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    Study protocol for the SMART2D adaptive implementation trial: a cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden

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    Date
    2018
    Author
    Guwatudde, David
    Absetz, Pilvikki
    Delobelle, Peter
    Östenson, Claes-Göran
    Olmen Van, Josefien
    Molsted Alvesson, Helle
    Mayega, Roy William
    Ekirapa Kiracho, Elizabeth
    Kiguli, Juliet
    Sundberg, Carl Johan
    Sanders, David
    Tomson, Göran
    Puoane, Thandi
    Peterson, Stefan
    Daivadanam, Meena
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    Abstract
    Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes. Methods and analysis An adaptive implementation cluster randomised trial is being implemented in two rural districts in Uganda with three clusters per study arm, in an urban township in South Africa with one cluster per study arm, and in socially disadvantaged suburbs in Stockholm, Sweden with one cluster per study arm. Clusters are communities within the catchment areas of participating primary healthcare facilities. There are two study arms comprising a facility plus community interventions arm and a facility-only interventions arm. Uganda has a third arm comprising usual care. Intervention strategies focus on organisation of care, linkage between health facility and the community, and strengthening patient role in selfmanagement, community mobilisation and a supportive environment. Among T2D participants, the primary outcome is controlled plasma glucose; whereas among prediabetes participants the primary outcome is reduction in plasma glucose.
    URI
    https://nru.uncst.go.ug/handle/123456789/3035
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    • Medical and Health Sciences [3670]

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