Interview topics.

People living with insulin dependent diabetes (PLWIDD) in low and lower-middle income countries (LLMICs), specifically rural areas, face significant barriers to diabetes management. Diabetes Self-Management Education (DSME) is an evidence-based intervention to educate and empower people living with diabetes to improve self-management. This pilot study evaluates the feasibility and clinical impact of a DSME program in a rural Package of Essential Noncommunicable Disease-Plus (PEN-Plus) clinic in Liberia. This study was conducted at two sites in Harper, Liberia. After being trained on how to administer DSME, clinic providers delivered DSME to PLWIDD during routine monthly clinic visits. Primary outcomes included acceptability, adoption, fidelity and the frequency of self-management behaviors; secondary outcomes included knowledge change and Hemoglobin A1c (HbA1c). Three providers and twenty-six PLWIDD were enrolled. DSME was feasible and well accepted by providers and PLWIDD. Patient knowledge scores increased from 33% at baseline to 64.6% at month 12. Average weekly blood glucose checks increased from 4.0 (95% CI 1.93, 6.23) checks per week month one, to 7.2 (95% CI 3.56, 10.79) checks per week month 12. Average weekly missed insulin injections decreased from 3.9 (95% CI 2.51, 6.03) in month one, to 0.82 (95% CI -0.14, 1.79) in month 12. Mean HBA1C decreased from 12.0% (107.7 mmol/mol) at baseline to 10.9% (95.6 mmol/mol) month 12, (modeled mean reduction of 1.1%,95% CI 0.0 to 2.0). This study adds to the growing body of literature showing that DSME can address many barriers faced by PLWIDD in LLMICs. Further research is warranted to expand the scope of self-management education to other noncommunicable conditions in the context of integrated PEN-Plus strategies.

胰岛素依赖型糖尿病患者（People living with insulin dependent diabetes, PLWIDD）在低收入及中低收入国家（low and lower-middle income countries, LLMICs），尤其是农村地区，面临糖尿病管理的多重显著障碍。糖尿病自我管理教育（Diabetes Self-Management Education, DSME）是一项基于证据的干预措施，旨在对糖尿病患者开展教育并赋予其能力，以改善自我管理水平。本先导性研究评估了在利比里亚一家农村基本非传染性疾病综合包（Package of Essential Noncommunicable Disease-Plus, PEN-Plus）诊所实施DSME项目的可行性与临床影响。本研究在利比里亚哈珀的两个临床站点开展。诊所医护人员在接受DSME实施培训后，在常规月度门诊就诊期间为PLWIDD提供DSME服务。主要结局指标包括可接受性、采用率、执行保真度以及自我管理行为的发生频率；次要结局指标包括知识水平变化与血红蛋白A1c（Hemoglobin A1c, HbA1c）水平。本研究共纳入3名医护人员与26名PLWIDD。研究结果显示，DSME具备可行性，且获得了医护人员与患者的广泛认可。患者的知识得分从基线时的33%提升至第12个月时的64.6%。每周平均血糖检测次数从第1个月的4.0次（95%置信区间[CI]：1.93, 6.23）提升至第12个月的7.2次（95%CI：3.56, 10.79）。每周平均漏注射胰岛素次数从第1个月的3.9次（95%CI：2.51, 6.03）降至第12个月的0.82次（95%CI：-0.14, 1.79）。平均HbA1c水平从基线时的12.0%（107.7 mmol/mol）降至第12个月的10.9%（95.6 mmol/mol），模型估算的平均降幅为1.1%（95%CI：0.0, 2.0）。本研究为日益增多的相关文献增添了证据，表明DSME能够解决LLMICs中PLWIDD面临的诸多管理障碍。未来有必要开展进一步研究，在综合PEN-Plus策略的框架下，将自我管理教育的覆盖范围拓展至其他非传染性疾病领域。