Nurse-Led Diabetes Self-Management Education Improves Clinical Parameters in Ethiopia

Background: Unlike developed countries, the clinical effectiveness of diabetes self-management education (DSME) is not well studied in the African context. Thus, this study determined the effect of DSME on clinical outcomes among type 2 diabetic (T2DM) patients in Ethiopia. Methods: A before-and-after controlled study design was employed, with random assignment of 116 T2DM adult patients to an intensified DSME group and 104 to a treatment-as-usual (comparison) group. A DSME supported with illustrative pictures handbooks and fliers and with six sessions customized to the local conditions was delivered by trained nurses over nine months. Our primary outcome was a change in the proportion of people with target glycated hemoglobin (HbA1c). We used chi-square test and mixed model analysis. Results: Seventy-eight (67%) of participants assigned to intervention and 64 (62%) of those assigned to comparison completed the study. Mean HbA1c was significantly reduced by 2.88% within the intervention group and by 2.57% within the comparison group. However, the change in the proportion of participants with target HbA1c and the end-line mean HbA1c difference between groups were not significant. Adjusted end-line fasting blood sugar (FBS), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly lower in the intervention group, by 27±9 mg/dL, 12±3 mmHg, and 8±2 mmHg, respectively. Conclusion: After nine months of nurse-led DSME, long-term glycemic control was significantly improved in both groups. However, there was no significant difference in long-term glycemic control between groups. The intervention showed some clinically significant effects on blood pressure and FBS. Trial registration: ClinicalTrials.gov Identifier: NCT03185689, retrospectively registered on June 14, 2017 on ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03185689