Two-year impact of an educational intervention in primary care on blood glucose control and diabetes knowledge among patients with type 2 diabetes mellitus: a study in rural China

Shaofan Chen; Dongfu Qian; Bo Burström

doi:10.1080/16549716.2021.1893502

Two-year impact of an educational intervention in primary care on blood glucose control and diabetes knowledge among patients with type 2 diabetes mellitus: a study in rural China

Glob Health Action. 2021 Jan 1;14(1):1893502. doi: 10.1080/16549716.2021.1893502.

Authors

Shaofan Chen^{1

2

3}, Dongfu Qian^{3

4

5}, Bo Burström^{2

4}

Affiliations

¹ Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
² Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
³ School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
⁴ Center for Health Policy Studies, Nanjing Medical University, Nanjing, China.
⁵ Center for Global Health, Nanjing Medical University, Nanjing, China.

Abstract

Background: Type 2 diabetes mellitus is increasing in rural China and should be managed in primary health care, but knowledge is lacking. Educational interventions have been implemented but not followed up long-term.Objective: The study aimed to assess the long-term impact of an educational intervention on patients' diabetes knowledge and fasting blood glucose (FBG) level, and whether these outcomes differed between two rural counties.Methods: The study was nested in an educational intervention project in primary health care in Jiangsu province. Patients with type 2 diabetes mellitus from Huaiyin county and Gaochun county were randomly divided into an intervention group receiving an educational intervention and follow-up visits, and a control group with standard care. Questionnaires and medical records, including FBG level and diabetes knowledge score, were compared, at baseline in 2015 and two follow-ups, in 2016, and 2017, respectively. A paired t-test and two mixed-effects linear regression models were used.Results: The diabetes knowledge score increased in the intervention group in 2016 and in 2017, compared with 2015. The FBG level decreased in 2016 compared with 2015 in the intervention and control groups. Comparing data in 2015 and 2017, there was no significant change in FBG level in the intervention or control group, but the diabetes knowledge score increased in the intervention group both in 2016 and 2017. A significant association between FBG level and the interaction of time and group, suggesting a long-term effect, was only found in Gaochun county in 2017.Conclusion: The educational intervention improved the diabetes knowledge score in the intervention group, while no significant improvement was found in the control group in both year 2016 and 2017. Meanwhile, the intervention had a positive impact on FBG level in the intervention group in 2017. Patients in Gaochun county had better improvement in both diabetes knowledge and controlling FBG level, compared with Huaiyin county.

Keywords: Diabetes care; educational intervention; long-term impact; primary care; rural China.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose
China
Diabetes Mellitus, Type 2* / therapy
Glycemic Control
Humans
Primary Health Care
Rural Population

Substances

Blood Glucose

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant no. 71473130), and by the China Scholarship Council (grant no. 201600160076). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.