Consensus on potential interventions for improving glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo: a Delphi study

Figures & data

Figure 1. Description of the Delphi study process.

Table 1. Characteristics of the participants of the Delphi study, n = 36.

	Categories	Number	Percentage (%)
Age (years)
	<40	14	38.9
	40–65	20	55.5
	≥65	2	5.5
Sex
	Male	28	77.8
	Female	8	22.2
Role
	Clinician	8	22.2
	Manager	6	16.7
	National Program Against Diabetes	9	25.0
	University	7	19.4
	Non-Government Organization	6	16.7
Background
	Physician	26	72.2
	Nurse	3	8.3
	Economist	4	11.1
	Pharmacist	1	2.8
	Political Scientist	1	2.8
	Lawyer	1	2.8
Expertise (years)
	<10	16	44.4
	10–19	13	36.1
	≥20	7	19.4
Location
	National	31	86.1
	International	5	13.9

Table 2. Summary of grouped statements by domain.

	Number of statements in each domain		Proportion of statements where consensus was reached
	Round 1	Round 2	Round 1	Round 2
Strengthening the healthcare system for better diabetes care	14	17	13	17
Enhancing the awareness of diabetes among the population/patients	3	5	3	5
Alleviating the financial burden of diabetes	4	9	4	9
Enhancing the adoption of lifestyle modifications in our setting	4	5	3	5
Reducing the proportion of undiagnosed patients with diabetes	3	3	3	3
Total	28	39	26	39

Table 3. Analysis of the responses to statements throughout the Delphi process.

		First round statistics (n = 36)				Second round statistics (n = 34)
		Responses (%)				Responses (%)
Domains	Strategies	Agreed/ strongly agreed	Disagree/ strongly disagree	Mean***	Standard deviation	Agreed/ strongly agreed	Disagree/ strongly disagree	Mean***	Standard deviation	Stability (%)
Strengthening the healthcare system for better diabetes care	Set up a diabetes primary care team	100.0	0.0	3.7	0.4	97.1	2.9	3.6	0.6	2.9
	Equip the health structures with basic equipment	100.0	0.0	3.7	0.4	97.1	2.9	3.8	0.6	2.9
	Set up an effective drug delivery system	94.1	5.9	3.5	0.6	100.0	0.0	3.6	0.7	5.9
	Develop a diabetes management protocol	91.7	8.3	3.6	0.6	97.1	2.9	3.7	0.6	5.4
	Augment geographical access to care	100	0.0	3.6	0.5	94.1	5.9	3.6	0.7	5.9
	Reduce waiting time for access to care	97.1	2.9	3.5	0.6	91.2	8.8	3.3	0.7	5.9
	Technical supervision	94.3	5.7	3.5	0.6	94.1	5.9	3.5	0.7	0.2
	Adopt glycosylated haemoglobin for glycaemic control	91.2	8.8	3.3	0.6	94.1	5.9	3.4	0.7	2.9
	Implement ‘gatekeeping’ on prescriptions to improve adherence to evidence-based guidelines*	69.7	30.3	2.9	0.7
	Strengthen the National Diabetes Control Program**					97.1	2.9	3.7	0.6
	Develop individual care for patients	94.2	5.8	3.5	0.6	97.1	2.9	3.5	0.7	2.9
	Adhering to evidence-based clinical guidelines	100.0	0.0	3.6	0.5	94.1	5.9	3.4	0.7	5.9
	Innovative approach to patients	100.0	0.0	3.5	0.5	97.1	2.9	3.4	0.7	2.9
	Support self-management of the patients	85.7	14.3	3.3	0.8	91.2	8.8	3.5	0.7	5.5
	Identify patients at risk of poor glycaemic control	100.0	0.0	3.7	0.4	94.1	5.9	3.5	0.7	5.9
	Educate the family and communicate the objectives of the family with the patient’s consent**					97.1	2.9	3.6	0.7
	Identify patients with poor glycaemic profile**					94.1	5.9	3.5	0.8
	Send text messages to remind patients to take their medicines or to respond to follow-up visit**					85.3	14.7	3.3	0.8
Enhancing the awareness of diabetes among the population/patients	Develop radio/TV spots on diabetes	100.0	0.0	3.7	0.5	94.1	5.9	3.5	0.7	5.9
	Distribute information leaflets on diabetes	77.1	22.9	3.1	0.8	88.2	11.8	3.3	0.8	11.1
	Send text/videos through social media	97.2	2.9	3.5	0.6	91.2	8.8	3.3	0.8	6.0
	Community-based awareness activities in churches, schools, and open spaces (markets)**					97.1	2.9	3.7	0.6
	The train and involve community health workers in the sensitization of the population**					97.1	2.9	3.7	0.6
Alleviating the financial burden of diabetes	Implement universal health coverage	100.0	0.0	3.7	0.5	97.1	2.9	3.7	0.6	2.9
	Promoting health insurance	88.2	11.8	3.5	0.7	97.1	2.9	3.5	0.7	8.9
	Encourage the creation of health mutuals	97.1	2.9	3.6	0.5	97.1	2.9	3.6	0.7	0.0
	Encourage family involvement and support	85.3	14.7	3.2	0.8	94.1	5.9	3.6	0.7	8.8
	Partner with pharmaceutical industry to avail good quality generic drugs at affordable cost**					94.1	5.9	3.5	0.8
	Improve the standard of living of the Congolese population by granting an acceptable minimum wage to the lowest paid workers so that they are able to contribute to or support the mutual insurance system**					94.1	5.9	3.6	0.7
	Promote flat-rate pricing for disease episodes or even monthly patient care at the center or hospital.**					97.1	2.9	3.5	0.7
	Exempt imported equipment for diabetes care (insulin, strips, syringes …) from excise and import duties to reduce costs**					94.1	5.9	3.6	0.7
	Allocation of a significant budget for chronic diseases**					97.1	2.9	3.5	0.7
Enhancing the adoption of lifestyle modifications in our setting	Develop a suitable exercise plan for patients considering their occupations	91.4	8.6	3.5	0.7	94.1	5.9	3.4	0.7	0.0
	Encourage realistic dietary plans that considers affordability	97.1	2.9	3.8	0.5	97.1	2.9	3.6	0.6	0.0
	Create food banks*	55.9	44.1	2.7	0.8
	Providing accurate information on recommended diet and exercise	97.1	2.9	3.6	0.5	97.1	2.9	3.7	0.6	0.0
	Promote primary prevention using policies that target marketing and sales of of tobacco, alcohol, sweetened beverages, and fast foods**					82.2	17.8	3.3	0.8
	Open gymnasiums and encourage healthy and balanced eating**					88.2	11.8	3.2	0.7
Reducing the proportion of undiagnosed patients with diabetes	Implement opportunistic screening at primary care level	94.4	5.6	3.7	0.6	97.1	2.9	3.7	0.6	2.7
	Promote cases finding among in high-risk population e.g. patients’ families	88.2	11.8	3.2	0.6	88.2	11.8	3.3	0.8	0.0
	Mass screening during diabetes international day	88.6	11.4	3.3	0.8	94.1	5.9	3.5	0.7	5.5

Legend:  *Strategy excluded after the first round; **strategy added after the first round; ***scale range: for each statement, the overall interpretation is: 4.00–3.00: strongly agree; 2.99–2.00: agree; 1.99–1.00: disagree; 1.00–0.99: strongly disagree.