Abstract:
Diabetes Mellitus (DM) and its complications are associated with high mortality and morbidity rates in Nigeria. Diabetes Self-Management Education (DSME) is germane to achieving optimum glycaemic control but is thwarted by a non-supportive family ambience. Evidence suggests that Family Integrated Diabetes Education (FIDE) is associated with better glycaemic control and Quality of Life (QoL). However, there is dearth of evidence regarding FIDE’s effectiveness in Nigeria. This study was designed to determine the effects of FIDE on the two important health-related outcomes among type-2 diabetes patients attending two tertiary hospitals in Southwestern, Nigeria.
A quasi-experimental study was carried out. University College Hospital (UCH) and Olabisi Onabanjo University Teaching Hospital (OOUTH) were selected based on similarity in diabetes management programme and randomly assigned to Control group (CG) and Intervention group (IG), respectively. A total of 170 patients; 88 in CG and 82 in IG, with an equal number of family members (170), were recruited at baseline, (P1). At baseline (P1), patients completed questionnaire on Diabetes Knowledge Test (DKT), with scores ranging from 0 – 14; and QoL, having scores between 0 and 66; also capillary blood was taken for measurement of Point of Care (POC) glycosylated haemoglobin (HbA1c). Family members completed the questionnaire on DKT. A one-day FIDE was given to IG, in addition to routine diabetes education. Patients and family members were immediately assessed for post-intervention knowledge (P2), same day after FIDE. Follow-up SMS messages were sent to family members weekly for three weeks after FIDE. Glycaemic control (HbA1c) and QoL were measured for patients, at three and six-month post-intervention (P3 & P4). Analyses were conducted using independent t-test, paired t-test and ANOVA, at α0.05.
The IG and CG patients were not significantly different in age (59.8±11.6 and 61.7±11.1 years, respectively). Similarly, family members of IG (40.0±15 years) and CG (41.8±16.7 years) were comparable in age. At P1, DKT of patients in IG (5.8± 2.4) was similar to that of CG (6.1±2.3); QoL was also similar among the two groups of patients at P1 (IG: 49.7±7.6; CG: 50.5±7.1). The HbA1c for IG: 8.6±2.2% and CG: 7.5±2.1%, at P1 were significantly different, indicating worse glycaemic control in IG. Family members’ DKT was similar between IG (5.6±2.4) and CG (5.9 ±2.3) at P1. At P2, DKT improved significantly among patients and family members in IG (IG: 9.7±2.6; CG: 6.1 ±2.3, and IG: 8.6 ±3.0; CG: 5.8±2.2, respectively) but not in CG. At P3, the QoL of IG (51.7 ± 8.8) and CG (51.3±9.9) were not significantly different. Mean HbA1c reduced significantly in IG at P3 (7.7±1.5%) compared to P1 (8.6±2.2%) but it increased significantly in CG (P3=8.0±2.1; P1=7.5±2.1%). This shows improvement in IG’s glycaemic control. At P4, there were neither differences in the QoL of IG (56.2 ±11.9) and CG (55.0 ±9.5) nor their HbA1c (IG: 7.5± 1.8; CG: 7.8 ±2.1%).
Family-integrated diabetes-education effectively contributed to better glycaemic control but not quality of life of type 2 diabetes patients. Family members should be formally included in structured and regular diabetes-education.
