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Int J Nurs Stud. 2019 Jul;95:65-72. doi: 10.1016/j.ijnurstu.2019.04.020. Epub 2019 May 11.

Effectiveness of Managing Diabetes During Ramadan Conversation Map intervention: A difference-in-differences (self-comparison) design.

Author information

1
Department of Nursing, University of Haifa, Haifa, Israel; Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel. Electronic address: esrulovici@univ.haifa.ac.il.
2
Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel.
3
Eli Lilly, West Ryde, New South Wales, Australia.
4
Eli Lilly and Company, United States.
5
Community Nursing Division, Clalit Healthcare Services, Tel Aviv, Israel.
6
Eli Lilly, Ruhama, HaDarom (South) District, Israel.
7
Eli Lilly, Sydney, Australia.

Abstract

BACKGROUND:

Some individuals with diabetes fast during Ramadan despite medical concerns for risk of adverse outcomes. The Managing Diabetes During Ramadan Conversation Map is a self-management education group-based intervention for Muslim individuals with type 2 diabetes, specifically addressing diabetes management during Ramadan.

OBJECTIVE:

The aim of this study was to evaluate the effectiveness of the Managing Diabetes During Ramadan Conversation Map intervention in improving short-term clinical outcomes and reducing healthcare utilization following Ramadan.

DESIGN:

This was a retrospective rolling cohort study.

SETTINGS:

Participants were Clalit Health Services members with type 2 diabetes who participated in the intervention between 2014 and 2017 across Israel.

PARTICIPANTS:

This study included 1732 participants who enrolled in the intervention over the five-year study period. The cohort was mainly between the ages of 45 and 74 years (83.3%), female (71.9%), of lower socioeconomic status (92.1%), with a diabetes duration of 10 years or more (51.7%), obese (64.0%), and had never smoked (73.8%).

METHODS:

The data used in this study came from Clalit Health Services' electronic health records, which are integrated in a central data warehouse. We used a difference-in-differences (self-comparison) design to examine the effect of the intervention on changes in laboratory results and healthcare utilization over a six month baseline and follow-up. Mixed model linear regressions and Poisson regressions were used to estimate continuous and count outcomes, respectively.

RESULTS:

Post intervention, participants experienced a reduction of 8.61 mg/dL in their glucose levels (p = 0.005) and 0.34% in their HbA1c levels (p < 0.001). In a sub-group analysis of participants with HbA1c > 7%, larger reductions in glucose (17.02 mg/dL [p < 0.001]) and HbA1c (0.63% [p < 0.001]) levels were recorded. This sub-group also experienced a reduction of 4.83 mg/dL in LDL level (p = 0.007) and had 0.2 fewer primary care visits (p < 0.001).

CONCLUSIONS:

Participation in the Managing Diabetes During Ramadan Conversation Map improved patient glucose and HbA1c levels. A greater benefit was reported in those individuals with HbA1c > 7%. These findings hold important global health implications for the millions of individuals with type 2 diabetes for whom Ramadan can pose a challenge in disease control.

KEYWORDS:

Diabetes conversation map; Diabetes mellitus; Program evaluation; Ramadan; Self-management; Type 2

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