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Diabetes (NEEDS) Project

Introduction to Diabetes: Why is our work important?

Around 436 million adults across the world live with diabetes, and prevalence continues to rise. Figures are rapidly rising in low- and middle-income countries, where approximately 80% of adults with diabetes are located. In many low-income countries, including those in Sub-Saharan Africa, diabetes is often poorly managed. As many as 89% of diabetes patients in Uganda are undiagnosed or are not on medication for diabetes management. Many patients go on to develop complications such as diabetic foot ulcers, leading to higher rates of lower limb amputations, and increased mortality. However, with proper care and management, type-2 diabetes can be managed and deterioration of the condition, including the development of diabetic ulcers, can be prevented.

We have begun plans to expand our Diabetic Foot Clinic & Programme to Zanzibar. Please click here if you wish to read more, and would like to support the project by donating!

Overview of the Research and Implementation

K4C’s diabetes project was created to develop a nurse-led self-management educational programme and diabetic foot clinic for adults with type-2 diabetes in Uganda and Tanzania, aiming to reduce the development of diabetic foot complications (leading to amputations) in these settings. A lack of services and research informed initiatives to reduce the significant diabetes health related complications that are impacting Ugandan healthcare resources, patients and communities. 

Work began in March 2023, funded by a grant of £58,896 from the Burdett Trust for Nursing’s “Type 2 Diabetes Prevention programme”. Operationalised by a research team comprised of two nurse researchers, a social scientist, a biomechanics scientist, the work is being conducted in collaboration with the University of Salford, where the research will also contribute towards Rincy Sajith’s PhD by published works. The team identified a goal was to address the issue of diabetes complications by introducing 'frugal innovations' to demonstrably improve morbidity, reduce mortality, in-patient stays and associated health systems costs. 

Taking a complex interventions approach (MRC, 2021), the team wanted to highlight the dynamic relationships between the intervention (DSME and foot clinic) and contexts (Ugandan Healthcare system and the communities it serves) supporting evaluation and creating opportunities for further knowledge translation to support policy transfer to other contexts. The project would focus on task shifting of roles as in LMICs nurses (mainly women) are the most numerous and absenteeism amongst doctors results in both an explicit task-shifting agenda but also task-shifting by default (Tweheyo, 2018). The team aimed to create a model for nurse leadership in the multi-disciplinary management of diabetic foot complications. Ethical approval was sought from the University of Salford and Mbarara University of Science and Technology.

A multi-method approach combined analysis of 1). facility-based data to characterise patient populations, 2). a scoping review of the literature to establish the components of successful nurse-led DSMEs (Sajiith et al., 2024), and 3). a ‘kick off event’ with stakeholders from the Ministry of Health, service users, clinicians and healthcare managers. This was to coproduce a nurse led, culturally congruent, frugal, and sustainable education intervention and diabetic foot screening service.

Training on diabetes mellitus, diabetes management, diabetic foot and foot scanning was provided as part of a 5-day workshop in FPRRH, involving colleagues from the UK, Zanzibar, and Kasangati Health Centre in Kampala, as well as expert users who discussed their lived experiences of diabetes. A DSME programme called NEEDS (Nutrition, Education, Exercise, Drugs and Self-management) was coproduced as an intervention programme. Three sessions were designed for the NEEDS programme, advising patients on what diabetes is, the importance of diet and exercise, types of diabetes medication and how to take them, and proper eye, dental and foot care for diabetic patients.

After each cycle of delivery, a period of reflexivity was built into the process to allow local staff time to consider ‘The What, So What and Now What' (Driscoll, 2007). Changes were made to deliver the programme in the local language (Roturo) only, and sessions became more interactive, including the use of a Fitness Instructor and Nutritionist. Posters and leaflets were created to meet the health literacy needs of the participants. 34 adults completed the DSME and attended the DFU prevention clinic.
A mixed-method evaluation ran alongside the DSME programme.
The findings showed statistically and clinically significant improvements in HbA1c with a reduction for 72% of participants (Mean -1.04±2.05, t(32)=2.901, p=0.003), for 48% of participants HbA1c was reduced to below 7% representing change equivalent to efficacy seen in drug trials. Participants also showed an increase in self-management activities. The participants reported how they had become advocates and champions of a healthy lifestyle to family, friends and work colleagues. Many reported the previously held view of diabetes being a death sentence had been lifted.

Alongside project funding, a donation of £1500 raised by K4C students on elective placement enabled us to construct a diabetic foot clinic at Fort Portal Regional Referral Hospital (FPRRH). A Diaped Flux-200 Doppler and monofilaments were purchased, and nurses trained in their use, to diagnose patients with potential diabetic foot pre-ulceration.

A Voxel Care 3D Foot Scanning System was also purchased (co-funded by the University of Salford) for use in the new foot clinic. Orthopaedic technicians were trained in the use of the scanner and its software to create bespoke insoles for patients identified as medium or high risk of diabetic foot ulcers in outpatient clinic. Insoles help to offload areas of pressure on the foot, protecting it from calluses and ulcer development.

Project Impact

Impact of the NEEDS project includes:

  • Patient reports of 'a death sentence' being lifted
  • Two publications (a scoping review and chapter on the impact of long term conditions on amputation in a monograph on Rehabilitation Services in Uganda).
  • A Palgrave Pivot monograph proposal dedicated to the diabetes work.
  • A Burdett Trust Scholarship to a Ugandan Nurse who led the project locally to attend and speak at a UK Nursing conference

Project Awards

This year in 2025, the team were awarded Highly Commended from the Diabetes Nursing Awards 2025 for
  • Innovation -celebrating nurses whose ingenuity is helping to transform diabetes care and;
  • Research Project of the Year - which honours an outstanding initiative that advances the field of diabetes nursing through rigorous inquiry.
The team were also awarded the University of Salford Research and Knowledge Exchange Award 2025 in the category Making a Difference Through Partnerships and Collaboration with Key Stakeholders​: Enabling Healthier Living. It was granted by the judges that this excellent research is already delivering impact and has been recognised for innovation. Global reach is well aligned to this theme and the University’s focus on social justice​.

Fundraiser

As mentioned above, K4C is expanding its Diabetes Foot Clinic programme to Zanzibar, to Kiddongo Chekundu Hospital. Please take a moment to read the KindLink fundraiser and proposal we have set up to support the project. Alternatively, if you wish to donate directly, please click here. Any support you can offer is greatly appreciated.