The effect of structured diabetes self-management education on type 2 diabetes patients attending a Primary Health Center in Kuwait.

AIM: To evaluate the impact of diabetes self-management education (DSME) on diabetes control measured by glycated hemoglobin (HbA1c) in nationals and expatriates with type 2 diabetes mellitus (T2DM) in Kuwait. METHOD: A total of 291 patients with T2DM (intervention = 150, control = 141) were assessed in a single-center, controlled study to compare the impact of DSME sessions on HbA1c levels as a measure of metabolic control of diabetes mellitus. Measurements of HbA1c were taken at baseline, 6-months, and 12-months. Multiple explorative association tests and regression models were constructed to examine the intervention effects. RESULTS: Patients that received DSME sessions demonstrated better diabetes control with an average reduction of 1.3% (14 mmol/mol) HbA1c over 12-months compared to an average HbA1c increase of 1.1% (12 mmol/mol) in the control group (p < 0.001). Using pairwise comparisons, young, male, and expatriate patients and patients with HbA1c above 7% demonstrated the highest improvements in HbA1c with DSME sessions. In multivariate regressions, DSME intervention was associated with a 1.7% (18 mmol/mol) HbA1c reduction indicating better control of diabetes (p < 0.001). CONCLUSION: DSME sessions were associated with better glycemic control in patients with T2DM over 12 months. This study establishes the effectiveness of DSME sessions for both Kuwaiti nationals and expatriates, which represent a significant portion of the population in Kuwait and the Arabian Gulf region. The favorable impact of DSME suggests a promising cost-effective approach to reduce the risk of complication associationed with diabetes suitable for the unique demographic characteristics in the region.

Primary care healthcare policy implementation in the Eastern Mediterranean region; experiences of six countries: Part II.

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.Objectives: This paper describes and analyses the health systems of Algeria, Kuwait, Morocco, Saudi Arabia, Jordan and Iraq to PHC.Methods: Data were collected during a workshop at the Wonca East Mediterranean Regional Conference in 2018. Academic family physicians (FP) presented their country; using the Wonca framework of 11 PowerPoint slides, with queries of the country demographics, main health challenges, and the position of PHC in the health system.Results: The six countries had achieved a significant improvement in populations' health but currently face challenges of health financing, a small number of certified FPs, difficulties in accessing services and bureaucratic procedures. Primary concerns were the absence of a family practice model, brain drain and immigration of FPs. Countries differed in building a coherent policy.Conclusion: Priorities should be focused on: developing PHC model in Eastern Mediterranean region with advocacy for community-based PHC to policymakers; capacity building for strengthening PHC-oriented health systems with FP specialty training and restrict practising to fully trained FPs; engage communities to improve understanding of PHC; adopt quality and accreditation policies for better services; validation of the referral and follow-up process; and, develop public-private partnership mechanisms to enhance PHC for UHC.