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.

Nitchamon Rakkapao,Chung-Ying Lin,Karen Hay,Cameron P Hurst

doi:10.1371/journal.pone.0244692

Nitchamon Rakkapao, Chung-Ying Lin + Show 2 more

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https://doi.org/10.1371/journal.pone.0244692

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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.

Highlights

Diabetes mellitus is a major health problem and represents a substantial burden in terms of mortality, morbidity, and health-system costs, worldwide
The bivariate analysis (Table 2) demonstrates that both diabetes self-management (ORSDSCA:10 = 1.62; 95%CI:1.46, 1.80; p < 0.001) and diabetes management self-efficacy (ORDMSES:10 = 2.20; 95%CI:1.97, 2.46 p < 0.001) were positively associated with glycemic control, while an inverse relationship was observed between diabetes knowledge
In this study we examine the associations of diabetes self-management, diabetes management self-efficacy and diabetes knowledge with glycemic control

Summary

Introduction

Diabetes mellitus is a major health problem and represents a substantial burden in terms of mortality, morbidity, and health-system costs, worldwide. In 2015, the number of people living with diabetes was estimated to be 415 million globally and this number is expected to rise to 642 million cases by 2040 [1]. 90% of people with diabetes have Type 2 Diabetes Mellitus (T2D) and the increasing prevalence of T2D is likely to be attributable to factors such as ageing populations and an increasing level of sedentary life styles that seem to accompany economic development. The increasing prevalence of T2D, along with the associated development of T2D complications as a cause of early morbidity and mortality, and the enormous burden on health care systems make diabetes a priority health concern. In 2017, diabetes was one of the highest contributors to disability, ranked 5th in both years lived with disability (YLD) and disability-adjusted life years (DALYs), with increases of more than 50% over the 10 years period from 2007–2017 [7]

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