Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013

IntroductionEarly detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. This study evaluated outcomes of MoPoTsyo’s diabetes program in Takeo Province by assessing glycemic and blood pressure outcomes for individuals diagnosed with diabetes over a 24-month follow-up period between 2007–2013.MethodsThis is a retrospective cohort analysis of records without a comparison group. We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow-up. The proportion of patients reaching recommended treatment targets for FBG and BP was assessed.ResultsOf the 3411 patients enrolled in the program, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow-up time in the program was 16 months (4.9–38.4 months). Mean FBG decreased 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow-up (pConclusionThe improved outcome indicators of diabetes care for MoPoTsyo’s Takeo program evaluation showed promise. The program demonstrated a reasonable and practical approach to delivering effective diabetes care in a rural area and may serve as a model for other low-income communities. Future prospective evaluations with more complete data are necessary for longer-term outcomes.引言 糖尿病的早期筛查与治疗对于降低该病所致残疾与死亡风险至关重要。在资源匮乏国家，为糖尿病患者提供有效的筛查与治疗方案仍是一项挑战。柬埔寨非政府组织MoPoTsyo通过采用多维度干预方案填补了这一空白，该方案涵盖社区同伴教育者支持、实验室检测服务、本地门诊医疗咨询以及循环药物基金。本研究针对2007至2013年间MoPoTsyo在茶胶省（Takeo Province）推行的糖尿病项目，通过对确诊糖尿病患者开展为期24个月的随访，评估其血糖与血压结局，以此评价该项目的实施效果。 方法 本研究为无对照组的回顾性队列分析，基于既往诊疗记录开展。研究人员在随访固定时间点计算受试者的平均空腹血糖（fasting blood glucose, FBG）与血压（blood pressure, BP）水平，并评估达到推荐治疗目标的FBG与BP患者占比。 结果 该项目共招募3411例患者，最终2230例纳入本研究。研究队列以女性为主，占比68.9%，受试者年龄中位数为54岁。受试者中位随访时长为16个月（四分位间距4.9~38.4个月）。随访满1年时，受试者平均空腹血糖水平较基线降低63.9 mg/dl（95%置信区间58.5~69.3）（原文此处P值相关内容存在截断）。 结论 MoPoTsyo茶胶省糖尿病项目的评估结果显示，其糖尿病照护的结局指标得到显著改善，展现出良好的应用前景。该项目证实了在农村地区开展高效糖尿病照护的合理可行方案，可为其他低收入社区提供借鉴范本。后续需开展数据更完整的前瞻性评估，以进一步明确该项目的长期照护效果。