AIMS: Delivering adequate diabetes care is difficult in rural Africa because of drug and equipment shortages; as well as lack of trained medical expertise. We aimed to set up and evaluate a nurse-led protocol and education-based system in rural Kwazulu Natal in South Africa. METHODS: A treatment algorithm and education system adapted from previously validated methods was used; care was devolved to primary health clinics and was delivered by two nurses. Glycaemic control was assessed by glycated haemoglobin (HbA1c), assayed off site and not available for clinical use during the study. Results A total of 284 patients were enrolled, with 197 followed for 18 months (13 died and 26% lapsed during the period). HbA1c was 11.6 +/- 4.5% (sd) at baseline, 8.7 +/- 2.3% at 6 months and 7.7 +/- 2.0% at 18 months. There was a small associated increase in weight but no increase in hypoglycaemia. Subgroup analysis showed that education alone, without drug type or dose changes, also improved control (HbA1c 10.6 +/- 4.2% baseline and 7.6 +/- 2.3% at 18 months). The service was very popular with patients, families and other health workers. CONCLUSIONS: We conclude that a simple protocol and education-based diabetes care system can be successfully introduced and run by nurses in rural Africa. Medium-term glycaemic improvements are excellent and the service has been very well received.
AIMS: Delivering adequate diabetes care is difficult in rural Africa because of drug and equipment shortages; as well as lack of trained medical expertise. We aimed to set up and evaluate a nurse-led protocol and education-based system in rural Kwazulu Natal in South Africa. METHODS: A treatment algorithm and education system adapted from previously validated methods was used; care was devolved to primary health clinics and was delivered by two nurses. Glycaemic control was assessed by glycated haemoglobin (HbA1c), assayed off site and not available for clinical use during the study. Results A total of 284 patients were enrolled, with 197 followed for 18 months (13 died and 26% lapsed during the period). HbA1c was 11.6 +/- 4.5% (sd) at baseline, 8.7 +/- 2.3% at 6 months and 7.7 +/- 2.0% at 18 months. There was a small associated increase in weight but no increase in hypoglycaemia. Subgroup analysis showed that education alone, without drug type or dose changes, also improved control (HbA1c 10.6 +/- 4.2% baseline and 7.6 +/- 2.3% at 18 months). The service was very popular with patients, families and other health workers. CONCLUSIONS: We conclude that a simple protocol and education-based diabetes care system can be successfully introduced and run by nurses in rural Africa. Medium-term glycaemic improvements are excellent and the service has been very well received.
Authors: Sara L Marshall; Deborah V Edidin; Vincent C Arena; Dorothy J Becker; Clareann H Bunker; Crispin Gishoma; Francois Gishoma; Ronald E LaPorte; Vedaste Kaberuka; Graham Ogle; Laurien Sibomana; Trevor J Orchard Journal: Diabetes Res Clin Pract Date: 2014-10-07 Impact factor: 5.602
Authors: Mayowa O Owolabi; Joseph O Yaria; Meena Daivadanam; Akintomiwa I Makanjuola; Gary Parker; Brian Oldenburg; Rajesh Vedanthan; Shane Norris; Ayodele R Oguntoye; Morenike A Osundina; Omarys Herasme; Sulaiman Lakoh; Luqman O Ogunjimi; Sarah E Abraham; Paul Olowoyo; Carolyn Jenkins; Wuwei Feng; Hernán Bayona; Sailesh Mohan; Rohina Joshi; Ruth Webster; Andre P Kengne; Antigona Trofor; Lucia Maria Lotrean; Devarsetty Praveen; Jessica H Zafra-Tanaka; Maria Lazo-Porras; Kirsten Bobrow; Michaela A Riddell; Konstantinos Makrilakis; Yannis Manios; Bruce Ovbiagele Journal: Diabetes Care Date: 2018-05 Impact factor: 19.112
Authors: Alain Lekoubou; Paschal Awah; Leopold Fezeu; Eugene Sobngwi; Andre Pascal Kengne Journal: Int J Environ Res Public Health Date: 2010-01-27 Impact factor: 3.390