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

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
• primary care
• rural China
• long-term impact

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

All authors acknowledge the colleagues in Nanjing Medical University who performed the interviews. We also appreciate valuable comments and suggestions on previous versions of the manuscript from the members of the Health Outcomes and Economic Evaluation Research Group and the Equity and Health Policy Research Group at Karolinska Institutet.

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contributions

SC participated in literature search and data collection, analyzed and interpreted the data, wrote the first draft of the manuscript, and led the manuscript writing. DQ conceptualized and designed the project. BB participated in the data analysis, guided the interpretation of the data, and commented on previous versions of the manuscript. DQ is the principal investigator of the project and led the data collection, contributed to the data analysis and interpretation of the data. All authors have read and approved the final version of the manuscript.

Ethics and consent

Ethical approval was obtained by the Nanjing Medical University Ethics Committee (2015; #300). All participants received written information about the aim of the study, that participation was voluntary and that they could decide to leave the study at any time and for any reason. Patients in the intervention area were informed that they would get additional diabetes services rather than the routine service, while patients in the control areas were informed that there would not be any changes in the diabetes services. The research team at Nanjing Medical University was trained and collected the data. To protect confidentiality, all analyses were carried out on group level and traceability to individuals is therefore not possible.

Paper context

Educational interventions have been implemented in China to improve glucose control and diabetes knowledge for patients with type 2 diabetes mellitus, while knowledge is still lacking in rural China. The present study reported that the educational intervention improved the diabetes knowledge as well as the fasting blood glucose (FBG) level in rural China. Meanwhile, the educational intervention had a long-term (2 years) impact in improving the diabetes knowledge, and controlling the FBG level.

Additional information

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.