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Principal Investigator: Prof David Guwatudde

Project period: 1/1/2015-31/3/2019

Funder:    European Union/Karolinska Instituet

Type 2 diabetes mellitus (T2DM) and pre-diabetes are becoming a major problem in both developing and developed countries. It is projected that by 2035, cases of diabetes will have increases to 4 million from 20 million in 2013. In Uganda, a steady increase in the number of diabetes cases has been observed. In 2011, the prevalence was only 0.6% among those aged 13 years or older whereas in 2014, the national prevalence of diabetes was estimated to be 1.4% among adults aged 18 years or older. One of the main risk factors for T2DM is about 10-15%. Ore-diabetes has been estimated to be 21% in a rural Uganda. Healthcare systmes in low and middle-income countries are largely poorly equipped to tackle the T2DM epidemic and emphasize medical care rather than preventive care.

Rationale

Delaying T2DM onset and its complications through appropriate preventive strategies and improving the management of diabetes through effective control of blood glucose and early detection and management of complications is of paramount importance.

By developing and expanding the reach of the health system to the community level through proven strategies, we can reduce the burden on the formal health system, while increasing its effectiveness. That is the focus of the SMART2D project which aims at determining the effectiveness of the health facility and community interventions intended to improve prevention, management, access and adherence to T2DM care.

The SMART2D Intervention

The SMART2D study aims to empower an individual with T2DM, or an individual with pre-diabetes and their family to live a quality life with their chronic condition through supported self-management. In addition, we aim to optimize diabetes care delivery at health facilities to improve patient management.

This is done through a set of strategies that include organization of the care process (provision of basic equipment, use of standardized car guidelines, task shifting, and information systems), strengthening patient role in self-management (through motivational coaching and access to measuring devices) and strengthened environmental support (through peer groups and care companions). This is being implemented through an 18 month cluster randomized study. The study is being conducted in Iganga and Mayuge districts. We are collaborating with partners in South Africa and Sweden who are conducting similar studies in their studies.

Policy Implications

It is expected that this study will provide locally relevant evidence on how to utilize health facilities, communities and social networks to promote and enable self-management for T2DM and other non-communicable diseases. Findings from this should be important in informing the design and implementation of national and local prevention strategies aimed at improving prevention and management of T2DM and its complications through enhanced self and patient management.

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