Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon

Kengne, Andre Pascal; Fezeu, Leopold; Sobngwi, Eugene; Awah, Paschal Kum; Aspray, Terence J.; Unwin, Nigel C.; Mbanya, Jean-Claude

doi:10.1016/j.pcd.2009.08.005

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Volume 3, Issue 3 , Pages 181-188, August 2009

Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon

Andre Pascal Kengne
- The George Institute for International Health, The University of Sydney, Australia
- The Health of Population in Transition (HoPiT) research group, Yaounde, Cameroon
- Corresponding author at: The George Institute for International Health, PO Box M201, Sydney, Australia. Tel.: +61 299934597; fax: +61 299934502.
Leopold Fezeu
- The Health of Population in Transition (HoPiT) research group, Yaounde, Cameroon
- Inserm U780-IFR69, Villejuif, France
Eugene Sobngwi
- The Health of Population in Transition (HoPiT) research group, Yaounde, Cameroon
- Department of Internal Medicine, Yaounde Central Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
Paschal Kum Awah
- The Health of Population in Transition (HoPiT) research group, Yaounde, Cameroon
- Department of Anthropology, University of Yaounde I, Cameroon
Terence J. Aspray
- Sunderland Royal Hospital, Sunderland, United Kingdom
Nigel C. Unwin
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, United Kingdom
Jean-Claude Mbanya
- The Health of Population in Transition (HoPiT) research group, Yaounde, Cameroon
- Department of Internal Medicine, Yaounde Central Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon

Received 10 February 2009; received in revised form 9 August 2009; accepted 12 August 2009. published online 14 September 2009.

Abstract

Aims

To implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon.

Methods

We set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits.

Results

The total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6mmol/L (95% CI: 0.8–2.3; p≤0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight.