Studying an educational intervention and its impact on health-related quality of life and fasting blood glucose levels among patients with type 2 diabetes mellitus in rural China.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Diabetes Mellitus, Type 2*/therapy ; Diabetes Mellitus, Type 2*/blood ; Diabetes Mellitus, Type 2*/psychology ; Blood Glucose*/analysis ; Patient Education as Topic*/methods ; Quality of Life*; Fasting/blood ; Humans ; China ; Male ; Female ; Middle Aged ; Rural Population ; Aged

Background: Type 2 diabetes mellitus (T2DM) remains a major public health challenge in rural China, where healthcare access and health literacy are limited. Although primary healthcare (PHC) plays a key role in chronic disease management, evidence on the long-term effects of educational interventions in rural settings is scarce. This study, part of the initiative "Studying the Vertical Integration Strategy of Chronic Disease Service Based on Multiple Incentive Mechanisms in Rural China" (2015-2017), evaluated the impact of a structured educational intervention on fasting blood glucose (FBG) trajectories and health-related quality of life (HRQoL) among rural T2DM patients.
Methods: A quasi-experimental study was conducted in two rural counties in Jiangsu Province, enrolling 784 patients (389 intervention, 395 control) from township health center registries. Over 24 months, the intervention group received bi-monthly education sessions, home visits, and enhanced provider training, while the control group received routine care. Outcomes were measured at baseline (2015) and two follow-ups (2016, 2017). FBG levels and HRQoL (assessed via EQ-5D-3 L, EQ-VAS, and Paretian Classification of Health Change [PCHC]) were analyzed using difference-in-differences (DID) models and multinomial logistic regression.
Results: After adjusted for potential confounding factors, the intervention group exhibited a slower FBG increase compared to controls (DID: -0.65, 95% CI: -1.13 to -0.17), despite an overall upward trend in both groups. HRQoL improvements were significant in the intervention group, with greater gains in mobility (84.7% vs. 86.0% reporting "no problems" in 2017, p < 0.001), pain/discomfort (62.3% vs. 55.4%, p < 0.001), and anxiety reduction (80.7% vs. 78.5%, p < 0.001). The PCHC analysis revealed intervention participants were 1.83 times more likely to improve (95% CI: 1.29-2.59) and had 83% lower risk of deterioration (OR: 0.17, 95% CI: 0.09-0.34) versus controls.
Conclusion: Structured educational interventions embedded in rural PHC systems effectively attenuated glycemic deterioration and enhanced multidimensional well-being in T2DM patients. However, continued FBG elevation signals the need for more comprehensive strategies, integrating digital tools and workforce reforms.
Trial Registration: ISRCTN13319989 (Date: 31/07/2019).
(© 2025. The Author(s).)

Declarations. Ethics approval and consent to participate: Ethical approval for this study was obtained from the Ethics Committee of Nanjing Medical University (Approval Year: 2015; Reference Number: #300). All participants received written information explaining the aim of the study, emphasizing that participation was voluntary, and that they could withdraw at any time and for any reason without any consequences. Participants in the intervention area were informed that they would receive additional diabetes-related services beyond the standard care, while those in the control areas were informed that no changes would be made to their usual diabetes services. Informed consent was obtained from all participants prior to their inclusion in the study. Data collection was conducted by a trained research team from Nanjing Medical University. To ensure participant confidentiality, all analyses were performed at the group level, and no individual-level data can be traced back to any participant. This study strictly adhered to the ethical principles outlined in the Declaration of Helsinki. All procedures prioritized participant rights, safety, and well-being, with confidentiality rigorously maintained throughout data collection and analysis. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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2022SJYB0295 Jiangsu Provincial Department of Education

Keywords: Diabetes care; Educational intervention; Health-related quality of life; Primary healthcare; Rural China

0 (Blood Glucose)

Date Created: 20250703 Date Completed: 20250703 Latest Revision: 20250705

20260130

PMC12225221

10.1186/s12913-025-13075-z

40604789