The effect of therapeutic education program on quality of life among type 2 diabetic North-African patients: a randomized controlled trial


Imen Turki
Mouna Mnif
Chekib Zedini


Introduction: Type 2 Diabetes Mellitus (T2DM) is a chronic non-communicable disease with major impact on health in general and quality of life (QoL) in particular. The ultimate goal of all health interventions is to reduce the burden of this disease.

Aim: To evaluate the effect of therapeutic education program on the QoL among patients with T2DM.

Methods: Between May 2021 and July 2022, 320 outpatients were enrolled in a randomized controlled trial in Sfax, Tunisia. The experimental group received the therapeutic education program, whereas the control group received only standard care. For data collection, the Arabic version of the Diabetes Quality of Life (DQoL-Arabic) questionnaire was used.

Results: In total, 263 patients completed the intervention, 132 in the experimental group and 131 in the control group. In terms of the main baseline characteristics, the two groups were comparable. After the intervention, there was a significant difference in all domains of QoL scores (median [interquartile]) between the experimental and control groups: satisfaction (3.14 [2.64-3.36] vs. 3.57 [3.43-3.71], p<0.001, respectively), impact (2.09 [1.91-2.36] vs. 2.45 [2.27 2.64], p<0.001, respectively) and worries (2.50 [2.25-2.75] vs. 3.00 [2.75 3.14], p<0.001, respectively). The QoL improves over time in the experimental group (3.01 [2.79-3.17] vs. 2.59 [2.21-2.80], p<0.001, respectively) and remains comparable in the control group (2.99 [2.81-3.14] vs. 3.01 [2.81-3.15], p=0.724, respectively).

Conclusions: The benefits of implementing an educational program among patients with T2DM are observed in terms of all QoL domains.


Diabetes Mellitus, Health Promotion, Healthy Lifestyle, Personal Satisfaction, Self-Care, Self-Management



  1. Maoui A, Bouzid K, Ben Abdelaziz A, Ben Abdelaziz A. Epidémiologie du diabète de type 2 au Grand Maghreb. Exemple de la Tunisie. Revue systématique de la littérature. Tunis Med 2019;97(2):286–95.
  2. Al-Matrouk J, Al-Sharbati M. Quality of life of adult patients with type 2 diabetes mellitus in Kuwait: a cross-sectional study. Med Princ Pract 2022;31(3):238–45.
  3. Gillani SW, Ansari IA, Zaghloul HA, Abdul MIM, Sulaiman SAS, Baig MR. Bridging glycated hemoglobin with quality of life and health state; a randomized case-control study among type 2 diabetes patients. Diabetol Metab Syndr 2018;10:23.
  4. El-Kebbi IM, Bidikian NH, Hneiny L, Nasrallah MP. Epidemiology of type 2 diabetes in the Middle East and North Africa: Challenges and call for action. World J Diabetes 2021;12(9):1401–25.
  5. Moradinazar M, Babakhani M, Rostami R, Shakiba M, Moradi A, Shakiba E. Epidemiological status of type 2 diabetes mellitus in the Middle East and North Africa, 1990-2019. East Mediterr Health J 2022;28(7):478–88.
  6. Świątoniowska N, Sarzyńska K, Szymańska-Chabowska A, Jankowska-Polańska B. The role of education in type 2 diabetes treatment. Diabetes Res Clin Pract 2019;151:237–46.
  7. Mustapa A, Justine M, Manaf H. Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: a scoping review. Malays Fam Physician 2022;17(3):22–32.
  8. American Diabetes Association Professional Practice Committee. 6. Glycemic targets: standards of medical care in diabetes—2022. Diabetes Care 2021;45(1 Suppl):S83–96.
  9. Baghianimoghadam MH, Afkhami N, Ardekani M, Baghianimoghadam B. Effect of education on improvement of quality of life by SF-20 in type 2 diabetic patients. Acta Med Indones 2009;41(4):175–80.
  10. Anet JD. Tunisia. In: Centre for Affordable Housing Finance, ed. 2019 Housing Finance in Africa Yearbook – 10th anniversary edition [Internet]. 10th ed. South Africa, 2019:265–8. Available from:
  11. Al-Qerem W, Al-Maayah B, Ling J. Developing and validating the Arabic version of the Diabetes Quality of Life questionnaire. East Mediterr Health J 2021;27(4):414–26.
  12. IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp; 2011.
  13. Nooseisai M, Viwattanakulvanid P, Kumar R, Viriyautsahakul N, Baloch GM, Somrongthong R. Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand. Prim Health Care Res Dev 2021;22:e46.
  14. Boels AM, Rutten G, Zuithoff N, de Wit A, Vos R. Effectiveness of diabetes self-management education via a smartphone application in insulin treated type 2 diabetes patients – design of a randomised controlled trial (‘TRIGGER study’). BMC Endocr Disord 2018;18(1):74.
  15. Castillo-Hernandez KG, Laviada-Molina H, Hernandez-Escalante VM, Molina-Segui F, Mena-Macossay L, Caballero AE. Peer support added to diabetes education improves metabolic control and quality of life in Mayan adults living with type 2 diabetes: a randomized controlled trial. Can J Diabetes 2021;45(3):206–13.
  16. Baraz S, Zarea K, Shahbazian HB. Impact of the self-care education program on quality of life in patients with type II diabetes. Diabetes Metab Syndr 2017;11:S1065–8.
  17. Mahmoud SS, Mahdy MHE, Mahfouz MS, et al. Effects of a psychoeducational program on hemoglobin A1c level and health-related quality of life in patients with type 2 diabetes mellitus, Jazan, Saudi Arabia. Biomed Res Int 2018;2018:6915467.
  18. Wichit N, Mnatzaganian G, Courtney M, Schulz P, Johnson M. Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with type 2 diabetes. Diabetes Res Clin Pract 2017;123:37–48.
  19. Jing X, Chen J, Dong Y, et al. Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis. Health Qual Life Outcomes 2018;16(1):189.
  20. Guldbrand H, Lindström T, Dizdar B, et al. Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus. Diabetes Res Clin Pract 2014;106(2):221–7.
  21. Goldenberg JZ, Day A, Brinkworth GD, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ 2021;372:m4743.
  22. Zhang F, Huang L, Peng L. The degree of influence of daily physical activity on quality of life in type 2 diabetics. Front Psychol 2020;11:1292.
  23. Soleimani Tapehsari B, Alizadeh M, Khamseh ME, Seifouri S, Nojomi M. Physical activity and quality of life in people with type 2 diabetes mellitus: a randomized controlled trial. Int J Prev Med 2020;11:9.
  24. Cai H, Li G, Zhang P, Xu D, Chen L. Effect of exercise on the quality of life in type 2 diabetes mellitus: a systematic review. Qual Life Res 2017;26(3):515–30.
  25. Gao L, Ji L, Su Q, et al. Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes mellitus: Results from the COMPASS study. Diabetes Res Clin Pract 2016;112:88–93.
  26. Young LA, Buse JB, Weaver MA, et al. Glucose self-monitoring in non–Insulin-treated patients with type 2 diabetes in primary care settings. JAMA Intern Med 2017;177(7):920–9.
  27. Lin LY, Lee BO, Wang RH. Effects of a symptom management program for patients with type 2 diabetes: implications for evidence-based practice. Worldviews Evid Based Nurs 2019;16(6):433–43.
  28. Sonal Sekhar M, Unnikrishnan MK, Vijayanarayana K, Rodrigues GS. Impact of patient-education on health related quality of life of diabetic foot ulcer patients: a randomized study. Clin Epidemiol Glob Health 2019;7(3):382–8.
  29. Damhudi D, Kertia N, Effendy C. The effect of modified diabetes self-management education and support on self-care and quality of life among patients with diabetic foot ulcers in rural area of Indonesia. Open Access Maced J Med Sci 2021;9(G):81–7.
  30. Raju BN, Mateti UV, Mohan R, et al. Educational interventions and its impact on the treatment outcomes of diabetic foot ulcer patients. J Diabetol 2022;13(1):1–7.
  31. Naous E, Boulos M, Sleilaty G, Achkar AA, Gannagé-Yared MH. Quality of life and other patient-reported outcomes in adult Lebanese patients with type 2 diabetes during COVID-19 pandemic. J Endocrinol Invest 2022;45(4):763–72.