Effects of Self-Management Support Program for Delayed Progression of Diabetic Nephropathy on Self-Management Behaviors and Clinical Outcomes in Patients with Uncontrolled Type 2 Diabetes Mellitus

Abstract

          This quasi-experimental study aimed to evaluate the effects of a self-management support program for delayed progression of diabetic nephropathy on self-management behavior and clinical outcomes in patients with uncontrolled type 2 diabetes mellitus. The sample group of 50 subjects was purposively selected and assigned to experimental group  (n = 25) and control group (n = 25) using simple random method and matched pair sample group following properties   (1) age difference does not exceed 5 years (2) hemoglobin A1c difference does not exceed 2 percent and (3) same stages of chronic kidney disease. The control group was received regular care and the intervention group was received the self-management support program, promoting management skill by self-management concept combined with 5 A’s Behavior Change Model Adapted for Self-Management Support. Data were collected from control group and experimental group at a first week and twelfth week. The instrument for data collection was a self-management behaviors questionnaire and its reliability was examined using Cronbach’s alpha coefficient (α = .74) and the instrument for collection of clinical outcomes include those for measuring fasting plasma glucose, HbA1c, blood pressure, serum creatinine and glomerular filtration rate: the tool had been validated according to hospital standards. The data were analyzed using descriptive statistics and the hypotheses were tested using Paired t-test and Independent t-test for the data with passing a preliminary agreement and using Mann-Whitney U Test and Wilcoxon Signed Ranks Test for the data with did not a preliminary agreement.

          The results revealed that the intervention program was able to increase the self-management behavior scores significantly (p < .05) and after using intervention program the clinical outcomes between control group and experimental group did not difference. Within for experimental group the clinical outcomes had significantly higher mean score than before (p < .05) except diastolic blood pressure within experimental group which did not difference. Diabetes clinic should apply the self-management support program in order to improve self-management behavior and delayed progression of diabetic nephropathy.