Diabetes Self-Management Educational Program
Condition: Diabetes Mellitus
MeSH terms: Diabetes Mellitus
Study type: Interventional

Summary: 
      Diabetes mellitus is the third most prevalent chronic disease globally. It is a metabolic
      disorder characterized by elevated blood glucose because of impaired insulin production,
      reduced insulin effectiveness, or both. It is a major contributor to physical disability and
      impaired quality of life. Diabetes Self-Management programs help to control blood glucose,
      reduce hospitalization, and increase compliance; however, the program is underutilized in
      primary care settings globally, due to cognitive, financial, behavioral, and emotional
      factors. Addressing the increasing trend in diabetes, Jordan is currently in need of a
      diabetes self-management program that promotes patient empowerment and overall well-being.
      The primary aim of this study was to investigate the effectiveness of a diabetes
      self-management education program for patients with type 2 diabetes in improving self-care,
      medication adherence, illness perception, health-related quality of life, and glycemic
      control (HbA1c level). This study is a two-arm randomized controlled trial study of patients
      with type 2 diabetes attending two outpatients' diabetes clinic settings in Jordan. The
      education program and also usual medical care were applied to the intervention group, only
      usual medical care was applied to the control group.
    

Detailed description: 
      Diabetes mellitus (DM) is a growing public health problem highly amenable to prevention and
      health promotion interventions. Diabetes mellitus is a chronic disease that requires ongoing
      medical care and ongoing patient self-management education and support to prevent acute
      complications and reduce the risk of chronic complications of diabetes. The prevalence of
      diabetes mellitus is reaching epidemic proportions in many parts of the world. Globally it is
      estimated that approximately 537 million adults (20-79 years) are living with diabetes
      according to International Diabetes Federation (2021). The total number of people living with
      diabetes is projected to rise to 643 million by 2030 and 783 million by 2045. Moreover, the
      International Diabetes Federation estimated that diabetes caused at least USD 966 billion
      dollars in health expenditure - 9% of total spending on adults. In Jordan, the
      age-standardized prevalence rate of diabetes and impaired fasting blood glucose was 17.1% and
      7.8%, respectively. The high prevalence of diabetes point to the need for immediate
      implementation of educational programs and other interventions to prevent and control the
      burden of diabetes in Jordan. The majority of researchers and clinicians advocate that
      diabetes is a disease that requires diabetes self-management care abilities and that patients
      need to be taught diabetes self-management skills to become reliable, capable, and
      sufficiently responsible to take care of themselves. Diabetes self-management is of great
      importance because the adoption of healthy lifestyle behaviors will produce optimum glycemic
      control for diabetes, which in turn will help minimize or prevent subsequent acute and
      long-term complications of the disease. Diabetes is a lifelong disease that needs behavioral
      changes, most often through education, counseling, and support through behavioral
      interventions offered by health care providers, to enable diabetic patients to perform
      self-care activities. Behavioral changes are complex processes that are influenced by such
      factors as illness perceptions, quality of life, beliefs, attitudes, skills, motivation, and
      social support. In Jordan, diabetes nursing education services are at an early stage of
      development and have recently been introduced to healthcare facilities and the implementation
      of such services is still limited. Improving diabetes self-management, preventing diabetes
      complications, and reducing health service utilization for patients with diabetes are ongoing
      challenges for nurses and other healthcare providers globally and in Jordan. There is a need
      to investigate the impact of implementing a nursing educational care program on reaching
      glycemic control goals and other clinical outcomes because of the increasing prevalence of
      diabetes and the limited implementation of effective nursing services for patients with type
      2 diabetes in Jordan. The primary aim of this study is to evaluate the effect of a structured
      diabetes education program on glycemic control and other health-related clinical outcomes in
      patients with poorly controlled type 2 diabetes. This study is a two-arm randomized
      controlled trial of patients with type 2 diabetes attending two outpatient diabetes clinic
      settings in Jordan. The education program for 24 weeks and also usual medical care were
      applied to the intervention group, only usual medical care was applied to the control group.

      The education intervention consists of structured face-to-face individual/ group-based
      education and counseling sessions with telephone follow-up instructions. At each clinic
      visit, diabetes nurse educators meet the participants in the intervention group in a private
      room. Printed educational material was developed by the researchers containing information
      about diabetes, diabetes medications, lifestyle modifications, and self-care activities also
      given to patients in the intervention group. Diabetes nurse educators also encourage patients
      to adhere to prescribed medications and advise participants to follow healthy lifestyle
      behaviors. Finally, follow-up telephone calls were made by the diabetes nurse educator to
      each intervention participant to discuss and review the prescribed therapy, to emphasize the
      importance of adherence to the treatment plan, and to answer patient questions or address
      their concerns. The education and counseling were maintained through follow-up via phone for
      the intervention group. The control group was not exposed to the structured education
      intervention but continued with their usual care provided by the medical and nursing staff
      and was followed according to the institution's routine diabetes follow-up protocol. The
      baseline assessment (pre-intervention) for both groups involves obtaining data about study
      outcome measures. The primary outcomes are glycemic control (HbA1c level) and self-care
      activities; whereas medication adherence, illness perception, and health-related quality of
      life are the secondary outcomes. Follow-up assessment involves obtaining data about HbA1c
      results for both the intervention group and the control group from their medical records at 3
      and 6 months intervals. The baseline questionnaires were re-administered at six months
      post-intervention for both groups.
    

Intervention name(s): Diabetes Self-Management Education Program
Intervention type(s): Behavioral
Intervention description(s): diabetes self-management education and counseling program with follow-up via phone for the intervention group for 24 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study is a two-arm - experimental vs. control group Randomized Controlled Trial. The sampling frame was patients with uncontrolled type 2 diabetes registered in two outpatient diabetes clinics located in two cities in Jordan. Diabetes self-management program is delivered by a trained diabetes educator facilitator in diabetes management. In addition to the usual care, the intervention group was provided with an education program that consisted of nine 60-min sessions, which included face-to-face interactive sessions with the dissemination and presentation of written and visual materials. The education and counseling were maintained through follow-up (24 weeks) via phone for the intervention group. The control group received only usual care and they were followed according to the institution's diabetes follow-up protocol.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Diabetes Self-Care Activities; Illness Perceptions; Medication Adherence; Health Related Quality of Life; Glycemic Control