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EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND)-a feasibility study in Mozambique and Malawi.

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journal contribution
posted on 13.10.2021, 08:30 by Emer M Brady, EXTEND Collaborative, Catherine Bamuya, David Beran, Jorge Correia, Amelia Crampin, Albertino Damasceno, Melanie J Davies, M Hadjiconstantinou, Deirdre Harrington, Kamlesh Khunti, Naomi Levitt, Ana Magaia, Jayna Mistry, Hazel Namadingo, Anne Rodgers, Sally Schreder, Leopoldo Simango, Bernie Stribling, Cheryl Taylor, Ghazala Waheed

Background

Globally, there are estimated 425 million people with type 2 diabetes (T2D) with 80% from low-middle income countries (LMIC). Diabetes self-management education (DSME) programmes are a vital and core component of the treatment pathway for T2D. Despite LMIC being disproportionally affected by T2D, there are no DSME available that meet international diabetes federation criterion.

Methods

The aims were to test the feasibility of delivering a proven effective and cost-effective approach used in a UK population in two urban settings in Malawi and Mozambique by; (1) developing a culturally, contextually and linguistically adapted DSME, the EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND) programme; (2) using a mixed-method approach to evaluate the delivery of training and the EXTEND programme to patients with T2D.

Results

Twelve healthcare professionals were trained. Ninety-eight participants received the DSME. Retention was high (100% in Mozambique and 94% in Malawi). At 6 months HbA1c (-0.9%), cholesterol (-0.3 mmol/L), blood pressure (-5.9 mm Hg systolic and -6.1 mm Hg diastolic) improved in addition to indicators of well-being (problem areas in diabetes and self-efficacy in diabetes).

Conclusion

It is feasible to deliver and evaluate the effectiveness of a culturally, contextually and linguistically adapted EXTEND programme in two LMIC. The DSME was acceptable with positive biomedical and psychological outcomes but requires formal testing with cost-effectiveness. Challenges exist in scaling up such an approach in health systems that do not have resources to address the challenge of diabetes.

History

Citation

BMJ Open 2021;11:e047425. doi: 10.1136/bmjopen-2020-047425

Author affiliation

Diabetes Research Centre, College of Life Sciences

Version

VoR (Version of Record)

Published in

BMJ open

Volume

11

Issue

9

Pagination

e047425

Publisher

BMJ

issn

2044-6055

eissn

2044-6055

Copyright date

2021

Available date

13/10/2021

Language

eng

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