Prospective cohort study evaluating feasibility, acceptability, and clinical impact of diabetes self-management education in a PEN-Plus program in Southeastern Liberia

People living with insulin dependent diabetes (PLWIDD) in low and lower-middle income countries (LLMICs), specifically rural areas, face significant barriers to diabetes management. Diabetes Self-Management Education (DSME) is an evidence-based intervention to educate and empower people living with diabetes to improve self-management. This pilot study evaluates the feasibility and clinical impact of a DSME program in a rural Package of Essential Noncommunicable Disease-Plus (PEN-Plus) clinic in Liberia. This study was conducted at two sites in Harper, Liberia. After being trained on how to administer DSME, clinic providers delivered DSME to PLWIDD during routine monthly clinic visits. Primary outcomes included acceptability, adoption, fidelity and the frequency of self-management behaviors; secondary outcomes included knowledge change and Hemoglobin A1c (HbA1c). Three providers and twenty-six PLWIDD were enrolled. DSME was feasible and well accepted by providers and PLWIDD. Patient knowledge scores increased from 33% at baseline to 64.6% at month 12. Average weekly blood glucose checks increased from 4.0 (95% CI 1.93, 6.23) checks per week month one, to 7.2 (95% CI 3.56, 10.79) checks per week month 12. Average weekly missed insulin injections decreased from 3.9 (95% CI 2.51, 6.03) in month one, to 0.82 (95% CI -0.14, 1.79) in month 12. Mean HBA1C decreased from 12.0% (107.7 mmol/mol) at baseline to 10.9% (95.6 mmol/mol) month 12, (modeled mean reduction of 1.1%,95% CI 0.0 to 2.0). This study adds to the growing body of literature showing that DSME can address many barriers faced by PLWIDD in LLMICs. Further research is warranted to expand the scope of self-management education to other noncommunicable conditions in the context of integrated PEN-Plus strategies.