A Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala

INTRODUCTION: Diabetes self-management education (DSME) is a fundamental element of type 2 diabetes care. Although 75% of adults with diabetes worldwide live in low-income and middle-income countries (LMICs), limited DSME research has been conducted in LMICs. The objective of this study was to evaluate a home-based DSME intervention in rural Guatemala. METHODS: We conducted a prospective study of a DSME intervention using a quasi-experimental, single-group pretest–posttest design. We enrolled 90 participants in the intervention, which consisted of 6 home visits (May 2014–July 2016) conducted by a diabetes educator using a curriculum culturally and linguistically tailored to rural Mayan populations. Primary outcomes were changes in mean hemoglobin A1c (HbA1c) and mean systolic and diastolic blood pressure at baseline and at 12 months. Secondary outcomes were diabetes knowledge and self-care activities at baseline and intervention completion. RESULTS: HbA1c decreased significantly from baseline to 12 months (absolute mean change, −1.5%; 95% confidence interval [CI], −1.9% to −1.0%; P < .001). Systolic blood pressure also improved significantly at 12 months (−6.2 mm Hg; 95% CI, −10.1 to −2.2 mm Hg; P = .002); changes in diastolic blood pressure were not significant (−1.6 mm Hg; 95% CI, −3.9 to −0.7 mm Hg; P = .17). We also found significant improvements in diabetes knowledge and self-care activities from baseline to intervention completion. CONCLUSION: DSME interventions can be successfully delivered in a setting with an underresourced health system, high poverty rate, and unique cultural characteristics like Mayan Guatemala. Our findings point to the need for more DSME research in resource-limited settings globally.