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Assessment of a group-based comprehensive diabetes management program to improve glycemic control, quality of life and self-care behavior in patients with type 2 diabetes mellitus in a primary healthcare setting of a metropolitan city in India: CDMP MUM Trial

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Abstract

Background

Resource-poor primary health settings in an urban slum presented with special challenges in diabetes care. The study evaluated a need-based, patient-friendly, acceptable, appropriate package of care and its implementation in primary healthcare setup.

Material and Methods

An open-label two-arm parallel randomized controlled trial with 40 patients in the control group who received medical management as prescribed by physician and patients in the intervention group receiving usual medical care + group-based comprehensive diabetes management program. HbA1c, weight, BMI, Quality of Life Instrument for Indian Diabetes Patients (QOLID) scores, and audit of Self Care Inventory-Revised Version (SCI-R) were assessed at baseline and 6 months.

Result

There was a significant reduction in mean HbA1c levels in the intervention arm (8.44, SD = 1.802 to 7.56, SD = 1.87) as compared with the control arm (8.4, SD = 1.87 to 8.19, SD = 1.77). Multiple linear regression model (R2 = 0.886, ANOVA F (7, 72) = 79.733, p < 0.001) found a fall in blood sugar levels (β = − 0.511, p < 0.001), improvement in QOLID scores (β = 0.221, p = 0.004), increase in physical activity (β = 0.198, p = 0.006), and fall in BMI (β = 0.153, p = 0.009) to be predictive of change in HbA1c.

Discussion

The patient profile consisted predominantly of homemakers, with low formal education and belonging to lower socio-economic strata. They depended primarily on the public health system for their health care needs and could benefit most from the implementation of the program. There was an improvement in knowledge, regular follow-up, compliance to medication, diet, and physical activity along with improvement in glycemic control, self-care behavior and quality of life of patients in the intervention arm.

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Acknowledgments

Late Dr. Ratnendra Shinde, Former Professor & Head, Community Medicine and the Department of Community Medicine Seth GS Medical College and KEM Hospital, Mumbai.

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Authors and Affiliations

  1. Department of Community Medicine, Pravara Institute of Medical Sciences (DU), Loni, Tal-Rahata, Ahmednagar, Maharashtra, India

    Mandar Padmakar Baviskar

  2. ESIS, Mumbai, India

    Sumitra Rangari

  3. Seth GS Medical College & KEM Hospital, Mumbai, India

    Sandeep Mishra

  4. Divisional Railway Hospital, Malda, India

    Biswendu Sundar Mohanta

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  1. Mandar Padmakar Baviskar
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  2. Sumitra Rangari
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  3. Sandeep Mishra
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  4. Biswendu Sundar Mohanta
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Correspondence to Mandar Padmakar Baviskar.

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The study was approved by Institutional ethics committee of Seth GS Medical College & KEM Hospital.

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The authors declare that they have no conflict of interest.

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Baviskar, M.P., Rangari, S., Mishra, S. et al. Assessment of a group-based comprehensive diabetes management program to improve glycemic control, quality of life and self-care behavior in patients with type 2 diabetes mellitus in a primary healthcare setting of a metropolitan city in India: CDMP MUM Trial. Int J Diabetes Dev Ctries 41, 156–163 (2021). https://doi.org/10.1007/s13410-020-00828-1

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