IMPACT OF DIABETES HEALTHCARE PROGRAM ON GLYCEMIC CONTROL, SELF-EFFICACY AND DIABETES KNOWLEDGE AMONG TYPE-II DIABETICS IN ISLAMABAD PAKISTAN

N/ACompletedNCT06719076

Health Services Academy, Islamabad, Pakistan128 enrolled

Overview

Type-II Diabetes Mellitus is a significant public health challenge in Pakistan, characterized by a growing prevalence and substantial economic burden. The alarming rise in T2DM cases in Pakistan highlights the need for evidence-based solutions to control the disease. However, there is a notable knowledge gap in the effectiveness of diabetes healthcare program interventions in Pakistan. The goal of this randomized controlled trial (RCT) is to evaluate the effectiveness of a Diabetes Healthcare Program in improving glycemic control and enhancing Self-efficacy and diabetes knowledge in Type-II Diabetics in Islamabad, Pakistan. The main questions it aims to answer are whether the Diabetes Healthcare Program can reduce HbA1c levels and enhance Self-efficacy and diabetes knowledge in Type-II Diabetic patients. Researchers will compare the outcomes of 65 patients receiving the Diabetes Healthcare Program with 65 patients receiving standard care to see if the program improves glycemic control and enhances Self-efficacy and diabetes knowledge. Participants will attend 12 weeks of Diabetes Healthcare Program sessions, receive standard care from the hospital's diabetes department, and complete surveys and questionnaires to assess their Self-efficacy and glycemic control at baseline and after the 3 months intervention period.

Objective: To evaluate the impact of Diabetes Healthcare Program on reducing HbA1c levels, enhancing Self-efficacy and Diabetes Knowledge in Type-II Diabetics in Islamabad. Setting, Duration, Study Type: The study was carried out as a randomized controlled trial (RCT) in Federal General Hospital Islamabad, which will be completed in 6 months. The study protocols was approved by ethical review board of Health Services Academy under letter no 000574/HSA/MSPH-2023 dated 23- Aug-2024. throughout the recruitment process. Methods: Type-II Diabetics were invited to participate in the study, and those who visited the hospital underwent the recruitment process using a concealed envelop method. Recruitment was stopped once the required sample size of 128 participants was met. Using random allocation, 64 subjects were assigned to the control group and 64 to the intervention group. Both the control group and the intervention group received usual care delivered at FGH. The intervention group additionally received a Diabetes Health Care Program Intervention for 12-week duration. Expected Outcome: The study aims to demonstrate that the Diabetes Healthcare Program (DHCP) intervention group will have enhanced Self-efficacy scores and diabetes knowledge and reduced HbA1c levels compared to the control group among Type-II Diabetics in Islamabad. If successful, the study's findings will be generalizable to similar settings worldwide, contributing significantly to the existing body of literature on improving glycemic control and Self-efficacy and diabetes knowledge in Type-II Diabetes. The study's results will have practical implications, informing policymakers on the development of evidence-based strategies to manage type II diabetes at a national level. This will ultimately enable the creation of targeted interventions and policies to improve the health outcomes of individuals with type II diabetes, contributing to global efforts to combat this growing health concern.

Interventions

Diabetes Healthcare Program (DHCP)BEHAVIORAL

Training for Type-II Diabetics The program includes 6 structured training sessions, each session will delivered biweekly and lasting for 1 hour and 20 minutes , covering topics such as: Week 1: Diabetes Education and Goal Setting Week 3: Nutrition and Meal Planning Week 5: Physical Activity and Exercise Week 7: Medication Management Week 9: Stress Management and Emotional Well-being Week 11: Review and Future Plans Time, Venue, and Interactive Activities Sessions will be held at the Federal General Hospital Basement, on Fridays, from 10:00 am to 11:20 am. Each session includes interactive elements, such as group discussions, practical exercises, and hands-on activities, to ensure participants are fully engaged and equipped to manage their T2DM diabetes.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Type-II Diabetes on follow-up treatment in FGH for last 6 months. * Type-II Diabetic age 18 years and above of both genders. * Type-II Diabetic with uncontrolled Diabetes whose HbA1c reading is \>6.4% at last assessment within 3 months * Type-II Diabetic living in Islamabad. Exclusion Criteria: * Type-II Diabetic recognized as disabled and suffering from loss of hearing. * Type-II Diabetics with serious complications such as retinopathy/kidney disease/tachycardia in a stable status \> 100/minute, or serious diabetic feet * Type-II Diabetic currently using injection insulin impaired glucose tolerance, metabolic syndrome, maturity onset diabetes of youth and gestational diabetes

Outcomes

Primary Outcomes

Change in Glycemic Control (HbA1c Levels)

The HbA1c test is a widely used indicator of glycemic control, reflecting the average blood glucose concentration over the preceding 2-3 months. The level of HbA1c is influenced by the blood glucose concentration, the duration of red blood cell exposure to varying concentrations, and the quantity of red blood cells. The HbA1c test has been reviewed and validated in numerous studies (Sherwani et al., 2016). The score ranges from 5% to 15%, with a normal score of 5.7% or less, a prediabetes score of 5.8% to 6.4%, and a diabetes score of 6.5% or higher.

Time frame: HbA1c level comprised the baseline and after a 3-month intervention period followed by a 4-month follow-up period.

Secondary Outcomes

Enhance Self-efficacy

Self-efficacy is a crucial component of Social Cognitive Theory in diabetes management. The Diabetes Management Self-efficacy Scale (DMSES) will be used to assess Self-efficacy in diabetes management. The DMSES measures confidence in conducting self-care activities, such as blood sugar monitoring, healthy eating, and physical activity. The scale ranges from 0 to 200, categorizing Self-efficacy into low (0-79), moderate (80-119), high (120-159), and very high (160-200). The Urdu version of the DMSES (U-DMSES) has been validated with moderate to strong psychometric properties (Bijl et al., 1999) (Riaz et al., 2017). The U-DMSES will be administered to participants to assess their Self-efficacy in managing Type-II Diabetes, informing interventions to enhance Self-efficacy and overall health and well-being (Luszczynska \& Schwarzer, 2015).

Time frame: Diabetes self-efficacy comprised the baseline data and after a 3-month intervention period followed by a 4-month follow-up period.

Diabetes Knowledge

Diabetes knowledge was assessed with the help of the 22-item Diabetes Knowledge Questionnaire-Revised (DKQ-R). The scores can vary from 0 to 22; high score reflects good diabetes knowledge (KR-20 = 0.77).

Time frame: Diabetes knowledge comprised the baseline data and after a 3-month intervention period followed by a 4-month follow-up period.