Review of the Effects of Diabetes Mellitus Group Education with Practitioner-directed Insulin Dosage Adjustments on Glycaemic Control at a Public Sector Primary Health Care Clinic in Khayelitsha

Neumuller, Caroline

Review of the Effects of Diabetes Mellitus Group Education with Practitioner-directed Insulin Dosage Adjustments on Glycaemic Control at a Public Sector Primary Health Care Clinic in Khayelitsha

Thesis / Dissertation

2023

Abstract

Aim: In view of the high burden of poorly controlled diabetes mellitus in South Africa, this study evaluated the effect of diabetes group education sessions, coupled with the provision of practitioner-directed insulin dosage adjustments based on home blood glucose readings, on patients' glycaemic control in the short and medium term. Methods: Using routine data, glycaemic control was assessed before, after and three years after the intervention. Additionally, patients' change in glycaemic control over a three-year period was compared to a control group. Results: After the group education sessions and insulin dosage adjustments, the mean HbA1c of 66 intervention patients decreased by 2.03% in the short term, from 12.57% (95%CI [12.05%, 13.09%]) to 10.54% (95%CI [9.96%, 11.11%]), and by a further 0.43% three years after the intervention. However, this change in glycaemic control after three years was not different to that of the control group. Conclusion: The 2% improvement in HbA1c in the short term is a significant achievement; although this is related to patients' poor initial glycaemic control. The control group's similar improvements over a three-year period is due to the improved clinical care and access to glucose monitors for all patients over the course of the study period at the study facility.

Keywords

Public Health and Family Medicine

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