The Model of Self Care Behaviour and the Relationship with Quality Of Life, Metabolic Control and Lipid Control of Type 2 Diabetes Mellitus Patients in Binjai City, Indonesia

Community-based lifestyle intervention for diabetes (Co-LID study) management rural Nepal: study protocol for a clustered randomized controlled trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM.

METHODS

We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention.

DISCUSSION

This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.

Personal characteristics, families, and community support associated with self-care behavior among Indonesian diabetic patients

Self-care management is the way to prevent the complication in diabetes. However, adherence to self-care management is low. This study aims to assess the association of personal characteristics, supports the system, including families and community, with the self-care behavior among diabetes patients. A cross-sectional study was used in this research. 158 participants were randomly selected based on the primary health care database in Malang City, Indonesia. There are eight parts of the questionnaire as the instruments in this study. Multivariate logistic regression was used to analyze the association of all independent variables with self-care behavior as a dependent variable. This study showed that 60.80% of respondents had complications while the less practicing self-care behavior was 46.84%. Furthermore, the ordinal regression logistic showed that duration of DM (OR:4.347, 95%CI 1.671-11.310), illness perception (OR: 0.028, 95%CI 6.090- 51.346), family supports (OR: 3.295, 95%CI 1.325-8.192), and community supports (2.802, 95%CI 1.209-6.493) were associated with self-care behavior among diabetes Mellitus. This finding can support the primary health care to involved family and community around diabetes patients to success the self-care management.

Factors influencing self-care behavior of socio-economically disadvantaged diabetic patients: A systematic review

Diabetes mellitus and its complications carry broad financial misfortune to the diabetic patients and their family, to the well-being frameworks, and to the public economies through direct clinical expenses and decreased work efficiency. The present study systematically reviewed the possible factors that are influencing self-care behavior of disadvantaged diabetic patients that contribute heavily to the management of this chronic illness. Structured searches were conducted on PubMed, ScienceDirect, and manual searches on Google Scholar for articles published between the years 2000 and 2020. The review was limited to a particular time frame due to the change in WHO criteria for diagnosis and classification of abnormal glucose tolerance. Initially, 96858 articles were identified, and following the screening and full-text reading, 10 studies that met the inclusion criteria were chosen for systematic review. Seven studies had reported the factors influencing self-care behavior among disadvantaged diabetic population. Three studies had reported the importance of intervention strategies and its impact on self-care behavior among them. Findings show that self-care management of socio-economically disadvantaged people entails dimensions including diabetes knowledge, lack of physical activities, social support, lack of access to services, life disruptions, denial of illness, societal attitudes, responsibilities, and treatment costs. It was additionally discovered that diabetes self-management support mediations are successful in drawing in lower economy patients, tending to contending life needs and hindrances to self-care, and encouraging behavior change. Taken together, future methodologically efficacious studies that establish health promoting behaviors and explorations of the factors influencing self-care behaviors of disadvantaged diabetic patients are needed.

On the efficacy of behavior change techniques in mHealth for self-management of diabetes: A meta-analysis

BACKGROUND

Diabetes prevalence has become a global crisis. Due to the substantial rise in smartphone use, a variety of mobile interventions have been developed to help improve the clinical outcomes of diabetes patients.

OBJECTIVES

This study seeks to examine specific behavior change theories and techniques used in the design of self-management mobile app-based interventions aimed at achieving glycemic control in type 1 and type 2 diabetes.

METHODS

A meta-analysis of randomized control trials published in PubMed/Medline and Web of Science between January 2010 and October 2020 was conducted using studies that included diabetes patients, reported on well-described mobile app-based interventions, compared mHealth to usual care, and evaluated glycated hemoglobin (HbA1c) at baseline and follow-up.

RESULTS

We reported on 21 studies with a total of 1,920 diabetes patients. Our findings show that mHealth apps led to statistically significant clinical outcomes as compared to standard care for glycemic control (-0.38, 95% CI = -0.50 to -0.25, p < 0.0001) indicating that such interventions result in a reduction in HbA1c. Interventions that used behavior theory for developing mHealth apps were not statistically different from those that did not (p = 0.18). However, increased use of behavior change techniques (BCTs) may result in slightly higher HbA1c reduction. Among all BCTs, the most effective ones appear to be "Action planning" and "Self-monitoring of outcome(s) of behavior.

CONCLUSIONS

The current meta-analysis provides evidence that mHealth is likely to be beneficial for diabetes patients when the right behavior change techniques are applied to realize the full advantage of the intervention. Further investigation of the role of theory in the design of mHealth app-based interventions is warranted.

The nursing outlook of the self- and family management support programs among Indonesian with diabetes: An umbrella review

BACKGROUND AND AIMS

Diabetes is one of the most critical diseases particularly in developing countries such as Indonesia. Various diabetes approaches have been well conducted to prevent complications. However, little has been discussed in association with the achievement of self- and family management support programs in Indonesia. Thus, the objective of the umbrella review is to evaluate the implementation of the self- and family management support programs among Indonesian with diabetes.

METHOD

To guide this review, the revised self- and family management framework developed by Grey, Schulman-Green, Knafl, and Reynolds (2015) was used. A literature search was conducted via online databases including Cochrane, Scopus, ProQuest, SAGE, EBSCO, and PubMed. The inclusion criteria were diabetes studies related to self- and family management in Indonesia; articles published from 2000 to 2019; quantitative, qualitative, and review studies; used humans as research subjects; and English articles were prioritized. Meanwhile, the exclusion criteria were studies not addressing the nature of self- and family management in Indonesia, laboratory-based research using human cell and study protocol.

RESULTS

A total of 78 studies were involved in the final analysis. The facilitators and barriers, process, and outcomes (distal and proximal) were presented. The results indicated that the implementation of the self- and family management process generated favorable outcomes for the diabetes population in Indonesia.

CONCLUSIONS

The self- and family management support program is a promising strategy to improve the facilitators and overcome the barriers to diabetes care. Patients, families, diabetes nurses, and health policymakers are recommended to work in tandem to achieve successful diabetes care, particularly in the community.

Validity and Reliability of an Instrument for Assessing Self-Care Behaviours in Diabetes Mellitus Type 2 Patients in Binjai City, Indonesia

BACKGROUND:

Self-care behaviour becomes very important for diabetic patients; good self-care behaviour will prevent complications and improving the quality of life.

AIM:

The aim of this study was to provide a preliminary assessment of the validity and reliability of a new measure of self-care behaviour of Diabetes Mellitus Type 2.

METHODS:

The research was a cross-sectional study. The study population was T2DM patients from Primary Health Centers (PHC) in Binjai City, Indonesia. Sample determination using a single simple formula for the hypothesis of one population with calculation is 115 patients; sampling was done by convenience sampling with inclusion and exclusion criteria. Research questionnaire Self-care behaviour of T2DM patients was forming by knowledge, attitudes, communication, family support, financing, motivation, and self-efficacy. Each of the predictors forms self-care behaviour and finally, the instrument consists of 28 questions. The data analysis techniques were Confirmatory Factor Analysis (CFA) tests with Structural Equation Models (SEM) with AMOS aids.

RESULTS:

Based on the results of the confirmatory analysis proved that the instrument is valid and reliable, the measure the self-care behaviour of T2DM.

CONCLUSION:

The new instrument for assessing self-care behaviour of T2DM patients is valid and reliable, besides being able to assess self-care behaviour, they can also know the components that make up self-care.

Diabetic Neuropathy among Type 2 Diabetes Mellitus Patients at Amplas Primary Health Care in Medan City

BACKGROUND:

Diabetic neuropathy is one of the most complicated complications of diabetes patients with Type 2 diabetes.

AIM:

The purpose of this study was to determine the diagnosis of diabetic neuropathy based on Clinical Neurological Examination (CNE) and the factors that influence the occurrence of diabetic neuropathy in Type 2 DM patients at Amplas Primary Health Care (PHC) in Medan City.

METHODS:

The research design was descriptive-analytic with the cross-sectional approach. The study population was all Type 2 DM patients who came to Amplas PHC with a total sample of 53 people using the consecutive sampling. The research data source is primary data, namely the assessment of diabetic neuropathy using the Clinical Neurological Examination (CNE) criteria. Data were processed using SPSS and analysis using the chi-square test.

RESULTS:

The results showed the majority of Type 2 DM patients had mild neuropathy as many as 24 people (45.3%). The Chi-square test results showed there was a relationship between age and duration of diabetes with the incidence of diabetic neuropathy in Type 2 DM patients at Amplas Primary Health Care.

CONCLUSION:

Education and early detection with proper management can prevent more severe complications so that the quality of life of patients can be maintained better.