Improving glycaemic control for children of African descent in London, policy recommendations based upon a narrative literature review and audit of a support group intervention.
Background: Children and adolescents from African backgrounds with type 1 diabetes treated at University College Hospital London (UCLH) have been identified as having poorer glycaemic control compared to the Caucasian population treated at UCLH [White British mean HbA1c 7.8 (0.1), African mean HbA1c 9.4 (0.5) significant at p <0.001 (19)].
Purpose: Haemoglobin A1c is an element of the haemoglobin to which glucose is bound (12). In someone without diabetes the normal range of HbA1c is 4-5.9%, while in someone with diabetes a HbA1c of 6.5-7.5% represents good glycaemic control (13). Patients who consistently have an HbA1c over 8.0% are at a significantly increased risk to the long term complications of diabetes (14, 20). The purpose of this policy report is to explore and make recommendations about appropriate methods to improve HbA1c in children treated at UCLH from African backgrounds.
Method: Intervention, support groups involving translated education sessions, peer group facilitation, and culturally specific dietary advice. An observational study of the intervention over a one year period, outcome to be audited after one year. A narrative literature review to inform policy recommendations related to glycaemic control in ethnic minorities and support groups as a solution to improve diabetes related outcomes.
Results: (confidence intervals presented in brackets) Fifteen participants for which data has been collected. Intervention (n=6) are those who attended three or more support groups, n=10 attended two or fewer sessions (control). Before attending support group sessions, the average HbA1c in the intervention group was 8.5% (6.6, 10.4). After attending at least three of these sessions, it had decreased to 7.6% (6.4, 8.8). At the start of the intervention, the control group’s average HbA1c was 8.8% (8.1, 9.6) and afterwards was 9.1% (7.9, 10.2). There is a 0.9% decrease in the average HbA1c following the intervention, compared to a 0.3% increase in those who attend fewer than two sessions. A t-test showed weak evidence against the null hypothesis of no underlying difference in means (p=0.06).These preliminary data suggest that there may be an improvement in HbA1c due to the support group intervention. However, it is not surprising that significance was not reached due to the small size of the sample.
Literature review results: Of the papers reviewed that discussed support group interventions, four found that the support group improves glycaemic control (26, 32, 43, 55), two found no improvement in glycaemic control (25, 53), two of the papers gave mixed results suggesting some improvements in overall diabetes knowledge but no improvement in glycaemic control (41, 54).