IDF21-0472 The effect of structured diabetes self-management education care on glycaemic control in Accra subsequent to COVID-19

Background:Diabetes specific education has traditionallybeen tied to routine visits and delivered in-person thus requiringrepeated clinic visits. The ongoing COVID-19 pandemic makes itimperative to adopt alternative ways of delivering diabetes educa-tion in low-income settings.DESMOND is a structured DSME that is widely published andhas been shown to improve adherence, positive diabetes out-comes and be cost effective particularly in the United Kingdom.EXTEND (EXTending availability of self-management structuredEducation programs for people with Diabetes in LMICs) is a cul-turally tailored and linguistically modified version of DESMONDwhich has been tested in Malawi and Mozambique.We sought to culturally adapt EXTEND for the Ghanaian pop-ulation and to determine the effect of EXTEND in adults withT2DM in Accra, Ghana.Aim:To compare structured DSME with usual care amongadults living with type 2 diabetes.Method:A prospective parallel-group randomised controlledtrial with three months follow-up was conducted in KBTH Poly-clinic/Family Medicine Centre and Weija Gbawe Municipal Hospi-tal, two primary care facilities in Accra. After screening, 206participants were individually randomised 1:1 to usual care or 6hours of structured diabetes self-management education (DSME)delivered in person on one day. The primary outcome, mean gly-cated haemoglobin (HbA1c) was measured at three months.Intention to treat analysis was used.Results:A total of 206 adults with diabetes (59.2% females)met the eligibility criteria and were randomised. In all 177 partic-ipants (85.9%) completed the study; 89 (86.6%) in the interventionarm and 88 (85.4%) in the usual care arm. The average age of par-ticipants was 56.2 (standard deviation (SD): 11.2) years and 56.8(SD: 12.3) years in the intervention and control arms, respectively.Majority of participants did not complete secondary education: 63(61.6%) and 68 (66.0%) in the intervention and control armsrespectively. About 10% of participants in both groups had neverreceived formal education. The number of participants who usedthe National Health Insurance was 96(94.1%) in the interventionarm and 101 (98.1%) in the control arm. Finally, 74 (71.8%) partic-ipants in the intervention arm and 74 (72.8%) in the control armhad other chronic medical conditions.The baseline mean HbA1c of all participants was 9.8% and11.3% in the intervention and control arms, respectively.HbA1c levels had decreased significantly in both groups after 3months. Pairwise comparisons showed that, participants in theintervention arm had a mean reduction in HbA1c (%) of 1.07(95% CI: 1.94 to 0.21) while participants in the usual care armhad a mean HbA1c (%) reduction of 0.33 (95% CI:?1.21to 0.55).The end-line mean HbA1c of all randomised patients was 8.7%and 9.4% in the intervention and control arms respectively.Discussion:A structured group education programme forpatients with type 2 diabetes resulted in a clinically relevantimprovement in glycaemic control at 3 months. Delivering DSMEto people with low literacy in low resource settings is challenging.We recommend the adoption and use of evidence based struc-tured DSME programs such as EXTEND in low resource settingsduring the COVID-19 pandemic and beyond.