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

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

Abstract

Objectives: Our 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).

Methods: We 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.

Results: 177 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.

Conclusions: 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. This is of importance for the scaling up of efficient interventions in low-resource settings in the future.

Trial registration: ClinicalTrials.gov NCT01485913.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of participants.
Fig 1. Flow chart of participants.
ST2EP trial.
Fig 2. Evolution of HbA1c levels between…
Fig 2. Evolution of HbA1c levels between baseline and 12 months–levels in % and 95% confidence interval.
Fig 3. Evolution of body mass index,…
Fig 3. Evolution of body mass index, waist circumference and blood pressure between baseline and 12 months– 95% confidence interval.

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