Structured Counselling Transforms Diabetes Lifestyles in Northern Nigeria Trial, but Blood Sugar Gains Remain Elusive

A randomised controlled trial conducted in Northern Nigeria has found that a carefully structured programme of lifestyle modification counselling can dramatically shift the day-to-day health behaviours of people living with Type-2 diabetes, even though the behavioural improvements did not translate into statistically significant improvements in blood sugar control over the study period. The trial, known as SLIC-T2D, was carried out by a team of physicians and researchers based largely at Aminu Kano Teaching Hospital in Kano, Nigeria, and published in BMC Endocrine Disorders. Its findings offer both encouragement and a sobering reality check for diabetes care in resource-limited settings, where the burden of the disease is rising fast and the tools available to manage it are often scarce.

Type-2 diabetes mellitus is a chronic metabolic disorder characterised by elevated blood glucose resulting from insulin resistance and progressive impairment of insulin secretion. Long-term elevation of glucose damages blood vessels and nerves, driving complications that range from kidney failure and vision loss to foot ulcers, stroke and heart disease. Optimal glycaemic control, meaning the maintenance of blood glucose within recommended targets, is therefore the central objective of diabetes management, because it minimises these complications over time. Alongside medication, adherence to a healthy lifestyle, encompassing diet, physical activity, weight management and avoidance of tobacco, is recognised as a cornerstone of diabetic care, and it is precisely this behavioural dimension that the Nigerian team set out to address.

The study was designed as a randomised controlled trial, the most rigorous experimental format for evaluating the effect of an intervention, because random allocation distributes known and unknown confounding factors evenly between groups. It was conducted among patients with Type-2 diabetes over a period of 22 weeks, running from November 2023 to April 2024. Participants were randomly assigned to either an intervention arm or a control arm using block randomisation in blocks of four, with allocation determined by a table of random numbers at a one-to-one ratio. Sixty-three participants were enrolled in each arm, giving a total of 126 patients in the trial. Block randomisation of this kind helps to keep group sizes balanced throughout the recruitment process, which is particularly useful in a clinical setting where enrolment may proceed unevenly.

Data collection relied on an adapted version of the World Health Organization STEPS questionnaire, a standardised instrument widely used in population health research to capture sociodemographic characteristics, clinical features and behavioural risk factors. The researchers administered the questionnaire both before and after the intervention, allowing each participant to serve as their own baseline comparator as well as enabling comparison between the two trial arms. To summarise lifestyle practices in a single interpretable metric, the team employed a composite Health Behaviour Score, which aggregates individual behaviours into an overall measure of how healthy a participant’s daily practices are. This composite approach is valuable because individual behaviours often move in different directions, and a summary score can capture net change more reliably than any single item alone.

The intervention itself was a programme of structured lifestyle modification counselling delivered using the 5 A’s framework, a widely adopted behavioural counselling model that guides clinicians through five sequential steps: assessing the patient’s current behaviour and readiness, advising clear and personalised behaviour change, agreeing on realistic goals collaboratively, assisting the patient with practical strategies and support, and arranging follow-up to sustain momentum. Crucially, the counselling was reinforced by five follow-up telephone reminders containing standard pre-recorded messages delivered in Hausa, the predominant language of the region, and in English. This dual-language, telephone-based reinforcement is a pragmatic adaptation to the realities of Northern Nigerian primary care, where patients may travel long distances, face competing economic demands and cannot easily attend frequent in-person follow-up sessions.

When the researchers compared the two arms after the intervention, the difference in healthy behaviour was striking. Among participants in the intervention group, 73.8 percent showed a post-intervention increase in healthy behaviour scores, compared with just 26.2 percent in the control group. This difference was highly statistically significant, with a chi-squared statistic of 29.3 and a p-value below 0.001, meaning the probability of observing such a difference by chance alone is extremely small. Importantly, the two arms had comparable baseline healthy behaviour scores before the intervention began, with a chi-squared value of 0.145 and a p-value of 0.703, which confirms that the groups started from essentially the same behavioural starting point and strengthens the argument that the counselling, rather than pre-existing differences, drove the change.

The trial also tracked two key biochemical markers of glycaemic control: fasting blood glucose, which measures circulating glucose after an overnight fast, and glycated haemoglobin, or HbA1c, which reflects average blood glucose over the preceding two to three months and is considered the gold standard for assessing long-term glycaemic control. Using the Wilcoxon signed-rank test, a non-parametric statistical method for comparing paired measurements, the team found statistically significant decreases in both markers within each arm after the study period. In the intervention arm, the decrease in median post-intervention fasting blood glucose was significant with a z-statistic of -4.124 and a p-value below 0.001, and in the control arm the decrease was also significant with a z-statistic of -3.225 and a p-value of 0.001. Similarly, post-intervention HbA1c fell significantly in both groups, with the intervention arm showing a z-statistic of -3.774 and a p-value below 0.001, and the control arm a z-statistic of -3.158 and a p-value of 0.002.

However, when the researchers used analysis of covariance, or ANCOVA, to adjust for baseline differences and isolate the specific effect of the counselling intervention on glycaemic control, the picture changed. The effect of counselling on post-intervention fasting blood glucose was not statistically significant, with an F-statistic of 0.000 and a p-value of 0.994, and the effect on post-intervention HbA1c was likewise not significant, with an F-statistic of 1.084 and a p-value of 0.300. In other words, although blood glucose measures improved over the 22 weeks in both groups, the improvement could not be attributed specifically to the counselling programme. Both arms received routine clinical care, and factors such as concurrent medication adjustments, seasonal dietary patterns, or regression to the mean may have contributed to the glucose declines observed in both groups alike.

The authors conclude that structured lifestyle modification counselling significantly improved healthy behaviour among patients with Type-2 diabetes, but produced no significant effect on glycaemic control within the trial’s timeframe. This dissociation between behaviour and biochemistry is not unusual in lifestyle intervention research. Behavioural change is the first link in a long causal chain, and measurable improvements in HbA1c often require sustained change over longer periods, greater intensity of intervention, or larger sample sizes to detect. A 22-week window may simply have been too short for newly adopted dietary and physical activity habits to exert a detectable, group-level effect on glycated haemoglobin, particularly if the magnitude of behavioural change, while statistically robust, was modest in absolute terms.

Nevertheless, the practical implications of the trial are considerable. The researchers suggest that integrating structured lifestyle counselling with telephone reminders may serve as an innovative way to promote healthy lifestyles in busy, resource-limited primary care settings. The approach requires no expensive equipment, no additional clinic visits and no specialist staff beyond trained counsellors, and the use of pre-recorded messages in the local language makes it scalable and culturally accessible. The trial was registered with the Pan African Clinical Trial Registry under number PACTR202601577207835 on 20 January 2026, and the research was fully funded by the authors themselves, with no external funding received. Ethical approval was obtained from the Health Research Ethics Committee of Aminu Kano Teaching Hospital, and all participants provided voluntary written informed consent. As diabetes prevalence continues to climb across sub-Saharan Africa, evidence that a low-cost, telephone-supported counselling model can meaningfully shift patient behaviour represents a promising foundation, and future trials with longer follow-up will be needed to determine whether these behavioural gains can ultimately be converted into the blood sugar improvements that matter most for preventing diabetic complications.

Subject of Research: Effect of structured lifestyle modification counselling on lifestyle practices and glycaemic control in Type-2 diabetes patients in Northern Nigeria

Article Title: Effect of structured lifestyle modification counselling on lifestyle practices and glycaemic control among Type-2 Diabetes patients in Northern Nigeria (SLIC-T2D trial): a randomised controlled trial

Article References: Gana, A. A., Abdulkadir, Z., Damagun, F. M., Ogunyele, T. T., Olawumi, A. L., Iroezindu, G. U., Suleiman, A. K., Kwaku, A. A., Benjamin, T. A., Chinedu, G. M., & Grema, B. A. (2026). Effect of structured lifestyle modification counselling on lifestyle practices and glycaemic control among Type-2 Diabetes patients in Northern Nigeria (SLIC-T2D trial): a randomised controlled trial. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02592-5

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02592-5

Keywords: Type-2 diabetes, lifestyle modification, counselling, randomised controlled trial, glycaemic control, HbA1c, fasting blood glucose, Nigeria, primary care, telephone reminders, Health Behaviour Score, 5 A's framework