MON-LB001 Interactive Online Education Is Comparable to In-Person Training to Teach Insulin Adjustment Skills in a Low-resource Setting: A Pilot Study with Non-Communicable Disease Providers in Rwanda

Increased diagnosis of type 1 diabetes in sub-Saharan Africa has produced a need for quality specialty care to improve outcomes, but this specialty care is scarce. Rwanda has 42 district hospitals, each with 2 nurses in non-communicable disease (NCD) who provide diabetic care with limited glucose checks. Sustainable training is difficult due to limited in-country expertise and the cost-prohibitive nature of bringing in specialists. This study compares the efficacy of live conference-style training to online educational modules using interactive problem sets to teach NCD nurses. The ability to recommend insulin adjustments and feasibility of intervention were measured as outcomes. Rwandan district hospitals were randomized into 2 groups of 21. NCD nurses from Group 1 facilities attended a 1.5-day conference on the practical care of type 1 diabetics, with breakout sessions to practice insulin adjustments. Group 2 participants received conference materials online with interactive e-modules to practice insulin adjustments. Participants completed a 10-question assessment before and after their learning intervention and surveys to assess demographics, medical experience, practice location, and perceived efficacy of their training. Descriptive statistics (mean ± SD, counts and percentages) were used to compare group characteristics, while pre- and post-assessment increments were compared by paired t-tests and group differences by unpaired t-tests or Fisher’s exact test. The following comprise initial results with planned reassessments over 1 year. Overall, 41 nurses in Group 1 (47% male, 9.3 ±6.1 years in practice, 2.6 ± 1.6 years in the NCD role) and 35 nurses in Group 2 (47% male, 7.9 ±4.2 years in practice, 3.1 ± 0.9 years in the NCD role) were enrolled. There were no group differences in regards to gender, time in practice, or time in NCD role. 90.7% of providers described their practice as based in a ‘small town’ or ‘rural area’. Pre- and post-assessments were completed by 85% (35/41) of Group 1 and 74% (26/35) of Group 2. Both groups improved on their post-assessment with no significant difference between groups (Group 1 increment +2.0 ± 2.0 vs Group 2 +1.5 ± 3.1, p=0.24). Of 43 nurses invited to complete online education, only 35 (80%) successfully enrolled in the online course and only 26 (60%) completed the requested online activities. A large majority of participants felt confident making insulin adjustments at the conclusion of their education (Group 1=83%, Group 2=100%, p=0.17) and that the training was applicable to their practice (Group 1=92%, Group 2=100%, p=0.55). Though completion rate was low for online education, participant performance was comparable between the live and online instruction modalities. Thus, online education is a feasible option for specialty care training. Studies to reduce barriers in online education in resource-limited settings may narrow the expertise gap. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.