การพัฒนารูปแบบการดูแลผู้ป่วยเบาหวานชนิดที่ 2 ให้เข้าสู่ระยะสงบ โรงพยาบาลรามัน จังหวัดยะลา

Thippawadee Seesuk; Niya  Sueni; Rusna  Thanatorntussiri; Sulainee  Satea

Authors

Thippawadee Seesuk Raman Hospital Yala Province
Niya Sueni Raman Hospital Yala Province
Rusna Thanatorntussiri Raman Hospital Yala Province
Sulainee Satea Raman Hospital Yala Province

Keywords:

system development, DM remission, low-carbohydrate diet, self-management

Abstract

This research and development study aimed to develop a care model for patients with type 2 diabetes to achieve remission and to evaluate the effectiveness of the model on body mass index (BMI) and HbA1c levels. The study was conducted in three phases: 1) a situational analysis of self-management among patients with type 2 diabetes using questionnaires and interviews; 2) development of a care model to achieve remission, involving a multidisciplinary team and role model patients; and 3) evaluation of the model’s effectiveness on BMI and HbA1c levels. The sample consisted of patients with type 2 diabetes, including 147 patients in Phase 1, 13 patients in Phase 2, and 59 patients in Phase 3. The research implementation tool was the developed care model for achieving diabetes remission. Data collection tools included questionnaires and a health logbook. Data were analyzed using the paired t-test.

The results revealed that in Phase 1, patients experienced problems related to: 1) knowledge of carbohydrate portion control, 2) self-management of nutrition and exercise, and 3) lack of motivation for continuous self-monitoring. In Phase 2, the model development resulted in a three-step process: 1) model development based on situational data, 2) formulation of care activities based on the conceptual framework, and 3) pilot testing and refinement of the model. In Phase 3, the effectiveness evaluation showed that post-intervention BMI was significantly lower than pre-intervention BMI (p < .001). Similarly, HbA1c levels after the intervention were significantly lower than before (p < .001).

The findings suggest that patients with diabetes can use this model to modify their health behaviors. Families can also apply the model to support and monitor patients, while healthcare providers can utilize it to effectively empower patients.

References

กรมควบคุมโรค. (2567). รายงานสถานการณ์และแนวทางการดูแลผู้ป่วยโรคไม่ติดต่อเรื้อรัง (NCD) ระดับปฐมภูมิ ปี 2567

พิชญ์ชญานิษฐ์ เรืองเริงกุลฤทธิ์, สาธิมาน มากชูจิต, นุรซาฮีดา เจ๊ะมามะ, กมลวรรณ สุวรรณ, บูคอรี มะมิง, และยูนัยดะ กะดะแซ. (2567). ความต้องการด้านการสนับสนุนการจัดการตนเองเพื่อควบคุมระดับน้ำตาลในเลือดของงผู้ป่วยโรคเบาหวานชุมชนท่าสาป จังหวัดยะลา. วารสารมหาราชนครศรีธรรมราชเวชสาร, 7(2), 68-82

สำนักงานปลัดกระทรวงสาธารณสุข. (2567). ฐานข้อมูล Health Data Center (HDC): Service Plan NCD ปีงบประมาณ 2567. https://hdc.moph.go.th

สำนักงานสาธารณสุขจังหวัดยะลา. (2566). รายงานสถานการณ์โรคไม่ติดต่อเรื้อรัง จังหวัดยะลา.

American Diabetes Association Professional Practice Committee. (2024). 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes—2024. Diabetes Care, 47(Suppl. 1), S68–S96. https://doi.org/10.2337/dc24-S005

American Diabetes Association Professional Practice Committee. (2024). 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of care in diabetes—2024. Diabetes Care, 47(Suppl. 1), S113–S124. https://doi.org/10.2337/dc24-S008

Anderson, R. M., & Funnell, M. M. (2010). Patient empowerment: A look back, a look ahead. The Diabetes Educator, 36(3), 351–359. https://doi.org/10.1177/0145721710369790

Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice-Hall.

Creer, L. (2000). Self-management of chronic illness. In M. Boekaerts, P. R. Pintrich, & M. Zeidner (Eds.), Handbook of self-regulation (pp. 601–629). Academic Press.

Daniel, W. W., & Cross, C. L. (2018). Biostatistics: A Foundation for Analysis in the Health Sciences (11th ed.). Wiley.

Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: A systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447–1463. https://doi.org/10.1016/j.jand.2015.02.031

Green, L. W., & Kreuter, M. W. (1991). Health Promotion Planning: An Educational and Environmental Approach. Mayfield Publishing Company.

Huntriss, R., Campbell, M., & Bedwell, C. (2018). The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. European Journal of Clinical Nutrition, 72(3), 311–325. https://doi.org/10.1038/s41430-018-0113-1

International Diabetes Federation. (2023). IDF Diabetes Atlas (10th ed.). https://diabetesatlas.org

Lean, M. E. J., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., Rodrigues, A. M., Rehackova, L., Adamson, A. J., Sniehotta, F. F., Mathers, J. C., & Taylor, R. (2018). Durability of a primary care–led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. The Lancet Diabetes & Endocrinology, 7(5), 344–355. https://doi.org/10.1016/S2213-8587(19)30068-3

Ludwig, D. S., & Ebbeling, C. B. (2018). The carbohydrate-insulin model of obesity: Beyond “calories in, calories out.” JAMA Internal Medicine, 178(8), 1098–1103. https://doi.org/10.1001/jamainternmed.2018.2933

Pender, N. J. (2021). Health Promotion Model Manual (Revised ed.). University of Michigan.

Polit, D. F., & Beck, C. T. (2021). Nursing Research: Generating and Assessing Evidence for Nursing Practice (11th ed.). Wolters Kluwer.

Powers, M. A., Bardsley, J., Cypress, M., Funnell, M. M., Harms, D., Hess Fischl, A., Maryniuk, M. D., Siminerio, L., & Vivian, E. (2022). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report. Diabetes Care, 45(6), 1401–1419. https://doi.org/10.2337/dci22-0023

Rosenstock, I. M. (1974). The Health Belief Model and preventive health behavior. Health Education Monographs, 2(4), 354–386. https://doi.org/10.1177/109019817400200405

Tay, J., Luscombe-Marsh, N. D., Thompson, C. H., Noakes, M., Buckley, J. D., Wittert, G. A., & Brinkworth, G. D. (2015). Comparison of low- and high-carbohydrate diets for type 2 diabetes management: A randomized trial. American Journal of Clinical Nutrition, 102(4), 780–790. https://doi.org/10.3945/ajcn.115.112581

Taylor, R., Al-Mrabeh, A., Zhyzhneuskaya, S., Peters, C., Barnes, A. C., Aribisala, B. S., Hollingsworth, K. G., Mathers, J. C., Sattar, N., & Lean, M. E. J. (2015). Remission of human type 2 diabetes requires decrease in liver and pancreas fat content. Cell Metabolism, 28(4), 667–685. https://doi.org/10.1016/j.cmet.2018.07.003

World Health Organization. (2023). Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes