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Hurst C, Rakkapao N, Malacova E, Mongkolsomlit S, Pongsachareonnont P, Rangsin R, Promsiripaiboon Y, Hartel G. Psychometric properties of the general self-efficacy scale among Thais with type 2 diabetes: a multicenter study. PeerJ 2022; 10:e13398. [PMID: 35646480 PMCID: PMC9135036 DOI: 10.7717/peerj.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/17/2022] [Indexed: 01/14/2023] Open
Abstract
Background Type 2 diabetes (T2D) is one of the most common chronic diseases in the world. In recent decades the prevalence of this disease has increased alarmingly in lower to middle income countries, where their resource-limited health care systems have struggled to meet this increased burden. Improving patient self-care by improving diabetes knowledge and diabetes management self-efficacy represents a feasible way of ameliorating the impact of T2D on the patient, and the health care system. Unfortunately, the relationships between self-efficacy, diabetes self-management, and thereafter, patient outcomes, are still far from well understood. Although a domain-specific measure of diabetes management self-efficacy, the Diabetes Management Self-Efficacy Scale (DMSES), has been validated in the Thai T2D population, more general measures of self-efficacy, such as the General Self-Efficacy scale (GSE) have not been validated in this population. In this paper we translate and examine the psychometric properties of the GSE in Thais living with T2D. Methods In this nation-wide study we examined the psychometric properties of the GSE in 749 Thais diagnosed with T2D within the last five years, and evaluated its relationship with the DMSES along with other patient characteristics. Reliability of GSE was assessed using Cronbach's alpha, and the construct validity was examined using confirmatory factor analysis, along with GSE's convergence and discrimination from DMSES. Results The Thai version of the GSE was shown to have good psychometric properties in Thais living with T2D. Cronbach's alpha was shown to be 0.87 (95% CI [0.86, 0.88]). We also demonstrated the structural validity of the GSE (Tucker-Lewis Index = 0.994, Cumulative Fit Index = 0.995, Adjusted Goodness of Fit Index = 0.998, Root Mean Square Error of Approximations = 0.025, 95% CI [0.06-0.039]), and that this instrument has a similar structure in Thais as in other populations. GSE was also shown to have some overlap with the DMSES with correlations among GSE and the DMSES domains ranging from 0.18 to 0.26, but also the GSE has substantial discrimination from DMSES (Disattenuated correlation coefficient = 0.283, 95% CI [0.214-0.352], p < 0.001). This suggests that while general and diabetes management self-efficacy are somewhat associated, there are aspects of diabetes management self-efficacy not captured by the more stable general self-efficacy. Conclusions We demonstrate that the Thai GSE is a reliable and valid measure. We believe the GSE may represent a useful tool to examine the efficacy of proposed and existing diabetes self-management, and management self-efficacy interventions.
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Affiliation(s)
- Cameron Hurst
- Biostatistics Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Public Health, Thammasat University, Rangsit, Prathumthani, Thailand
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Queensland, Australia
| | - Nitchamon Rakkapao
- Faculty of Public Health, Thammasat University, Rangsit, Prathumthani, Thailand
| | - Eva Malacova
- Biostatistics Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | | | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Din Daeng, Bangkok, Thailand
| | - Yindee Promsiripaiboon
- Department of Public Health, Surat Thani Rajabhat University, Mueng, Surat Thani, Thailand
| | - Gunter Hartel
- Biostatistics Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand. Prim Health Care Res Dev 2021; 22:e46. [PMID: 34521493 PMCID: PMC8444461 DOI: 10.1017/s1463423621000505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: The aim of this study is to assess the effect of diabetes self-management education (DSME) on lowering blood glucose level, stress, and quality of life (QoL) among female patients with type 2 diabetes mellitus (T2DM) in Thailand. Background: The burden of noncommunicable diseases has increased globally, and it has negatively affected the QoL of diabetic patients. Methods: A quasi-experimental study was conducted by including 77 T2DM patients selected from 2 public health centers in Thailand. The respondents were randomly selected 38 in control group and 39 in intervention group. Pretested, piloted, and validated tool were used during this study. Knowledge on blood glucose level, stress, and QoL was measured at baseline and then compared to end line after 3 months of the intervention. The effects of intervention were estimated by regression coefficient of intervention on blood glucose level and QoL. The study was ethically approved by the Chulalongkorn University, Thailand. Findings: Baseline characteristics of both the groups were similar before the start of the intervention and there were no significant differences observed in age, education, blood sugar monitoring behavior, medical checkup, knowledge, self-care, stress, and hemoglobin HbA1c (>0.05). However, blood HbA1c, stress level, and QoL among the T2DM patients had significant changes (<0.05) after the intervention. The control group was remained same and there was no statistically significant difference reported (>0.05). Conclusions: The study concluded that the designed intervention of DSME has proved effective in lowering the blood sugar level, HbA1c level, stress level, and improved QoL among T2DM patients during this limited period of time. Hence, policy-makers can replicate this intervention for diabetic patients in a similar context.
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Das B, Sheikh A, Ahmed B, Islam N. Clinical outcomes of Sodium-glucose cotransporter-2 inhibitors in patients with Type 2 Diabetes Mellitus: An observational study from Pakistan. Pak J Med Sci 2021; 37:1342-1346. [PMID: 34475909 PMCID: PMC8377933 DOI: 10.12669/pjms.37.5.3901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/04/2020] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the efficacy and safety of Sodium-glucose cotransporter-2 inhibitors (SGLT2i) use in the Pakistani population. Methods: Retrospective review of initial 100 patients who were prescribed with any agent of the SGLT2i group from July 1, 2018, to January 2019 at Aga Khan University Hospital, Karachi. SGLT2i was offered to patients of above 18 years of age with inadequate glycemic control on existing antidiabetic agents. Changes in HbA1c, the Body Mass Index (BMI), serum creatinine, any decrease in the requirement of insulin and sulphonylurea dose along with any side effects reported by the patients on follow-up visits. Results: Most study participants were females (56%) with the mean age of 52±10 years. Substantial changes were observed in the HbA1c (7.5±1.1%, 7.9±1.2% from 8.7±1.5%, p < 0.01), BMI (31.4±5.8, 31.8±5.8 from 32.4±5.9kg/m2, p < 0.01) and in creatinine (0.71±0.1, 0.75±0.1 from 0.79±0.1 mg/dl, p < 0.01) at three and six months of follow up visits. The reduction in insulin and sulphonylurea doses was also significant. Adverse drug events that led to drug discontinuation in 14 individuals were, Urinary tract infection (UTI) (seven patients), Genital infection (three patients), nausea +UTI, abdominal pain +UTI, mild Diabetic Ketoacidosis, and polyuria (one patient each). None reported Fournier’s gangrene, limb amputation, or fracture. Conclusion: SGLT2i significantly improved glycemic control, BMI, and serum creatinine in the Pakistani population with a very low number of observed adverse events.
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Affiliation(s)
- Bhagwan Das
- Bhagwan Das, FCPS. Department of Medicine, Section of Endocrinology, Aga Khan University, Karachi, Pakistan
| | - Aisha Sheikh
- Aisha Sheikh, FCPS. Department of Medicine, Section of Endocrinology, Aga Khan University, Karachi, Pakistan
| | - Bilal Ahmed
- Bilal Ahmed, PhD. Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Najmul Islam
- Najmul Islam, FRCP. Department of Medicine, Section of Endocrinology, Aga Khan University, Karachi, Pakistan
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Hurst CP, Rakkapao N, Hay K. Impact of diabetes self-management, diabetes management self-efficacy and diabetes knowledge on glycemic control in people with Type 2 Diabetes (T2D): A multi-center study in Thailand. PLoS One 2021; 15:e0244692. [PMID: 33382799 PMCID: PMC7774854 DOI: 10.1371/journal.pone.0244692] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
We investigate the relationship of diabetes knowledge, diabetes management self-efficacy and diabetes self-management with blood glucose control among people with Thai type 2 diabetes mellitus (T2D). Seven hundred outpatients from diabetes clinics from large university and small community hospitals in two provinces of Thailand (Khon Kaen and Bangkok) were interviewed to evaluate their diabetes knowledge (DK), diabetes management self-efficacy (DMSE) and diabetes self-management (DSM). In addition, patient medical records were accessed to obtain other patient characteristics including patients’ HbA1c levels. Bivariate and multivariable logistic regression modelling was conducted and unadjusted and adjusted odds ratios obtained, respectively. Over half (52.4%) of the patients in our sample failed to control their blood glucose (HbA1c > 7%). All three psychometric measures (DK, DMSE and DSM) were identified as associated with blood glucose control in the bivariate analysis (ORDK(unadj) = 0.89, 95%CI: 0.82, 0.96; ORDSM(unadj) = 1.64, 95%CI: 1.46, 1.82; ORDMSE(unadj) = 2.84; 95%CI: 2.43, 3.32). However, after mutual adjustment and adjustment for other patient characteristics, of the three psychometric measures, only diabetes management self-efficacy remained associated with blood glucose control (ORDMSE(adj) = 2.67; 95%CI: 2.20, 3.25). Diabetes management self-efficacy is shown to be strongly associated with blood glucose control in the Thai Type 2 diabetes population. Current early diabetes interventions in Thailand tend to focus on disease knowledge. A stronger emphasis on enhancing patients’ disease management self-efficacy in these interventions is likely to lead to substantial improvement in both diabetes self-management and blood glucose control, thereafter reducing the risk, or prolonging the development, of chronic diabetes complications.
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Affiliation(s)
- Cameron P. Hurst
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Public Health, Thammasat University, Muang, Lampang, Thailand
| | - Nitchamon Rakkapao
- Faculty of Public Health, Thammasat University, Muang, Lampang, Thailand
- * E-mail:
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Sieng S, Hurst C. A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels. BMC Health Serv Res 2017; 17:533. [PMID: 28784176 PMCID: PMC5545871 DOI: 10.1186/s12913-017-2486-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compares a combination of processes of care and clinical targets among patients with type 2 diabetes mellitus (T2DM) between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how differences between these two types of clinics differ with hospital type (community, provincial and regional). METHODS Type 2 diabetes mellitus patient medical records were collected from 595 hospitals (499 community, 70 provincial, 26 regional) in Thailand between April 1 to June 30, 2012 resulting in a cross-sectional sample of 26,860 patients. Generalized linear mixed modeling was conducted to examine associations between clinic type and quality of care. The outcome variables of interest were split into clinical targets and process of care. A subsequent subgroup analysis was conducted to examine if the nature of clinical target and process of care differences between GMCs and SDCs varied with hospital type (regional, provincial, community). RESULTS Regardless of the types of hospitals (regional, provincial, or community) patients attending SDCs were considerably more likely to have eye and foot exam. In terms of larger hospitals (regional and provincial) patients attending SDCs were more likely to achieve HbA1c exam, All FACE exam, BP target, and the Num7Q. Interestingly, SDCs performed better than GMCs at only provincial hospitals for LDL-C target and the All7Q. Finally, patients with T2DM who attended community hospital-GMCs had a better chance of achieving the blood pressure target than patients who attended community hospital-SDCs. CONCLUSIONS Specialized diabetes clinics outperform general medical clinics for both regional and provincial hospitals for all quality of care indicators and the number of quality of care indicators achieved was never lower. However, this better performance of SDC was not observed in community hospital. Indeed, GMCs outperformed SDCs for some quality of care indicators in the community level setting.
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Affiliation(s)
- Sokha Sieng
- Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand. .,School Health Department, Ministry of Education, Youth and Sport, Phnom Penh, Cambodia. .,Office of Dean for Undergraduate Studies Division, University of Cambodia, Phnom Penh, Cambodia.
| | - Cameron Hurst
- Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand. .,Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Sonthon P, Promthet S, Changsirikulchai S, Rangsin R, Thinkhamrop B, Rattanamongkolgul S, Hurst CP. The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study. PLoS One 2017; 12:e0180977. [PMID: 28753611 PMCID: PMC5533425 DOI: 10.1371/journal.pone.0180977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/24/2017] [Indexed: 01/29/2023] Open
Abstract
Objective The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients. Methods This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011–2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression. Results After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (≤7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59–0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sensitizer were also strongly associated with CKD stage progression. Conclusions This cohort study demonstrates the achievement of the HbA1c clinical target (≤7%) is the only QoC indicator protective against progression of CKD stage. Neither of the other clinical targets (BP and LDL-C) nor any process of care targets could be shown to be associated with CKD stage progression. Therefore, close monitoring of blood sugar control is important to slow CKD progression, but long-term prospective cohorts are needed to gain better insights into the impact of QoC indicators on CKD progression.
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Affiliation(s)
- Paithoon Sonthon
- Doctor of Public Health Program, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
- Phetchabun Provincial Public Health Office, Ministry of Public Health, Phetchabun, Thailand
| | | | | | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | | | - Cameron P. Hurst
- Center of Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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Thewjitcharoen Y, Yenseung N, Malidaeng A, Nakasatien S, Chotwanvirat P, Krittiyawong S, Wanothayaroj E, Himathongkam T. Effectiveness of long-term treatment with SGLT2 inhibitors: real-world evidence from a specialized diabetes center. Diabetol Metab Syndr 2017; 9:96. [PMID: 29213337 PMCID: PMC5709980 DOI: 10.1186/s13098-017-0297-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/24/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes is a progressive disease needing multiple drugs for achieving and maintaining good glycemic control. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) is a novel class of anti-diabetic agent which offers several beneficial effects. However, the long-term effectiveness in clinical practice and safety data of SGLT2 inhibitors is limited, especially in Asian patients. To better understand the effectiveness of SGLT2i in clinical practice, we conducted a retrospective evaluation of patients with diabetes on SGLT2i. METHODS This retrospective observational study uses data of patients with diabetes who had been prescribed SGLT2i and continued to use at least 6 months at Theptarin Hospital, Bangkok. The characteristics of patients, changes in glycemic control and body weight at 3, 6, 12, 18, 24 months and the last follow-up were evaluated. RESULTS A total of 189 patients with diabetes (females 50.3%, mean age 59.9 ± 12.3 years, T2DM 97.3%, duration of diabetes 16.3 ± 9.2 years, baseline BMI 29.9 ± 6.1 kg/m2, baseline HbA1c 8.8 ± 1.6%) were prescribed SGLT2i during the study period. At the time of first SGLT2i prescription, 80.4% used three or more other anti-diabetic agents concomitantly and 34.6% used insulin concomitantly. 151 patients who continue to use at least 6 months were included in analysis. At the last follow-up (median time 16 months), overall median HbA1c reduction and weight reduction were 1.0% and 1.5 kg, respectively. While glycemic control could maintain up to 18 months, weight loss gradually rebounded after the first 6 months and then backed to baseline body weight at 18 months (78.2 ± 18.0 kg vs. 78.0 ± 17.8, p value = 0.324). The incidence of adverse drug reactions of special interest (polyuria, volume depletion-related events, urinary tract infection, genital infection, and hypoglycemia) was 2.1, 1.6, 2.1, 2.6, and 7.9%, respectively. DISCUSSION This real-world study confirmed long-term durability of glycemic control with SGLT2i in not only monotherapy, but also add-on studies with other oral anti-diabetic drugs and/or insulin treatment. However, weight loss became evident early after 6 weeks then reached slightly rebounds after 24 weeks until the end of follow-up. Further studies should be done towards a better understanding of treatment with SGLT2i in routine clinical practice.
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Affiliation(s)
| | - Nalin Yenseung
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
| | - Areeya Malidaeng
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
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Rapoport M, Harel N, Shasha Y, Barkan R, Kitaee E, Buchs A, Izhakian S, Aviel-Gadot E. Achievement of partial combined control of major diabetes targets in primary care correlates with development of chronic complications in T2DM patients--A real life data. Prim Care Diabetes 2015; 9:412-417. [PMID: 26088066 DOI: 10.1016/j.pcd.2015.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 12/01/2022]
Abstract
AIMS Strict long term glucose, cholesterol and blood pressure control is advocated in type 2 Diabetes Mellitus (T2DM) patients. It is not known whether combined partial goals' achievement affects development of chronic complications. METHODS We evaluated the relative ability or failure of 5369 T2DM ambulatory patients to achieve and maintain control of blood pressure, glycaemia and cholesterol for 3 consecutive years. Correlation between the extent of combined goal achievement, and development of chronic complications was determined. RESULTS Only 9 patients (0.17%) fully achieved and none completely failed to achieve all strict goals. Therefore, patients were characterized as either partial achievers (PA) (n=699) or partial non achievers (PNA) (n=322). As compared to PA patients, PNA patients were significantly younger, single, and demonstrated a higher female and Arab ethnicity dominance. PNA patients had higher BMI, received more insulin treatment and consumed more hospital services. The incidence of microvascular complications during 3 years was significantly increased in PNA patients. CONCLUSIONS A negligible number of primary care patients completely and persistently achieve or fail to achieve combined control of major diabetes targets. Partial achievement of these targets correlates with specific patients' characteristics and incidence of chronic micro-vascular complications.
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Affiliation(s)
- Micha Rapoport
- Division of Internal Medicine and Diabetes Service Assaf Harofeh Medical Center affiliated to Tel Aviv University, Zerifin, Israel.
| | - Nissim Harel
- The Sami Shamoon College of Engineering, Ashdod, Israel
| | - Ygal Shasha
- Department of Family Medicine Leumit Health Services affiliated to Tel-Aviv University, Tel-Aviv, Israel
| | - Refael Barkan
- College of Management Academic Studies, Rishon-Lezion, Israel
| | - Eliezer Kitaee
- Department of Family Medicine Leumit Health Services affiliated to Tel-Aviv University, Tel-Aviv, Israel
| | - Andreas Buchs
- Division of Internal Medicine and Diabetes Service Assaf Harofeh Medical Center affiliated to Tel Aviv University, Zerifin, Israel
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