3 courses of 4 sessions) delivered in the community by five trained peer educators. Both groups underwent conventional diabetes monitoring and follow-up. Primary outcome was the mean absolute change in HbA1c from baseline to 12 months.Results177 education sessions were delivered to the intervention group. Patient attrition was 8%. From baseline to 12 months, the decrease in HbA1c levels was 1.05% (SD = 2.0; CI95%: 1.54;-0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006. Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005. Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56;-1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003.ConclusionsPeer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters. This is of importance for the scaling up of efficient interventions in low-resource settings in the future.Trial registrationClinicalTrials.gov NCT01485913

Highlights

Type 2 Diabetes (T2D) is a worldwide challenge
Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005
Peer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters

Summary

Introduction

Type 2 Diabetes (T2D) is a worldwide challenge. According to the International Diabetes Federation, 415 million people had diabetes in 2015 [1]. Africa’s chronic disease burden is largely attributed to increased sedentary lifestyle, modified diets with higher levels of added sugar, salt, total and saturated fat, as well as structural factors such as industrialisation, urbanisation and increasing food globalisation [4] This is compounded by weak health systems that are unable to cope with the double impact of infectious and chronic diseases [5]. From 2005 to 2010, the NGO Santé Diab0078te together with the Malian Ministry of Health developed an important programme to strengthen diabetes management services offered by the healthcare system This led to the opening of 23 diabetes consultation units in health structures located in different regions of the country [7]

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