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

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

研究目标
本研究旨在评估低收入国家马里中，同伴主导的自我管理教育（peer-led self-management education）对改善2型糖尿病患者血糖控制（glycaemic control）效果的有效性。

研究方法
本研究采用开放标签随机对照试验设计。于巴马科两家二级医疗中心的糖尿病门诊纳入151名成人2型糖尿病患者（其中女性占76%，平均年龄52.5岁，糖化血红蛋白（HbA1c）≥8%），将其随机分为同伴主导结构化患者教育组（n=76）与常规护理组（n=75）。干预组接受为期1年的适配本土文化的结构化患者教育，由5名经过培训的同伴教育者在社区开展，共分为3个课程模块，每模块包含4次授课。两组均接受常规糖尿病监测与随访。本研究的主要结局指标为基线至12个月时糖化血红蛋白的平均绝对变化值。

研究结果
干预组共计完成177次教育授课，患者脱落率为8%。基线至12个月时，干预组糖化血红蛋白水平较基线下降1.05%（标准差SD=2.0；95%置信区间CI95%：1.54~-0.56），对照组较基线下降0.15%（SD=1.7；CI95%：-0.56~0.26），组间差异具有统计学意义（p=0.006）。干预组体质量指数（BMI）平均变化为-1.65 kg/m²（SD=2.5；CI95%：-2.25~-1.06），对照组为+0.05 kg/m²（SD=3.2；CI95%：-0.71~0.81），组间差异显著（p=0.0005）。干预组腰围平均降低3.34 cm（SD=9.3；CI95%：-5.56~-1.13），对照组腰围平均增加2.65 cm（SD=10.3；CI95%：0.20~5.09），组间差异具有统计学意义（p=0.0003）。

研究结论
针对马里地区血糖控制不佳的2型糖尿病患者，开展为期1年的同伴主导结构化患者教育，可显著改善其血糖控制水平与人体测量学参数。该研究结果为未来在低资源环境中推广高效干预措施提供了重要依据。

试验注册
ClinicalTrials.gov NCT01485913