title: Effects of a lifestyle education program on glycemic control among patients with diabetes at Kigali University Hospital, Rwanda: A randomized controlled trial.
abstract: OBJECTIVE
  Evidence to show whether lifestyle intervention programs are beneficial for patients with diabetes in resource-limited countries is lacking. The present study assessed the additional efficacy of a structured lifestyle education program, as compared to the current standard of diabetic care in Rwanda.
  
  
  METHODS
  251 consecutive adult patients attending a tertiary diabetic care practice were randomly assigned to either an intervention group (standard of care plus monthly lifestyle group education sessions of 45min duration) or to a control group. The primary outcome was between-groups difference in glycated hemoglobin (HbA1c) observed after 12-months follow up. Outcome measures in the intervention and control groups were compared using the ANCOVA test with a two-sided significance of 5%.
  
  
  RESULTS
  Of the 251 subjects recruited, 223 were included in the analysis; of whom 115 were assigned to the intervention group, and 108 to the control group. After 12-months, the median HbA1c levels reduced by 1.70 (95% CI: -2.09 to -1.31; p<0.001) in the intervention group; and by 0.52 (95% CI: -0.95 to -0.10; p=0.01) in the control group. The difference in HbA1c reduction between the intervention and control groups was statistically significant (p<0.001) after adjustment for subjects' age, sex, education level, BMI, diabetes duration and diabetic medications.
  
  
  CONCLUSIONS
  This study demonstrated that a structured lifestyle group education program for people with diabetes is an attractive option in a resource-limited setting, as it showed significant benefits in improved glycemic control over a 12-month period.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02032108.
authors.affiliation: Department of Internal Medicine, University of Rwanda, Rwanda; King Faisal Hospital, Kigali, Rwanda. Electronic address: amendezoe@gmail.com.
authors.forename: Etienne
authors.initials: E
authors.lastname: Amendezo
authors.affiliation: Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Butare, Rwanda.
authors.forename: David
authors.initials: D
authors.lastname: Walker Timothy
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Vincent
authors.initials: V
authors.lastname: Karamuka
authors.affiliation: University Teaching Hospital of Kigali, Rwanda; Human Resources for Health, Rwanda; Brown University, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Robinson
authors.affiliation: Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Kigali, Rwanda.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kavabushi
authors.affiliation: Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Butare, Rwanda.
authors.forename: Cyprien
authors.initials: C
authors.lastname: Ntirenganya
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Uwiragiye
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Donatille
authors.initials: D
authors.lastname: Mukantagwabira
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Bisimwa
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Henriette
authors.initials: H
authors.lastname: Uwintwali Marie
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Henriette
authors.initials: H
authors.lastname: Umulisa
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Scholastique
authors.initials: S
authors.lastname: Niyomwungeri
authors.affiliation: University Teaching Hospital of Kigali, Rwanda.
authors.forename: Bernard
authors.initials: B
authors.lastname: Ndayambaje
authors.affiliation: Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Kigali, Rwanda.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dusabejambo
authors.affiliation: Department of Internal Medicine, University of Rwanda, Rwanda; University Teaching Hospital of Kigali, Rwanda.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Bavuma
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D000070497:Healthy Lifestyle; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012432:Rwanda
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes mellitus; Rwanda; Structured lifestyle education program