An effective system of nurse-led diabetes care in rural Africa

Gill, Geoff, Price, C., Shandu, D., Dedicoat, Martin and Wilkinson, D. (2008) 'An effective system of nurse-led diabetes care in rural Africa'. Diabetic Medicine, Vol 25, Issue 5, pp. 606-611.

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Abstract

Aims Delivering adequate diabetes care is difficult in rural Africa because of drug and equipment shortages; as well as lack of trained medical expertise. We aimed to set up and evaluate a nurse-led protocol and education-based system in rural Kwazulu Natal in South Africa.
Methods A treatment algorithm and education system adapted from previously validated methods was used; care was devolved to primary health clinics and was delivered by two nurses. Glycaemic control was assessed by glycated haemoglobin (HbA(1c)), assayed off site and not available for clinical use during the study.
Results A total of 284 patients were enrolled, with 197 followed for 18 months (13 died and 26% lapsed during the period). HbA(1c) was 11.6 +/- 4.5% (SD) at baseline, 8.7 +/- 2.3% at 6 months and 7.7 +/- 2.0% at 18 months. There was a small associated increase in weight but no increase in hypoglycaemia. Subgroup analysis showed that education alone, without drug type or dose changes, also improved control (HbA(1c) 10.6 +/- 4.2% baseline and 7.6 +/- 2.3% at 18 months). The service was very popular with patients, families and other health workers.
Conclusions We conclude that a simple protocol and education-based diabetes care system can be successfully introduced and run by nurses in rural Africa. Medium-term glycaemic improvements are excellent and the service has been very well received.

Item Type:	Article
Uncontrolled Keywords:	diabetes africa education hba(1c) nurses resource-poor settings south-africa controlled-trial complications mellitus prevalence risk
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WK Endocrine System > WK 810 Diabetes mellitus WK Endocrine System > WK 815 Therapy WY Nursing > WY 106 Community health nursing
Faculty: Department:	Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI):	https://doi.org/10.1111/j.1464-5491.2008.02421.x
Depositing User:	Users 43 not found.
Date Deposited:	24 Aug 2010 10:51
Last Modified:	06 Feb 2018 13:00
URI:	https://archive.lstmed.ac.uk/id/eprint/792

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