The effectiveness of diabetes self-management education in developing countries

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Illustration by PB Perkeni

Diabetes mellitus has become one of the six most widespread deaths due to non-communicable diseases, reaching 1.59 million in 2015. This is caused by an increase in the number of diabetes mellitus patients each year. There are two types of diabetes, diabetes mellitus type 1 and type 2. As lifestyle changes, including health behavior, type 2 diabetes mellitus has become the most common type today. Studies show a prevalence of up to 90% of cases. Type 2 diabetes mellitus is caused by insulin resistance. High blood glucose concentrations prevent insulin from being able to process it into cells. This poor regulation will progressively disrupt metabolism. The complications of diabetes mellitus have a significant impact, not only in terms of health but also in economics. This economic burden is prominent in developing countries, which account for 1.3% of regional gross domestic product.

Maintaining blood glucose within the normal range can help improve the condition of diabetes mellitus. Thus, controlling blood glucose becomes an essential aspect of diabetes management. Unfortunately, poor blood glucose control is a common problem among patients living in developing countries. According to the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), for diabetes alone, patient-centered care is more likely to be effective in controlling blood glucose than drugs. Some challenges can prevent patients from complying with diabetes mellitus therapy optimally, such as patient education and lifestyle. Diabetes mellitus self-management (DSME) and support from health care have become an essential part of the improvement and application of therapy for diabetes.

Previous reviews were conducted to evaluate the effectiveness of the DSME program for patients with type 2 diabetes mellitus. Several studies have applied DSME by individual and group interventions. Educators use telephone calls to provide education, and others use educational brochures, printed flyers, training videos, and pamphlets. Two other studies used a combination of telephone calls and educational booklets. Primary and secondary outcomes include clinical indicators and knowledge among patients. The study design was a randomized controlled randomized clinical trial (RCT), a double-blind, randomized clinical trial (RDBCT), a quasi-experimental trial (QET) and quasi-randomized trial (QRT). However, most of the research came from developed countries and some from middle east countries.

Diabetes self-management education is essential to improve the ability of patients with diabetes mellitus. Given the diversity of people in each region for each country, specific methods will follow people’s backgrounds and characteristics. Therefore this review highlights some evidence that DSME can improve glycemic control for patients with T2DM who live in the current area. This systematic review shows that DSME can improve glycemic control in all studies conducted in developing countries. Other international reviews also show that fasting blood glucose and HbA1c blood pressure. A total of 13 studies were identified that used interventions with various educational approaches and psychological therapies and ways of delivery. This review shows that the full effect of increasing HbA1c is with DSME, supported by previous research conducted in China

Based on research, DSME has a good impact on the groups. Interventions also have the same effectiveness as intensive programs. This increase is consistent with statements made by the American Diabetes Association (ADA), which show that the DSME program can increase HbA1c for DMT2 patients by about 1%. Various patient backgrounds affect the results of the study. The educational background, economic level, and perspective of the patient also contribute to the effect. As mentioned in this study, the effectiveness of DMSE is influenced by the culture and characteristics of the patients enrolled.

Apart from the factors that influence DSME implementation, the studies in this review have the same effect on small and large size groups. Another contradictory study shows that DSME is useful in extensive sample studies, and others mention that small sample studies can achieve an increase in HbA1c. However, apart from the different results regarding the size of the study sample, DSME will affect the two study group sizes. Not all studies focus on patient outcomes such as quality of life, knowledge, self-management behavior, adherence to medication, and self-efficacy; the results show improvements in these aspects after the DSME intervention. Another study states that a multidisciplinary DSME team involving more than one health professional can have a good impact on outcomes, although it has not been confirmed in RCTs.

Author: Tintin Sukartini, Rifky Octavia Pradipta, Dwi Yoga Setyorini, Superzeki Zaidatul Fadilah, and Ika Adelia Susanti


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