Effects of a Health Promotion Program Conducted by Nurses on Stabilization of HbA1C in Subjects at Risk for Diabetes: A Phase III Randomized Controlled Trial
Yuwarat Moungngern, Supaporn Sanguanthammarong, Piyanun Teparak, อภิรดี ศรีวิจิตรกมล*
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkoknoi, Bangkok 10700, Thailand; Phone: +66-2-4197799, Fax: +66-2-4197792; Email: apiradeesi99@hotmail.com
Background: Although pre-diabetes subjects are at increased risk for developing type 2 diabetes, several studies have shown that lifestyle modification can decrease the number of cases that progress to diabetes. Data from Thai pre-diabetes population relative to the effect of medium-term intervention to lower hemoglobin [HbA1C] and prevent the onset of diabetes are scarce.
Objective: To investigate the effect of a nurse-managed 6-month health promotion program designed to lower HbA1C and other risk factors for diabetes, and to prevent the onset of diabetes among Thai persons diagnosed with pre-diabetes.
Materials and Methods: This 6-month randomized controlled trial was conducted at the outpatient department of the Siriraj Hospital, Thailand’s largest national tertiary referral center-during the 2012 to 2014 study period. Subjects at risk for diabetes were recruited and randomly assigned to either the intervention group or the control group. Study group subjects participated in the study’s health promotion protocol, with control group subjects receiving only routine self-care recommendations for preventing diabetes. Clinical and laboratory characteristics in both groups were recorded at baseline and at preestablished time points.
Results: One hundred twenty-five pre-diabetes subjects were included, with 61 and 64 subjects assigned to the study and control groups, respectively. At the 6-month time point, 9.3% in the study group and 8.6% in the control group could reduce their HbA1C level by more than 0.5%. Increase of HbA1C at the end of study was less frequent in the study group than in the control group (16.7% vs. 36.2%, respectively; p = 0.025). Diet and exercise behavior with self-efficacy improved more in the study group than in the control group. Prevalence of metabolic syndrome was significantly reduced from 50% to 23.8% in the study group (p<0.001).
Conclusion: The nurse-managed health promotion program investigated among Thai pre-diabetes subjects in the present study improved HbA1C, several risk behaviors, and the incidence of metabolic syndrome. Implementation of this program may benefit both patients and health care systems by increasing patient health and lowering diabetes-related costs.
วารสารจดหมายเหตุทางการแพทย์ ปี 2561, October ปีที่: 101 ฉบับที่ 10 หน้า 1343-1348
Diabetes, nurses, Health belief model, Thailand Health promotion program, HbA1C reduction