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

Figures & data

Figure 1. Recruitment of the patient participants

Table 1. Sociodemographic characteristics of participants at baseline data collection (2015)

	Intervention (389)			Control (394)		p
	n	%		n	%
Mean age (SD)	62.4 (8.43)			62.3(8.20)		0.973
Mean diagnosed year^† (SD)	7.4 (5.05)			7.3 (5.16)		0.587
County
Huaiyin	201	51.7		234	59.4	0.030
Gaochun	188	48.3		160	40.6
Sex
Male	110	28.3		120	30.5	0.503
Female	279	71.7		274	69.5
Marital Status
Single	62	15.9		68	17.3	0.620
Married	327	84.1		326	82.7
Educational level
Lower education	308	79.2		294	74.6	0.130
Higher education	81	20.8		100	25.4
Occupation type
Farming or house working	344	88.4		339	86.0	0.316
Other types of occupation	45	11.6		55	14.0

†The diagnosed year means the years since being diagnosed with T2DM

Figure 2. (a,b) The changes in FBG level (mmol/l, mean value) and knowledge score (mean value). (a) The changes of FBG level (mmol/l, mean value). (b) The changes of knowledge score (mean value)

Table 2. Comparison* of knowledge score (mean value) and FBG level (mmol/l, mean value) between the intervention group and control group, at baseline and two follow-ups

		2015 vs. 2016				2016 vs. 2017				2015 vs. 2017
		Mean difference	95% CI	p		Mean difference	95% CI	p		Mean difference	95% CI	p
Knowledge score	Intervention	0.70	(0.48, 0.93)	<0.001		0.77	(0.53, 1.01)	<0.001		1.47	(1.24, 1.71)	<0.001
	Control	-0.30	(-0.53, -0.82)	0.007		0.61	(0.38, 0.84)	<0.001		0.31	(0.09, 0.53)	0.006
FBG	Intervention	-0.65	(-0.90, -0.39)	<0.001		0.45	(0.11, 0.80)	0.009		0.00	(-0.36, 0.36)	0.999
	Control	-0.54	(-0.81, -0.26)	<0.001		0.94	(0.62, 1.26)	<0.001		0.33	(-0.09, 0.75)	0.119

* Comparisons made using paired T-test

Table 3. Mixed-effects linear regression model for diabetes knowledge score and FBG level and in both counties

	Knowledge score				FBG
	Effect size*	p	95% CI		Effect size*	p	95% CI
Time (Reference: 2015)
2016	-0.25	0.012	(-0.45, -0.06)		-0.57	<0.001	(-0.85, -0.28)
2017	0.33	0.001	(0.13, 0.53)		0.22	0.189	(-0.11, 0.55)
Group (Reference: Control group)
Intervention	-0.97	<0.001	(-1.19, -0.75)		0.14	0.425	(-0.21, 0.49)
Time*Group (Reference: 2015*Control)
2016*Intervention	0.96	<0.001	(0.69, 1.24)		-0.15	0.470	(-0.54, 0.25)
2017*Intervention	1.14	0.007	(0.87, 1.42)		-0.46	0.042	(-0.90, -0.02)
Age	-0.02	<0.001	(-0.03, -0.01)		-0.02	0.028	(-0.04, 0.00)
Diagnose year	0.02	0.007	(0.01, 0.04)		0.10	<0.001	(0.07, 0.12)
Sex (Reference: male)
Female	-0.09	0.362	(-0.27, 0.10)		-0.02	0.878	(-0.34, 0.29)
Educational level (Reference: lower education)
Higher education	0.39	<0.001	(0.18, 0.59)		-0.43	<0.001	(-0.78, -0.07)
Occupation type (Reference: farming or house working)
Others	-0.08	0.532	(-0.32, 0.16)		-0.08	0.690	(-0.50, 0.33)
Marital status (Reference: Single)
Married	0.02	0.876	(-0.20, 0.23)		-0.18	0.344	(-0.54, 0.19)
(Constant)	6.66	<0.001	(5.91, 7.40)		9.75	<0.001	(8.46, 11.02)

*Effect size is the beta coefficient

Table 4. Stratified mixed-effects linear regression models for diabetes knowledge score and FBG level in Huaiyin and Gaochun

Huaiyin (North)									Gaochun (South)
	Knowledge score				FBG				Knowledge score				FBG
	Effect size*	p	95% CI		Effect size*	p	95% CI		Effect size*	p	95% CI		Effect size*	p	95% CI
Time (Reference: 2015)
2016	-0.33	0.018	(-0.61, -0.06)		-0.44	0.022	(-0.82, -0.06)		-0.14	0.298	(-0.41, 0.12)		-0.74	<0.001	(-1.15, -0.30)
2017	0.07	0.644	(-0.21, 0.34)		-0.10	0.698	(-0.62, 0.41)		0.72	<0.001	(-1.63, -1.04)		0.32	0.146	(-0.11, 0.75)
Group (Reference: Control group)
Intervention	-0.64	<0.001	(-0.96, -0.32)		0.28	0.232	(-0.18, 0.73)		-1.34	<0.001	(-1.63, -1.04)		0.06	0.819	(-0.47, 0.60)
Time*Group
2016*Intervention	0.69	0.001	(0.28, 1.09)		-0.50	0.068	(-1.04, 0.04)		1.23	<0.001	(0.88, 1.59)		0.24	0.411	(-0.33, 0.81)
2017*Intervention	0.83	<0.001	(0.42, 1.22)		0.40	0.279	(-0.32, 1.11)		1.39	<0.001	(1.03, 1.75)		-0.76	<0.001	(-1.32, -0.19)
Age	-0.02	0.003	(-0.03, -0.01)		-0.30	0.004	(-0.05, -0.01)		-0.03	<0.001	(-0.03, -0.15)		0.00	0.939	(-0.03, 0.03)
Diagnose year	0.03	0.030	(0.00, 0.05)		0.12	<0.001	(0.09, 0.16)		0.02	0.101	(-0.01, 0.04)		0.09	<0.001	(0.05, 0.12)
Sex (Reference: male)
Female	-0.14	0.319	(-0.42, 0.14)		0.19	0.382	(-0.23, 0.61)		-0.01	0.922	(-0.25, 0.23)		-0.22	0.359	(-0.69, 0.25)
Educational level (Reference: lower education)
Higher education	0.37	0.009	(0.09, 0.64)		-0.24	0.275	(-0.66, 0.19)		0.40	0.019	(0.07, 0.74)		-0.62	0.060	(-1.27, 0.03)
Occupation type (Reference: farming or house working)
Others	-0.07	0.692	(-0.40, 0.27)		0.06	0.808	(-0.45, 0.58)		-0.01	0.969	(-0.35, 0.34)		-0.24	0.490	(-0.91, 0.44)
Marital status (Reference: Single)
Married	-0.01	0.974	(-0.31, 0.30)		-0.31	0.190	(-0.78, 0.15)		0.04	0.812	(-0.25, 0.32)		0.05	0.864	(-0.51, 0.61)
(Constant)	6.54	<0.001	(5.52, 7.57)		10.09	<0.001	(8.51, 11.67)		7.01	<0.001	(5.90, 8.12)		8.70	<0.001	(6.56, 10.83)

*Effect size is the beta coefficient

Table A1. Key elements of the intervention

The actor
Conducted by service team in each county.
The service team consisted of:	One to two Diabetes experts from county-level hospitals (team leader)
	One public doctor from county-level CDC (team consultant)
	One nurse from county-level hospital
The action
For patients in the intervention area:	1. Health education lectures
	1). Basic information on diabetes
	2). Self-management strategies
	3). Advice on physical exercise and diet therapy
	4). Advice to patients when having high blood glucose level
	5). Introduction of measuring blood glucose and severe acute complications
	6). Prevention of diabetes
	2. Periodical follow-up go-to-door visits & physical examination
	3. Special medical services
Action target
For diabetes patient participants who live in the intervention area. Their FBG level was extracted from medical records, and their diabetes knowledge was tested by questionnaire.
Temporality
Huaiyin & Gaochun county: 2015–2017
Jingjiang county: 2015–2016
Dose
Health education lecture: every two months.
Periodical follow-up go-to-door visits: every two months; physical examination: once a year.
Special medical services: performed when patient needed.
Implementation outcome affected
Diabetes knowledge: measured by nine questions from a questionnaire
FBG level: extracted from medical records

Table B1. Questions related to diabetes knowledge

No.	Question	Options
1.	Do you know the diagnose criteria of diabetes (FBG)? ^†	Yes, it is ____ mmol/l	I do not know
2.	Is dizziness a symptom of diabetes?	Yes^‡	No	I do not know
3.	Is obesity a risk factor for diabetes?	Yes^‡	No	I do not know
4.	Do people with a diabetes family history have higher risk of diabetes?	Yes^‡	No	I do not know
5.	Is smoking or drinking a risk factor for diabetes?	Yes^‡	No	I do not know
6.	Will monitoring your blood glucose help to control diabetes?	Yes^‡	No	I do not know
7.	Will eating high fat or high sugar food help to control diabetes?	Yes	No^‡	I do not know
8.	Will you be blind if the diabetes cannot be controlled?	Yes^‡	No	I do not know
9.	Is it necessary to keep using medication if you have already controlled your blood glucose level?	Yes^‡	No	I do not know

^†The answer ‘Yes’, and FBG greater than 7 mmol/l, is classified as right answer.

^‡The right answer.