Effect of Structured Caregiver Nutrition Education on Management of Pediatric Type 1 Diabetes in Uganda: A Cluster Randomized Trial
Bari, Ndahura Nicholas
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Nutrition education is a vital component in the successful management of diabetes among pediatric type 1 diabetes mellitus (T1DM) patients. However, in Uganda, no published study has been done to find out if nutrition education affects the nutrition knowledge of caregivers and the glycaemic and dietary outcomes of their children.This study, therefore, evaluated the effect of the provision of a structured nutrition education course to caregivers of children and adolescents with T1DM on their level of type 1 diabetes nutrition knowledge and their children’s glycaemic control, dietary intake and diversity (DDS) in Uganda. The study was a cluster-randomised controlled trial in which study participants were randomly assigned to two groups; a control group and an intervention group at a ratio of 1:1. The total sample size was 100 caregiver-child dyads. Data was collected at baseline and 3 months post-intervention. The participants in the control group continued to receive routine medical care, while those in the intervention group received routine medical care and attended a structured group nutrition education course. The intervention lasted 12 weeks, it consisted of eight face-to-face sessions lasting 45 minutes each. The primary outcome was glycated haemoglobin (HbA1c) and the secondary outcomes (caregivers’ level of nutrition knowledge, children’s DDS and mean adequacy ratio (MAR). Data was collected using researcher-administered questionnaires. The data was analysed using SPSSVersion 26. Descriptive statistics such as frequencies, percentages, mean, standard deviation and medianwere used to describe the demographic, socioeconomic, diabetes-related characteristics, nutrient and dietary adequacy from the 24-hour recall. Independent samples t-test, Mann–Whitney U-test, analysis of variance (ANOVA) and Kruskal-Wallis Htest were used to determine the differences in continuous variables between the study groups. A Chi-square test was used to test for associations among categorized variables between the study groups.Spearman’s rank correlation coefficient was used to test for an association between the caregiver’s T1DM nutrition knowledge and dietary intake indices. The baseline findings revealed that 87.6%of the caregivers had low T1DM nutrition knowledge and this was significantly different across the levels of education (Kruskal-Wallis Htest: p = 0.007). Most type 1 diabetic children and adolescents had a mean DDS of 5.5 with adequate carbohydrate and protein but were found to be at risk of essential fatty acid and micronutrient deficiencies. The children’s mean HbA1c, DDS and MAR after the intervention were HbA1c (intervention: 10.87 versus control: 10.86; p= 0.347), (intervention: 5.93 versus control: 5.26; p=0.006) and (intervention: 0.81 versus control: 0.77; p = 0.021) respectively. The intervention group had a higher mean type 1 diabetes nutrition knowledge score (45.14%) compared to the control group (33.73%). There was no significant difference in the children’s HbAlc levels following their caregiver’s participation in the structurednutrition education course (Wilcoxon signed-rank test: p = 0.748). However, there was a 0.7 % decrease in the children’s HbAlc levels in the intervention group 3 months after the intervention compared to a 0.1 increase in the control group. A significant positive correlation between the caregiver’s nutrition knowledge scores and nutrient adequacy ratios (NARs) of vitamin B6, biotin, folic acid, and iron were observed (Spearman’s rank correlation: p< 0.05). Based on the gaps in the existing nutrition education module, a nutrition education guide for caregivers of children with T1DM in Uganda was developed and used during the intervention. This study concluded that structured nutrition education for caregivers of paediatric T1D patients can improve their nutrition knowledge and their children’s overall dietary adequacy. Therefore, the study recommends the developed contextualized guide should be used to conduct nutrition education sessions with caregivers of children with T1DM.