Ngetich Elisha, Pateekhum Chanapat, Hashmi Ahmar, Nadal Iliatha Papachristou, Pinyopornpanish Kanokporn, English Mike, Quansri Orawan, Wichit Nutchanart, Kinra Sanjay, Angkurawaranon Chaisiri
Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Arch Public Health. 2022 May 7;80(1):134. doi: 10.1186/s13690-022-00888-1.
Diabetes Self-Management Education (DSME) is a fundamental aspect of diabetes care, but no standard program exists in Thailand. Understanding current patterns of illness perceptions (concerns) and self-management practices among patients with diabetes in Thailand is vital to develop culturally tailored DSME programs. This study sought to explore the association between reported self-management practices and diabetes perceptions on glycemic control among patients with type 2 diabetes in Chiang Mai Province, Thailand. Specifically, the study examined whether the association between illness perceptions and diabetes control was mediated by self-management.
This was a cross-sectional study conducted among type 2 diabetes patients on outpatient care and follow-up in four districts hospitals in Chiang Mai, Thailand. Illness perceptions was measured by the Brief Illness Perceptions Questionnaire (BIPQ). Self-management practices were measured by Summary Diabetes Self-Care activities (SDSCA). For illness perceptions and self-management practices, patients were classified into two groups, high level and low level based on the median values. Univariate and multivariable analyses were done to determine the association between the determinant factors: self-care practices and illness perceptions and the outcome of interest- good glycemic control (HbA1c < 7%).
Of the 200 participants recruited into the study, 180 completed the questionnaire. Only 35% of participants had good glycemic control (HBA1c < 7.0). Both illness perceptions and self-management practices were independently linked to glycemic control. Among illness perceptions, a sense of personal control was strongly associated with good glycemic control (p = 0.01). For self-management, appropriate diet (p = 0.03) and medication adherence (p = 0.05) were associated with good glycemic control. After adjustments for key baseline characteristics, patients with high levels of illness perceptions were less likely to achieve glycemic control (OR 0.55, 95% CI 0.29 to 1.14, p = 0.11) and those with high level of self-management were more likely to achieve glycemic control (OR 2.11, 95% CI 1.04 to 4.30, p = 0.04). The effect size for illness perception attenuated when further adjusted for levels of self-management (OR 0.88, 95% CI 0.39 to 1.96, p = 0.75) while the effect size for self-management and glycemic control did not materially change (OR 2.30, 95% CI 1.06 to 5.02, p = 0.04).
Illness perceptions and self-management practices are associated with glycemic control. Future culturally tailored interventions in Thailand aimed at improving glycemic should focus on personal control, improving diet and treatment adherence as these are more likely to help improve diabetes control as demonstrated in this study.
糖尿病自我管理教育（DSME）是糖尿病护理的一个基本方面，但泰国尚无标准项目。了解泰国糖尿病患者当前的疾病认知（担忧）模式和自我管理实践对于制定适合当地文化的DSME项目至关重要。本研究旨在探讨泰国清迈省2型糖尿病患者报告的自我管理实践与糖尿病认知对血糖控制的关联。具体而言，该研究考察了疾病认知与糖尿病控制之间的关联是否通过自我管理来介导。
这是一项横断面研究，在泰国清迈的四家区级医院对接受门诊护理和随访的2型糖尿病患者进行。疾病认知通过简易疾病认知问卷（BIPQ）进行测量。自我管理实践通过糖尿病自我护理活动总结（SDSCA）进行测量。对于疾病认知和自我管理实践，根据中位数将患者分为高水平和低水平两组。进行单变量和多变量分析以确定决定因素（自我护理实践和疾病认知）与感兴趣的结果（良好血糖控制，糖化血红蛋白<7%）之间的关联。
在招募到该研究中的200名参与者中，180名完成了问卷。只有35%的参与者血糖控制良好（糖化血红蛋白<7.0）。疾病认知和自我管理实践均与血糖控制独立相关。在疾病认知方面，个人控制感与良好的血糖控制密切相关（p = 0.01）。对于自我管理，适当饮食（p = 0.03）和药物依从性（p = 0.05）与良好的血糖控制相关。在对关键基线特征进行调整后，疾病认知水平高的患者实现血糖控制的可能性较小（比值比0.55，95%置信区间0.29至1.14，p = 0.11），而自我管理水平高的患者更有可能实现血糖控制（比值比2.11，95%置信区间1.04至4.30，p = 0.04）。在进一步根据自我管理水平进行调整后，疾病认知的效应大小减弱（比值比0.88，95%置信区间0.39至1.96，p = 0.75），而自我管理与血糖控制的效应大小没有实质性变化（比值比2.30，95%置信区间1.06至5.02，p = 0.04）。
疾病认知和自我管理实践与血糖控制相关。泰国未来旨在改善血糖的适合当地文化的干预措施应侧重于个人控制、改善饮食和治疗依从性，因为正如本研究所示，这些更有可能有助于改善糖尿病控制。
