Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

Systematic Review of Community Type 2 Diabetes Structured Health Education (CT2DSHE)

Aim: This paper aims to evaluate disparities of type 2 diabetes structured health education programmes that is utilised within the communities. Design: systematic review, (a type of secondary research design) aiming to summarize the results of prior primary research studies on available evidence Community type 2 diabetes structured education (CT2DSHE). Methods: Research question: Type 2 diabetic structured health education within a community how effective is it? Qualitative Systematic review, defined as a way to get reliable and objective picture of current available evidence on the specific topic—(CT2DSHE), (Denscombe, 2021) through reflexivity synthesis of available data as an example. This is valuable in time constraints such as project assignments that must be met within specific time and also to bring together available evidence together [1]. Results: This review has shown that CT2DSHE is effective with seven out of the eleven authors supporting, three authors against and one was neutral, further showed that knowledge and skills acquired can last longer with patient activation improved among T2DM patients ideal for sustaining their self-management of T2DM. Conclusion: This research provides suggestive answers to the research question: “Type 2 diabetic structured health education within a community how effective is it?”, This has demonstrated CT2DSHE effectiveness in knowledge acquisition and improving T2DM awareness among T2DM patients, whilst evidencing long effects beyond the study times of 3 - 9 months period in relation to patient activation. Also Identified diabetes education self-management on newly diagnosed (DESMOND) patient as CT2DSHE program for recommendation. Patient or Public Contribution: This work aspires to contribute to CT2DSHE in these areas;Influencing policy decision-making for community diabetes care within the UK and world at large., Contributing to already vast knowledge on diabetes self-management and reasons why?, Influencing educators on how CT2DSHEP are designed, delivered by putting the patient at the Centre and bringing different perspectives on CT2DSHEP in one place that is serving users time of having to consult several resources especially busy clinicians [2] [3].

Upshots of health education among patients with type 2 diabetes mellitus: A field study in Mysuru

Objective:This study was conducted to assess the impact of health education on lifestyle modification and disease status of diabetic patients for 6 months in rural Mysuru in Southern India.Materials and Methods:A quasi-experimental study was conducted among 104 patients with type 2 diabetes mellitus in rural Mysuru,India from July to December 2022.Participants were assigned to two groups:intervention(n=52)and control(n=52),and their data were collected.The intervention group was educated about the disease and its management and was given printed pamphlets containing information to be followed,whereas the participants in the control group were asked to continue their routine health checkups.The body mass index(BMI),weight,fasting blood sugar(FBS),knowledge about the disease,and behavior changes were recorded and compared between the two groups before and after 6 months.Results:The mean FBS value,BMI and weight decreased significantly in the intervention group after 6 months(FBS:164.79±47.59 mg/dL vs.141.92±25.63 mg/dL,P<0.001;BMI:22.97±3.75 kg/m2 vs.22.62±3.29 kg/m2,P<0.05;weight:62.82±11.92 kg vs.61.54±10.67 kg,P<0.05).The posttest period also showed an improvement in physical activity,diet,and medication adherence in the intervention group compared to the control group(P<0.05).The knowledge scores also improved postintervention which was statistically significant with the Wilcoxon signed-rank test(P<0.05).Conclusions:The effectiveness of the educational intervention was also supported by lower FBS levels and decrease in BMI and weight compared to before.The findings of this study may help and make it easier to plan studies on people with diabetes mellitus in various settings.

Application of Structured Health Education and Combined 5A Nursing Model in Self-control of Vulnerable Chronic Diseases: Take Coronary Heart Disease as an Example

Objective:To explore the intervention effect of the Structured Health Education course and 5A nursing model for self-control of elderly patients with coronary heart disease.Methods:Using the random sampling method,124 elderly CAD patients admitted to the First Affiliated Hospital of Bengbu Medical University were randomly divided into an experimental group and a control group.The control group line routine health education,experimental group take structured health education combined with 5A nursing before and after the intervention using a coronary heart disease assessment questionnaire,coronary heart disease self-control scale evaluation of two groups of intervention,compare two groups before and after intervention blood pressure,blood sugar,body mass index,lipid index level and complications within 8 months after discharge.Results:After the course intervention,the disease cognition and self-behavior of the experimental group were higher than that of the control group,and the differences were statistically significant(all P<0.1).Conclusion:This course is suitable for elderly patients with coronary heart disease.The 5A model improves the cognitive and management ability of elderly patients to a certain extent,which is worthy of clinical application.

Prevention and Treatment of Diabetic Foot Ulcer by Health Education of Specialized Nurses

Objective:To analyze the preventive effect of specialized nurse health education on diabetic foot ulcers.Methods:From January 2022 to December 2022,90 diabetic high-risk foot patients that were admitted to the Endocrinology Department of a general hospital in Macao that met the inclusion criteria were selected as the research subjects.The research subjects were randomly divided into an intervention group and a control group,with 45 cases in each group by mechanical sampling method.The foot care knowledge of the patients one month and three months after the intervention were evaluated and analyzed.Results:The scores of foot care knowledge in the intervention group were higher than those in the control group at one month and three months after the intervention,and the dift'ercncc was statistically significant(P<0.05).Conclusion:Health education by specialized nurses are essential in preventing and treating diabetic foot ulcers.Effective prevention and management of diabetic foot ulcers can be achieved through guidance on diet control,exercise,foot care,blood sugar monitoring,infection prevention,stress reduction,appropriate medication,and regular follow-up.

Preferences of Persons with Type 2 Diabetes for Diabetes Self-Management Education Interventions: An Exploration

Objectives: Treatment preferences affect treatment engagement, adherence and outcomes. There is limited knowledge of patients’ preferences for Diabetes Self-Management Education (DSME). This study explored the preferences of Canadians with diabetes for components, mode and dose for implementing DSME interventions. Methods: A cross-sectional design was used. Adults with diabetes completed a questionnaire to assess participants’ preferences for components (i.e. content), mode (i.e. teaching strategies, delivering formats) and dose (i.e. number and length of sessions) of DSME. Descriptive statistics were used to analyze the data. Results: Participants (n = 100) were middle-aged men and women, who had diabetes for 6.1 years and previously received (95.0%) DSME. They indicated preference for DSME to include a combination of educational, behavioral and psychological components;to be delivered in individual, face-to-face sessions (4 sessions, 60 minutes each, given monthly) that allowed discussion with one diabetes educator to develop and carry out a care plan. Conclusions: Diabetes educators may consider eliciting patient’s preferences and tailoring DSME to fit patients’ preferences. Delivering interventions that are consistent with patients’ preferences increases their motivation to engage in intervention, satisfaction and adherence to treatment and achievement of desired outcomes.

Efficacy of empowerment education in self-management with Type 2 Diabetes Mellitus:A systematic review and meta-analysis

Objective:To evaluate the impact of empowerment education in self-management with Type 2 Diabetes Mellitus.Methods:A literature search was performed in PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),WanFang Data,CQVIP and China Biology Medicine disc(CBMdisc)and for randomized controlled trials published before November 2018.RevMan5.3 software was used for metaanalysis.Results:A total of 11 articles were included,involving 1139 patients.The group of empowerment education included 574 participants,and the regular education groups 565 participants.Meta-analysis showed that the group of empowerment education has an advantage over the control group in the levels of self-efficacy[MD=17.55,95%CI(14.14,20.96),P<0.00001],self-management[SMD=0.85,95%CI(0.60,1.11),P<0.00001],as well as the effectiveness of short-term empowerment education(within 6 months)on reducing HbA1c(P<0.05);however failed to long-term empowerment education(beyond 12 months)(P=0.05).Conclusion:This meta-analysis indicates that empowerment education can be an acceptable and appropriated nursing intervention for type 2 diabetes mellitus patients.

Effect of a new health education model on continuous nursing in elderly patients with diabetes mellitus

Objective: We aimed to explore the effect of a new health education model on continuous nursing care in elderly patients with diabetes mellitus who had undergone an operation for fracture.Methods: Convenience sampling was used to select 59 elderly patients with diabetes mellitus and fracture. New health education methods were used, and patient parameters were evaluated before and after the intervention.Results: Evaluation of medication, reasonable diet, regular exercise, blood glucose monitoring, and regular follow-up compliance were significantly improved in the experimental group compared to the control group(P<0.05). There were also significant differences between groups in fasting blood glucose, 2-hour postprandial blood glucose, triglyceride, high-density lipoprotein, and low-density lipoprotein levels(P < 0.05); however, the differences between groups in terms of glycosylated hemoglobin and total cholesterol levels were not statistically significant(P > 0.05). Finally, the functional recovery and mental health of the experimental group were significantly better than those of the control group(P < 0.05).Conclusions: The implementation of a menu of voluntary services in community-based continuous nursing provided standardized nursing care for elderly patients with fracture and diabetes mellitus and improved their quality of life.

A comprehensive health education plus monitoring support program for older adults with knee osteoarthritis coexisting with overweight and type 2 diabetes

Objectives:To examine the patient outcomes of a comprehensive health education plus village health volunteer monitoring support program on older adults with knee osteoarthritis who are overweight and have type 2 diabetes.Methods:Quasi-experimental,two-group,pretest-posttest design was applied.Using random geographic cluster sampling,older adults who met the inclusion criteria were assigned to two groups,62 in the intervention group and 71 in the control group.The intervention group received the comprehensive health education plus village health volunteer monitoring support program.The control group received only the comprehensive health education program.Study outcomes,including blood glucose level,knee pain and range of motion,body weight,physical ability(Timed Up and Go Test),fatigue,depressive symptoms,quality of sleep,and quality of life,were assessed at baseline,3 months,and 6 months after enrollment and analyzed using descriptive statistics and multivariate analysis of variance.Results:One hundred and ten participants completed the study(55 participants in each group).Most patient outcomes in the two groups showed general improvement with statistical significance(P<0.001):pain decreased,physical ability improved,less depressive symptoms and fatigue,quality of life and sleep improved.The interaction effect(the group and time)demonstrated statistically significant differences between the intervention and control groups on pain,knee range of motion,and fatigue according to each time follow-up(P<0.001).Conclusions:The comprehensive health education plus village health volunteer monitoring support program promotes good patient outcomes in this population.The integrated health education resource and support for older adults with knee osteoarthritis and type 2 diabetes is an effective,non-surgical treatment that highlights professional nursing roles and non-professional rolesdvillage health volunteers.Nurses should consider implementing a health education plus monitoring support program to mitigate the effects of chronic diseases and improve patients’quality of life.

Application Analysis of Diabetes Health Education in Endocrinology Nursing

Objectives:To explore the clinical value of applying diabetes health education to endocrinology care.Methods:A total of 122 patients with diabetes admitted to our department from October 2016 to October 2017 were selected.After consulting patients,they were randomly divided into two groups,with 61 cases in each group.The control group performs routine care,and the experimental group provides patients with diabetes-specific health education.After three months,the compliance of the two groups of patients was compared.The ADL scores of the two groups of patients before and after treatment were compared.Results:Experimental group had significantly higher compliance rate than control group in all aspects.The difference was statistically significant(P<0.05).The ADL scores of both groups were significantly improved.The effects before and after the care were compared.The difference was statistically significant(P<0.05).The score of experimental group increased more significantly than that of the control group.The difference was statistically significant(P<0.05).Conclusions:In the endocrinology care,the implementation of diabetes special health education for patients can improve patient compliance and improve patients'daily living ability,which is an ideal nursing measure.It is worth promoting.

Exploring the Influences of Continuous Self-Management Education on the Self-Care Skills and Health Behavior of Patients with PICC Intubation

Objective:To analyze the effects of continuous self-management education on the selfcare ability and health behavior of patients with tumor through peripherally inserted central venous catheters(PICC).Methods:The period from August 2018 to August 2020 was used as the research time range,and the random number table method was used as the basis for grouping.80 patients with malignant tumors who regularly performed fixed catheter maintenance care in the PICC clinic of our hospital were admitted in the experimental group(given PICC specialist nursing,and implemented continuous self-management education),and 80 patients with PICC tube malignant tumors discharged from the superior hospital during this time range served as the control group(return to the original catheterization hospital from time to time or perform catheter maintenance care in the nursing clinic of our hospital).The self-care ability scores,health behavior scores,and complications during intubation between both groups were analyzed.Results:(1)There was no significant difference in self-care ability score and healthy behavior score between groups before the intervention,P>0.05;the self-care ability score and health behavior score of the research group were better than the control group after intervention,P<0.05;(2)After investigation,the incidence of complications in the research group(2.50%)was lower than that of the control group(10.00%),but there was no difference between the groups,P>0.05.Conclusion:Continuous self-management education has good effects on improving the self-care ability of tumor patients with PICC intubation.It can urge patients to maintain good health behaviors and reduce complications.It is worthy of promotion.

Application Effect of Health Management in Community Diabetic Population

Objective: This study aims to improve the health level of patients with diabetes in the community through health management measures under the concept of health management. Methods: Community residents were selected to detect, collate and analyze the social demographic information, body mass index, fasting blood glucose and blood lipid level of diabetic patients before and after health management. Results: The study showed that after the implementation of health management education in the community, the detection rate of diabetes patients increased, but the population was no longer mainly elderly patients, but mainly people under 60 years old. The levels of body mass index, fasting blood glucose, triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) were significantly decreased (all P Conclusion: Through the investigation of patients before and after health management in residential communities, this study shows that the correct implementation of health management can effectively improve the physiological indicators of diabetes patients, improve the level of health quality, and provide a reference for the prevention and treatment of diabetes patients in communities.

Influence of education training in patients with type 2 diabetes in the improvement of lifestyle and biochemical characteristics: a randomized controlled trial

Objective: The objective of this randomized controlled trial study was to evaluate the education training in relation to lifestyle improvement in patients with type 2 diabetes through its influence in the levels of glycated hemoglobin(HbA1 c), blood pressure, triglyceride, cholesterol levels, and body mass index(BMI).Methods: The study included patients with type 2 diabetes randomly selected from 20 residential areas in Tirana, Albania where family physicians provide services. The sample size in total was 200 patients in both groups(control and intervention). The education training(four sessions) was conducted by trained nursing staff for 6 months. Patients were screened for the biochemical profile before and after the intervention. To compare the groups with respect to the interest outcomes, the t-test was used. The value of P < 0.05 was considered significant.Results: There were 104 male patients and 96 female patients. The mean age was 54.9 ± 8.7. No significant differences were found between the study groups in relation to clinical and biochemical data before the education sessions. After the intervention, in the intervention group, the mean level of HbA1 c was significantly lower than the value in the control group(6.2% vs 6.8%, P = 0.001) as well as for the mean values of BMI. The mean reduction(more than 15%) in HbA1 c after the intervention was 43% in the intervention group and 2% in the control group(OR = 36.9, P < 0.05). Differences in BMI, HbA1 c, triglycerides, and cholesterol were more significantly visible in the intervention group. However, the difference in systolic and diastolic blood pressure values was almost the same(P > 0.05).Conclusions: The results of this study further support that the approach for education of patients with type 2 diabetes on changing lifestyle benefit the patient in controlling diabetes. It is believed that the establishment of diabetes education classes in health centers is an important investment in improving the management of type 2 diabetes.

Effects of Diabetes Education on Emotional Distress in Patients with Type 2 Diabetes—An Experimental Study

Objective: It was to evaluate the effect of diabetes education on emotional distress in type 2 diabetes patients treated with oral medications. Methods: The experimental study took place in Albania and overall, 200 type 2 diabetes patients were enrolled (in both groups, intervention, and control) treated with oral medications, having levels of Glycated hemoglobin HbA1c > 6.5% as well the absence of associated diseases such as dementia and psychiatric disorders. Patients were randomly selected from the medical registry of family physicians in the Tirana region. Patients were screened for the emotional distress before and after the intervention with the self-administered questionnaire Problem Areas in Diabetes PAID 5. In addition, the levels of HbA1c in % were evaluated before and after intervention in both groups. Only intervention group underwent four diabetes education sessions offered by trained nursing staff while the control group continued the previous regime. The questionnaire reliability analysis was estimated by the Cronbach alpha coefficient. To compare the groups the t-test was used and the value of p Results: Mean age of patients in intervention and control group was respectively 54.03 ±9.57 and 55.82 ± 7.86. Before and after health education PAID 5 scores for the intervention group were respectively 11.3 vs. 8.75 while for the control group 11.9 vs. 11.35, p = 0.018. Levels of HbA1c% before and after education for the intervention group were 7.02 vs. 6.2 while for the control group 6.9 vs. 6.8, p = 0.001. Positive and significant correlation (r = 0.321, p = 0.001) was between level of emotional distress and the age of the patients. Conclusions: The study found that besides better control of diabetes, additional education of diabetic patients seemed to significantly improve the level of emotional distress due to diabetes in diabetic patients.

Preconception Care Health Education for Female Workers of Reproductive Age in Japan Evaluation up to 6 Months after the Program

Objectives: The aim of this study was to implement a health education program for education of preconception care (PCC) for female workers of reproductive age through a seminar and to evaluate the program based on PCC knowledge and awareness and behaviors before the seminar and at 3 and 6 months after the seminar. Methods: A small group health education seminar was implemented using leaflets for 84 female workers of reproductive age, age 20 to 35 years old, and an intervention by group discussion and feedback was provided. Of these participants, 60 (71%) who provided valid survey responses were included in the analysis. The primary outcome indicators were PCC knowledge, PCC awareness and behaviors, and a food frequency questionnaire, and the secondary outcome indicators were self-efficacy and the health awareness and stress management subscales of the Health-Promotion Lifestyle Profile scale. The survey was conducted three times, before the seminar and at 3 and 6 months after the seminar, and the results were compared. Results: The percentage of individuals with PCC knowledge was significantly increased at 3 months after the seminar as compared with before the seminar, and it remained at this level even at 6 months after the seminar. The percentage of individuals with PCC awareness and behaviors was significantly increased for the items actively eat foods containing folic acid, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 3 months after the seminar and for the items eat well-balanced meals, make the mind active, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 6 months after the seminar. Furthermore, the score for the health awareness subscale of the Health-Promotion Lifestyle Profile scale was significantly increased at 6 months after the seminar. Conclusion: The health education program established PCC knowledge at 6 months after the seminar and improved some PCC awareness and behaviors. Therefore, it was suggested that the program would be effective for education of PCC for female workers of reproductive age.

Education Outreach: Raising Awareness of Diabetes and Pharmacy Careers

Objectives: 1) To demonstrate that education outreach in public schools by students in pharmacy education programs is effective at increasing knowledge of important health topics;2) To assess subject attitude towards pharmacy careers after education outreach. Study: A lecture was constructed providing participants with information about careers in pharmacy, diabetes, and information about health literacy. A multiple choice paper-based quiz covering the presented content both preceded and followed each delivery of the lecture. Increases in post-lecture scores of content-knowledge questions were seen in 10 of 11 questions, which indicated an overall increased knowledge from baseline. An additional question, which gauged student interest in pharmacy careers, showed a 10% increase in those who indicated they considered pharmacy as a career. Conclusions: The lectures, delivered by a student pharmacist, were effective in increasing awareness and knowledge of pharmacy as a career, diabetes as an important health issue, and health literacy as a problem pharmacists and other healthcare providers encounter on a daily basis.

Knowledge about Diabetes Mellitus and Self-Care Activities before and after an Educational Program: A Pilot Study

Background: Health education has proven to be an effective strategy to enable people with diabetes mellitus to manage this condition. However, few studies in Brazilian population samples have been conducted to evaluate the effects of educational programs on diabetes knowledge and self-care. Aim: To evaluate the knowledge about diabetes mellitus and the performance of self-care activities, before and after participation in an educational program. Methods: This is an intervention study, with a quantitative approach, in a single comparison group, for the analysis of “before and after” results related to an educational program focused on self-care and concurrent physical training. The study interventions consisted of 42 exercise sessions, as well as individual educational meetings, according to the needs of each participant and through nursing consultations, using educational material prepared from the literature. The sample was initially composed of 33 adults with diabetes mellitus, but 18 completed the study. For the assessment of knowledge and self-care activities, the revised Brazilian versions of the Diabetes Knowledge Scale and the Diabetes Self-Care Activity Questionnaire were used, respectively, in the two moments of the study, that is, prior to the first educational meeting and immediately before the first physical training session, and after the last educational meeting, which ran parallel to the 42nd physical training session, making a six-month interval between the two assessment moments for each participant. Results: The analysis of knowledge about diabetes showed significant improvement after the educational program and, as for self-care, there was clinical improvement in all dimensions, but only the dimension “general diet” obtained statistically significant improvement. Conclusion: The educational program has been shown to be beneficial for improving knowledge and self-care of the disease, which reiterates the need to maintain interventions of this nature for people with diabetes mellitus.

Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes—The Active Ingredient in the Education. A Qualitative Study

Background: Diabetes self-management education (DSME) for patients with type 2 diabetes requires efficient teaching methods that make patients want to change lifestyle in terms of their diabetes. The study looks at what may be the active ingredient in this DSME. Objective: To explore how participants in DSME, with an interactive learning method, experienced changes in relation to diet and physical activity. Method: We studied possible changes in diet and physical activity by semi-structured individual interviews of 16 participants attending DSME. Results: Before the DSME, the participants felt insecure about what to eat, and they expressed little interest in changing their physical activity. Just after the DSME, they were more optimistic about diet because they had learned how to interpret food labels and compose their meals. Furthermore, they had experienced the benefit of physical activity in relation to their blood glucose levels. Behavior changes appeared to persist the following half year. We discuss the findings in light of the principles of interactive learning. The participants experienced an effect of their behavior changes, and blood glucose measurement was used as a tool to gain control and reach a state of well-being. Conclusion: From being insecure about what to eat, the patients acquired knowledge to handle their diet through the DSME. They learned how to compose their meals and use physical activity to regulate their blood glucose. We suggest that the interactive learning used in the DSME was an active ingredient that led to changes in behavior and should be considered as an educational method in DSME for patient with type 2 diabetes.

Comparative efficacy of social media delivered health education on glycemic control: A meta-analysis

Objective:To compare outcomes associated with patient education about glycemic control via group chat versus patient education as usual among individuals with diabetes in China.Methods:We searched the following databases both in English and in Chinese languages:PubMed,CNKI,Wanfang database,VIP database,and CBM for articles published up to Jan 1,2018.The studies were screened by two independent reviewers.Using criteria from the risk of bias assessment tool developed by Cochrane Collaboration to assess the risk of bias of eligible studies.A meta-analysis of studies was performed using comprehensive meta-analysis version 3.0.Results:Twenty-five unique randomized clinical trials,including 2,838 patients,were identified.The education delivered via group chat had large overall pooled effect sizes in improving glucose control measured by hemoglobin A1c[Hedges'g=-0.81,95%CI:(-0.98,-0.64)],fasting blood glucose[Hedges'g=-1.11,95%CI:(-1.37,-0.85)],and 2 h postprandial blood glucose[Hedges'g=-0.98,95%CI:(-1.20,-0.76)].Additionally,patient education delivered via group chat has shown consistently superior outcomes in glucose control in short-term(0-3 months),mid-term(3-6 months)and longer-term(6-12 months).Conclusions:Educational interventions via group chat had a superior outcome in blood glucose control compared to education as usual in China.Educational interventions via group chat had superior shortterm,mid-term,and longer-term outcomes in blood glucose control compared to education as usual in China.

Prediabetes and cardiovascular complications study:Highlights on gestational diabetes, self-management and primary health care

International collaboration on the prediabetes and cardiovascular complications study started in 2013.In 2017,a reflection was reported.Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus(GDM)was concerning.Hence,further observations have been made that warrant an update.The objective of this review is to highlight gaps between clinical knowledge and practice in GDM,diabetes self-management and primary health care(PHC)for rural dwellers.We followed a descriptive field notes method.Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment.Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed.Other data included cross-sectional evaluation of activities of daily living at two private hospitals.Up to 29%had high GDM risk factors,which fulfilled selection criteria for laboratory screening.Demographic data was complete in all women;however,incomplete documentation was observed with as much as 98%of basic data.High levels of physical activity were found in the population,and health lectures proved effective in food choices.The workforce need for diabetes care seems underestimated,but this may be better understood with reactivation of PHC services.The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus.Two proposals are to advance the use of a‘risk assessment and screening sheet’for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.