Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Rafael Perez-Escamilla

Second Advisor

Robert Dubrow

Abstract

Background: Between 1994 and 2004 the prevalence of diabetes in Jordan increased from 13.0% to 17.1%. Among individuals with diabetes in Jordan, 54% had unsatisfactory blood glucose control. In response to the diabetes epidemic in Jordan, the National Center for Diabetes Endocrinology and Genetics (NCDEG) was founded. NCDEG's primary objective is to improve diabetes treatment in Jordan, and does so by offering treatment facilities specific for diabetic patient needs. In 2008 NCDEG began implementation of an integrated patient education strategy (IPE). Certified diabetes educators joined NCDEG and were provided space within each diabetes clinic within the center for individual patient counseling. The program was fully implemented by 2009. However, NCDEG did not have a feedback mechanism to assess the effectiveness of the program. Methods: To assess the effectiveness of the integrated education program and assess whether response differed between gender, we sampled patients attending NCDEG prior IPE implementation (01Jan2006 - 31Dec2007) (P1) and patients enrolled at NCDEG after implementation (01Jan2010 - 31Dec2011) (P2). Patients eligible for study were diabetic, were new patients within each time period, had at least three visits to the center within each time period, and could not be pregnant during the periods of study. To collect data, an iPad application was developed to extract data from charts on the first 3 visits to the center. A team of physicians at NCDEG was assembled to collect the data. Chi-square tests and F-Tests were used to compare categorical variables and t-tests were used to compare continuous variables. A linear model was created with period being the primary predictor variable. Results: Univariate analyses showed that change in HbA1c did not differ between P1 (-1.54 SD=1.81) and P2 (-1.52 SD=1.85) (p=0.894). Univariate analysis showed that change in HbA1c differed between females (-1.30 SD=1.80) and males (-1.77 SD=1.84) (p<0.001). Univariate analysis showed the change in HbA1c was different between females and males within each period: female P1 (-1.26 SD=1.77) versus male P1 (-1.80 SD=1.81) (p=0.007) and female P2 (-1.32 SD=1.82) versus male P2 (-1.74 SD=1.87) (p=0.019). When controlling for Gender, Age, Duration of Diabetes, HbA1c at V1, Time between V2 and V3, BMI between V1 and V3 Chronic Kidney Disease status, Hyperthyroidism status, Sulfonylurea prescription, MIX Insulin prescription and NPH prescription the average change in HbA1c in P2 was -0.177 (SD=0.012) higher than in P1 and the average change of male HbA1c decrease was -0.222 (SD=0.088) higher than for females. Conclusions: Glucose control improved after implementation of diabetes education intervention and this improvement was more pronounced among male than female patients.

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This is an Open Access Thesis.

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