Effectiveness of Diabetes Self – Management Education in Thais with Type 2 Diabetes
Keywords:
Cost, Cost-benefit, Effectiveness, Hemoglobin A1c, Medication utilization, Self-management education, Type 2 diabetesAbstract
Diabetes is a major health problem and economic burden around the world including Thailand. Patient self-management is an important key to help patients control their disease and prevent complications. This study aimed to evaluate a self-management education program in Thais with type 2 diabetes. A retrospective cohort study was performed in 488 people with type 2 diabetes attending the diabetes self-management education program by multidisciplinary team and 488 people who did not attend the program. Mean differences in hemoglobin A1c and diabetes medication utilization as dispensed from the hospital’s pharmacy (adjusted to define daily dose) between baseline and follow ups were computed using mixed-effect regression analyses. Cost-benefit was analyzed as a difference between the direct cost of conducting the program and the benefit. Satisfaction, diabetes knowledge and behavioral changes were collected in the intervention group.
Results revealed that during the two-year follow up, mean differences in hemoglobin A1c reduction were similar between the two groups. However, the intervention group had a statistically significant reduction in diabetes medication utilization, compared to non-intervention group, especially during the second year. Cost-benefit analysis demonstrated that the diabetes self-management education program provided a cost saving. The intervention group increased their diabetes knowledge, changed diabetes self-care behaviors, and had high satisfaction with the program. Thus, this Diabetes Self-Management Education Program in Type 2 Diabetes is effective and associated with cost savings. Self-management program should be integrated as a routine nursing practice to improve outcomes in people with type 2 diabetes.
References
2. American Diabetes Association. Standards of medical care in diabetes-2017. Diabetes Care. 2017;40:S1-S142.
3. World health organization. Global report on diabetes 2016. [cited 2017 March13]. Available form https://apps.who. int/iris/bitstream/10665/204871/1/9789241565257
4. Centers for disease control and prevention. diabetes 2014 report card. .[cited 2017 April 4]. Available form https:// www.cdc.gov/diabetes/pdfs/library/diabetesreport card2014.pdf
5. Aekplakorn W, Chariyalertsak S, Kessomboon P, Sangthong R, Inthawong R, Putwatana P, et al. Prevalence and management of diabetes and metabolic risk factors in Thai adults: the Thai National Health Examination Survey IV, 2009. Diabetes Care. 2011;34(9):1980-5.
6. Aekplakorn W. Thai national health examination survey V. Institute. Nonthaburi: Health Systems Research; 2016
7. Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes research and clinical practice. 2010; 87(3):293-301.
8. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352(9131):837-53.
9. American Association of Diabetes Educators. The art and science of diabetes self-management education desk reference. 2nd ed. Chicago: American Association of Diabetes Educators; 2011.
10. Chrvala CA, Sherr D, Lipman RD. Diabetes selfmanagement education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926-43.
11. Lian JX, McGhee SM, Chau J, Wong CKH, Lam CLK, Wong WCW. Systematic review on the cost-effectiveness of self-management education programme for type 2 diabetes mellitus. Diabetes Res Clin Pract. 2017;127:21-34.
12. Hendrie D, Miller TR, Woodman RJ, Hoti K, Hughes J. Cost-effectiveness of reducing glycaemic episodes through community pharmacy management of patients with type 2 diabetes mellitus. The Journal of Primary Prevention. 2014;35(6):439-49.
13. Prezio EA, Pagán JA, Shuval K, Culica D. The community diabetes education (CoDE) program: cost-effectiveness and health outcomes. Am J Prev Med. 2014;47(6):771-9.
14. Reutrakul S, Deerochanawong C. Diabetes in Thailand: Status and Policy. Curr Diab Rep. 2016;16(3):28.
15. Jaipakdee J, Jiamjarasrangsi W, Lohsoonthorn V, Lertmaharit S. Effectiveness of a self‐management support program for Thais with type 2 diabetes: Evaluation according to the REAIM framework. Nurs Health Sci. 2015;17(3):362-9.
16. Wattana C, Srisuphan W, Pothiban L, Upchurch SL. Effects of a diabetes self‐management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes. Nurs Health Sci. 2007;9(2):135-41.
17. Saengtipbovorn S, Taneepanichskul S. Effectiveness of lifestyle change plus dental care (LCDC) program on improving glycemic and periodontal status in the elderly with type 2 diabetes. BMC Oral Health. 2014;14(1):72.
18. Wichit N, Mnatzaganian G, Courtney M, Schulz P, Johnson M. Randomized controlled trial of a family-oriented selfmanagement 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. Ounnapiruk L, Wirojratana V, Meehatchai N, Turale S. Effectiveness of a behavior modification program for older people with uncontrolled type 2 diabetes. Nurs Health Sci. 2014;16(2):216-23.
20. Drummond MF SM, Claxton K, Stoddart GL, and Torrance GW. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2015.
21. Norwegian Institute of Public Health .Guidelines for ATC classification and DDD assignment 2017. [cited 2017 May 13]. Available from https://www.whocc.no/ filearchive/publications_guidelines_web.pdf.
22. Bank of Thailand. Rates exchange of commercial banks [cited 2017 May 13]. Available from https://www.bot. or.th/english/_layouts/application/exchangerate/ exchangerate.aspx
23. Williams IC, Utz SW, Hinton I, Yan G, Jones R, Reid K. Enhancing diabetes self-care among rural African Americans with diabetes: results of a two-year culturally tailored intervention. The Diabetes Educator. 2014;40(2):231-9.
24. Piatt GA, Anderson RM, Brooks MM, Songer T, Siminerio LM, Korytkowski MM, et al. 3-Year follow-up of clinical and behavioral improvements following a multifaceted diabetes care intervention. The Diabetes Educator. 2010;36(2):301-9.
25. Tang TS, Funnell M, Sinco B, Piatt G, Palmisano G, Spencer MS, et al. Comparative effectiveness of peer leaders and community health workers in diabetes selfmanagement support: results of a randomized controlled trial. Diabetes Care. 2014;37(6):1525-34.
26. Murray CM, Shah BR. Diabetes self-management education improves medication utilization and retinopathy screening in the elderly. Primary Care Diabetes. 2016; 10(3):179-85.
27. Riewpaiboon A, Pornlertwadee P, Pongsawat K. Diabetes cost model of a hospital in Thailand. Value Health. 2007;10(4):223-30.
Downloads
Published
How to Cite
Issue
Section
License
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
