A Randomized Trial of an Intensive Education Intervention Using a Network of Involved Diabetic Patients (Peer Educators) to Improve Glycemic Control of Type 2 Diabetic Patients
Condition: Diabetes
Study type: Interventional

Summary: 
      The project will test the implementation of a specific methodology for education of type 2
      diabetic patients that will be set up using patients involved (peer educators) and 3 guides
      developed specifically for the therapeutic education of type 2 diabetic patients. This
      project will take place in 1 sites in mali : the capital Bamako. 75 diabetic patients will be
      subjected to intervention with this methodology and 75 other diabetic patients will be the
      control group. At various stages of the project, the investigators will analyze the impact on
      biological, anthropological constants, etc ... of the group undergoing the intervention
      compared to the control group.
    

Detailed description: 
      Title of project:

      A randomized trial of an intensive education intervention using a network of involved
      diabetic patients (peer educators) to improve glycemic control of type 2 diabetic patients

      Research question (s)/hypothesis:

      Main objective of the research: compare the improvement of HbA1c 1 year after an intervention
      led by peer educators, versus a conventional care in health centre

      Secondary objectives:

      Study the evolution of bio clinical parameters: fasting glucose, weight, BMI, blood pressure,
      waist size

      Method (s) :

      This study will be conducted by a multidisciplinary team that brings together high level
      skills in research projects and in peer education projects. It will be conducted in one site
      in one country Mali.

      This site was chosen because they meet a functional care, access to medicines and a dynamic
      association of diabetic patients. Peer educators and persons targeted by the project will be
      recruited through the local association of patients. This association will be a social
      support that provides on going prevention counseling, education and support services to
      people who have diabetes. It represents an important link between patients, educators and
      general medical services. The procedure will start by the training of peer educators who were
      identified and recruited to facilitate the sessions

      Then, the 4 educational sessions: control of cardiovascular risk (blood pressure, waist
      circumference, smoking, cholesterol, glycaemia), control of Food (balance, fat,
      carbohydrates), physical activity management, insulin management, will be carried out and
      patients will be able to:

        -  Analyze knowledge that appears in various forms, including forms adapted to illiterate
           patients (colour codes, presence of photos)

        -  Act on knowledge: the patient observes, makes hypothesis, he experiments, compares,
           deduces, analyzes, makes relations.

        -  Work in interaction with other learners, which gives education a social dimension.

        -  Decide on the implementation of actions taking into account individual, cultural,
           social, economic context

      For each situation, a day of training will be conducted by trained peer educators with
      theoretical contributions on the issue, practical scenarios, analyzes of the issues out of
      frame and put in "educational security ". These training days will be implemented with 8-10
      patients (1Hour and an half) and the 4 sessions will take place over a period of two months
      starting from the inclusion of patients.

      2 groups of 75 persons will be formed. One group will have specific education using
      methodology of learning nests. The other group will be a control group not subject to this
      specific education.

      To evaluate, we propose a classical randomized controlled experimental (RCT) design, with
      randomization at the person-level. For outcome measures, we propose change in HbA1c, increase
      of social and emotional support and increase of linkage to clinical care. In addition to
      HbA1c, we propose measuring changes in systolic, diastolic blood pressure, and weight.

      Public health significance (state how the project applies to your community and it potential
      impact(s))

      It is very important to find an education methodology adapted to the African context. This
      line of diabetes management is essential to improve the management of African diabetic
      patients.

      Sustainability plan:

      If the evaluation of this methodology is conclusive, the Malian state will implement the
      methodology in the 22 diabetes units of the country.
    

Intervention name(s): intensive education intervention using a network of involved diabetic patients (peer educators)
Intervention type(s): Other
Intervention description(s): the purpose of this methodology is to set up coordinated training and education activities targeting populations with diabetes based on a pragmatic approach (the learning nests methodology) of appropriation and construction of knowledge that takes into account the individual, social, economic, cultural context. This work is being implemented on the basis of group modules specifically designed in their running: are studied the concrete elements of knowledge to mobilize, patients' actions, the role of health the educator, indicators of progress and monitoring during sessions and on the long term. Each patient is gotten to consider the elements involved in his/her disease, and the actions that can be achieved taking into account the feasibility in his/her own context. The education monitoring is envisaged through a data compendium present in the individual booklets that are given to patients at the end of each education session.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Supportive Care
Keywords: Education; Diabetes; Prevention complications; Prevention of complications of diabetes