The Diabetic Program Evaluation for a Peer Educator Model in Takeo, Cambodia from 2007 to 2013

Abstract

University of Washington Abstract The Diabetic Program Evaluation for a Peer Educator Model in Takeo, Cambodia from 2007 to 2013 Dawn Taniguchi Chair of the Supervisory Committee: Professor, James LoGerfo M.D., M.P.H., F.A.C.P. Department of Global Health Background: Early detection and treatment for diabetes (DM) are essential for reducing disability and death from the disease. Finding effective ways of improving affordable screening, access, and quality of care for diabetic patients living in developing countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, was established to help address this lack of DM care in Cambodia utilizing a peer educator model. This study aimed to describe the outcomes of MoPoTsyo’s diabetic program in Takeo Province by assessing glycemic and blood pressure outcomes over 5 years of follow up. Methods: We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow up. The proportion of patients reaching recommended treatment targets for FBG and BP were assessed for each interval. The paired t-test was used to compare baseline and follow up at one year. Results: Of 3411 patients enrolled, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow up time in the program was 16 months (4.9-38.4 months). There was a significant decrease (p<0.001) of 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow up when compared to enrollment FBG. After one year, 45% (321/708) of patients achieved this goal. By year five, 41% (108/259) were within target FBG < 126. When assessing goal FBG < 150, 60% and 59% were within goal at one year and five years of follow up respectively. Systolic and diastolic BP levels significantly (p<0.001) decreased by 10.9 mmHg (95% CI 8.9 to 12.9) and 7.7 mm Hg (95% CI 6.4 to 8.8) respectively between enrollment and one year of follow up. Of the 65% with elevated BP at enrollment, 30% (163/529) of them reach the BP goal at one year of follow up and 34.4% (78/227) reach goal at 5 years. When accounting for all patients, 44.4% (156/351) had target BP at 5 years of follow up. When using the BP goal of less than 140/90 mmHg, 70% were within goal at 5 years of follow up (248/351). Conclusion: The outcome indicators of DM care for MoPoTsyo’s Takeo program evaluation are promising. This illustrates a reasonable approach to delivering effective quality DM care to a large number of patients in rural parts of LMIC.