Nurse-led theory-based educational intervention improves glycemic and metabolic parameters in South Asian patients with type II diabetes: a randomized controlled trial

Abstract

Objective: This study assessed whether a structured nurse-led diabetes educational program underpinned by the theories of the health belief model, change in locus of control, and patient empowerment is effective in improving glycemic and metabolic parameters among South Asians with type II diabetes compared to regular outpatient care.

Methods: This was a parallel-group randomized trial in South Asian adult patients with type II diabetes living in Qatar. 460 subjects were randomized to a nurse-led, group-based diabetes educational program (n = 230) or to usual care (n = 230). The primary outcome was the improvement in HbA1c and other metabolic parameters, including lipid profile, albumin/creatinine ratio, blood pressure, and body mass index. Patients in the intervention group were invited to attend four 2-h sessions of self-efficacy improvement education once weekly. Outcomes were assessed at baseline and 12 months later. An intention-to-treat analysis was performed using repeated measures ANOVA (analysis of variance) for each of the clinical outcome variables.

Results: After 12 months, 290 patients completed the study. Subjects in the intervention group had statistically significant improvements in HbA1c (-0.55 %, p = 0.012), fasting blood sugar (-16.6 mg/dl, p = 0.022), albumin/creatinine ratio (-3.09, p < 0.001), and HDL cholesterol (+6.08 mg/dl, p < 0.0001).

Conclusion: The inclusion of South Asian patients with type II diabetes in a structured, theory-based diabetes educational program that is led by nurses improves glycemic and metabolic parameters after 12 months.

Keywords: Diabetes; Education; Nurse-led intervention.

Fig. 1

Consort diagram of the study design. Of the 800 patients that were approached at the outpatient clinics in Qatar, only 430 gave their consent to be included in the study and completed the questionnaires. Those patients were randomized into an intervention group and a regular outpatient care group. The intervention group received an 8 h long, nurse-led diabetes education program in groups consisting of 10 people over four sessions. Patients in both groups were assessed at baseline and at 12 months. In the intervention group, 106 subjects were lost to follow-up, and 34 subjects were lost to follow-up in the control group. At the end of the study (12 months), the intervention group consisted of 40 males and 69 females, whereas the control group consisted of 50 males and 131 females