A Randomized Trial of an Intensive Education Intervention Using a Network of Involved Diabetic Patients (Peer Educators) to Improve Glycemic Control of Type 2 Diabetic Patients
A Randomized Trial of an Intensive Education Intervention Using a Network of Involved Diabetic Patients (Peer Educators) to Improve Glycemic Control of Type 2 Diabetic Patients
The project will test the implementation of a specific methodology for education of type 2
 diabetic patients that will be set up using patients involved (peer educators) and 3 guides
 developed specifically for the therapeutic education of type 2 diabetic patients. This
 project will take place in 1 sites in mali : the capital Bamako. 75 diabetic patients will be
 subjected to intervention with this methodology and 75 other diabetic patients will be the
 control group. At various stages of the project, the investigators will analyze the impact on
 biological, anthropological constants, etc ... of the group undergoing the intervention
 compared to the control group.
Title of project:

 A randomized trial of an intensive education intervention using a network of involved
 diabetic patients (peer educators) to improve glycemic control of type 2 diabetic patients

 Research question (s)/hypothesis:

 Main objective of the research: compare the improvement of HbA1c 1 year after an intervention
 led by peer educators, versus a conventional care in health centre

 Secondary objectives:

 Study the evolution of bio clinical parameters: fasting glucose, weight, BMI, blood pressure,
 waist size

 Method (s) :

 This study will be conducted by a multidisciplinary team that brings together high level
 skills in research projects and in peer education projects. It will be conducted in one site
 in one country Mali.

 This site was chosen because they meet a functional care, access to medicines and a dynamic
 association of diabetic patients. Peer educators and persons targeted by the project will be
 recruited through the local association of patients. This association will be a social
 support that provides on going prevention counseling, education and support services to
 people who have diabetes. It represents an important link between patients, educators and
 general medical services. The procedure will start by the training of peer educators who were
 identified and recruited to facilitate the sessions

 Then, the 4 educational sessions: control of cardiovascular risk (blood pressure, waist
 circumference, smoking, cholesterol, glycaemia), control of Food (balance, fat,
 carbohydrates), physical activity management, insulin management, will be carried out and
 patients will be able to:

 -  Analyze knowledge that appears in various forms, including forms adapted to illiterate
 patients (colour codes, presence of photos)

 -  Act on knowledge: the patient observes, makes hypothesis, he experiments, compares,
 deduces, analyzes, makes relations.

 -  Work in interaction with other learners, which gives education a social dimension.

 -  Decide on the implementation of actions taking into account individual, cultural,
 social, economic context

 For each situation, a day of training will be conducted by trained peer educators with
 theoretical contributions on the issue, practical scenarios, analyzes of the issues out of
 frame and put in "educational security ". These training days will be implemented with 8-10
 patients (1Hour and an half) and the 4 sessions will take place over a period of two months
 starting from the inclusion of patients.

 2 groups of 75 persons will be formed. One group will have specific education using
 methodology of learning nests. The other group will be a control group not subject to this
 specific education.

 To evaluate, we propose a classical randomized controlled experimental (RCT) design, with
 randomization at the person-level. For outcome measures, we propose change in HbA1c, increase
 of social and emotional support and increase of linkage to clinical care. In addition to
 HbA1c, we propose measuring changes in systolic, diastolic blood pressure, and weight.

 Public health significance (state how the project applies to your community and it potential
 impact(s))

 It is very important to find an education methodology adapted to the African context. This
 line of diabetes management is essential to improve the management of African diabetic
 patients.

 Sustainability plan:

 If the evaluation of this methodology is conclusive, the Malian state will implement the
 methodology in the 22 diabetes units of the country.
Inclusion Criteria:

 -  Patients followed in the diabetes units of the project area and doing regular
 consultations

 -  Patients with type 2 diabetes or treated or not with insulin

 -  Poorly controlled diabetes with HbA1c ≥ 8%

 -  Patients who accepted to undergo the whole process of peer education

 -  Patients who agreed to perform all biological measures included in the protocol

 -  Patients aged from 30 to 80 years old

 Exclusion Criteria:

 -  Diabetic patients not carrying out their monitoring in diabetes units of the
 intervention area

 -  Patients followed in the diabetes units of the intervention area but not realizing
 their consultations regularly

 -  Patients with type 1 diabetes

 -  Severe complications within the preceding 3 months: infection, coronary complications,
 severe renal failure

 -  Concomitant illnesses threatening the functional or vital prognosis