ArticleBMJ open2021
EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND)-a feasibility study in Mozambique and Malawi.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- The application of the RE-AIM and PRISM framework to process evaluations of diabetes self-management programs: a systematic review and secondary analysis of literature.Frontiers in public health · 2025Pooled it
- Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature.American journal of health promotion : AJHP · 2024Pooled it
- Health economic evaluation of structured education programs for patients with diabetes: a systematic review.Frontiers in public health · 2024Pooled it
- The Feasibility of the Diabetes Self-Management Coaching Program in Primary Care: A Mixed-Methods Randomized Controlled Feasibility Trial.International journal of environmental research and public health · 2024Trial
- Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.BMC health services research · 2023Trial
- Type 5 diabetes mellitus: nutritional-imprinted β-cell insufficiency, diagnostic gaps, and emerging therapeutic strategies.Frontiers in endocrinology · 2026Review
- Development of a collaborative chronic care model for management of cardiometabolic disease in low- and middle-income countries.PloS one · 2026Article
- Components and Effectiveness of Self-Management Interventions Among Adults Living With Type 2 Diabetes in Low-Income Countries: A Systematic Review.Diabetes spectrum : a publication of the American Diabetes Association · 2025Article
- Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes.BMJ public health · 2025Article
- The practice, nature, and impact of nurse-led type 2 diabetic foot prevention services and educational programs in Sub-Saharan Africa: a scoping review.Frontiers in public health · 2024Article
- Implementation of non-insulin-dependent diabetes self-management education (DSME) in LMICs: a systematic review of cost, adoption, acceptability, and fidelity in resource-constrained settings.Frontiers in health services · 2023Review
- Use of the socio-ecological model to explore factors that influence the implementation of a diabetes structured education programme (EXTEND project) inLilongwe, Malawi and Maputo, Mozambique: a qualitative study.BMC public health · 2021Article
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Authors and funding
21 authors.
Funding
Abstract
backgroundGlobally, there are estimated 425 million people with type 2 diabetes (T2D) with 80% from low-middle income countries (LMIC). Diabetes self-management education (DSME) programmes are a vital and core component of the treatment pathway for T2D. Despite LMIC being disproportionally affected by T2D, there are no DSME available that meet international diabetes federation criterion.
methodsThe aims were to test the feasibility of delivering a proven effective and cost-effective approach used in a UK population in two urban settings in Malawi and Mozambique by; (1) developing a culturally, contextually and linguistically adapted DSME, the EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND) programme; (2) using a mixed-method approach to evaluate the delivery of training and the EXTEND programme to patients with T2D.
resultsTwelve healthcare professionals were trained. Ninety-eight participants received the DSME. Retention was high (100% in Mozambique and 94% in Malawi). At 6 months HbA1c (-0.9%), cholesterol (-0.3 mmol/L), blood pressure (-5.9 mm Hg systolic and -6.1 mm Hg diastolic) improved in addition to indicators of well-being (problem areas in diabetes and self-efficacy in diabetes).
conclusionIt is feasible to deliver and evaluate the effectiveness of a culturally, contextually and linguistically adapted EXTEND programme in two LMIC. The DSME was acceptable with positive biomedical and psychological outcomes but requires formal testing with cost-effectiveness. Challenges exist in scaling up such an approach in health systems that do not have resources to address the challenge of diabetes.
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