Page 1 Factors associated with glycemic control in type 2 diabetes patients at Primary Care Unit,...

Factors associated with glycemic control in type 2 diabetes patients at Primary Care

Unit, Pathumrat District, Thailand

Advisor : Prathurng Hongsranagon; Ph.D

Submitted by Mrs. Niyom Pragosuntung LWP_5279135853

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Diabetes is a chronic illness and major public health problem worldwide.

Risk of microvascular and macrovascular complications; such as blin

dness, kidney damage, c ardiovascular dise ase, and lower – limb amputation.

Short – term complication ; Hypoglycemia, Hyperglycemia, etc

2010 2030Total world population (billions) 7.0 8.4Adult population (20-79 years, billions)

4.3 5.6

Diabetes and IGT (20-79 years) Diabetes Global prevalence (%) 6.6 7.8Comparative prevalence (%) 6.4 7.7Number of people with diabetes (millions)

285 438

IGT Global prevalence (%) 7.9 8.4Comparative prevalence (%) 7.8 8.4Number of people with IGT (millions)

344 472

Table 1: Global Burden: Prevalence and Projections, 2010 and 2030

WHO estimates people in the world with diabetes are increase to 366 million by the year 2030.

International Diabetes Federation (IDF) estimates of the prevalence of dia

betes mellitus that some 285 million in2010.

American Diabetes Association(ADA): t he number of deaths attributable to d

iabetes in 2010 shows 5.5% increase ove r the estimates for the year 2007.

Diabetes mellitus in Thailand ;data from Bureau of Non communicable Disease showed that ;

Table 2. The prevalence of diabetes patients in Thailand ;2009.

Data from Bureau of Non communicable Disease, 2009

PrevalenceMale 6.4 Female 7.3

(Rate per 100 thousand)

Pre-diabetes in Thailand(FPG 100-125 mg/dl)

Number of case Rate

Total 7,725 12.22

Roi et 373 28.52

Table 3: The number and mortality rate of diabetes patients in Thailand and Roi Et province, 2009. (Rate per 100 thousand)

Data from Bureau of Non communicable Disease, 2009

Diabetes mellitus in Pathumrat district;

The number of type 2 diabetes patients by the year 2007 to 2010 have been increased from 950 , 1,300 and 1925; respectively.The re - admission number of type 2 diabetes inpatients with short –term complication are increasing from 55 to 69 patients(rate per 1000 people) in 2009

Have 9 type 2 patients with chronic kidney disease and used Continuous Peritoneal Dialysis (CAPD). There are 7 patients who ever referred to PCU.

(Information and Technology Center of Pathumrat hospital,2009 )

Diabetes mellitus in Pathumrat district;

The number of type 2 diabetes patients 1,425 were referred to 13 Primary Care Unit (PCU) for treatment and continuity of care since the year 2007.

(Data from DM clinic ; Pathumrat hospital,2009 )

Review of related Review of related literatureliterature

1.Prevalence and management of diabetes and associated risk factors by regions of Thailand: Third National Health Examination Survey 2004. Diabetes Care 2007;30:2007-12.

2. B.Wongsunoparat,Chatraon Ngamukos, Pongamorn Bunnag. Quality of life and Glycemic control of people with diabetes at Medical Out Patient unit, Ramathibodi Hospital 2004.

3. Varataya P, Factors associated with glycemic control in type 2 diabetes mellitus patients in Pattananikom Hospital. 2005

4. Vitool lohsoontorn , Viroj Jiamjarasrangsi. 2008. “Epidemiology of diabetes Mellitus in Thailand. HSRI

Theory and researches have been reviewed as follows: 1. Knowledge of type 2 diabetes mellitus

1.1 Definition 1.2 Classification 1.3 Diagnostic test for diabetes 1.4 Signs and symptoms 1.5 Causes and risk factors for type 2 diabetes 1.6 Complications 1.7 Treatment and self care

2. Health behaviors

2.1 Dietary 2.2 Physical activity 2.3 Drug compliance

3. Factors associated with glycemic control in diabetes patients and involved research 3.1 Age 3.2 Gender 3.3 Marital status 3.4 Occupation 3.5 Family Income 3.6 Education level 3.7 Body mass index 3.8 Duration of Diabetes Mellitus

3.9 Dietary 3.10 Physical activity 3.11 Drug compliance 3.12 Knowledge of diabetes 3.13 Family support 3.14 Stress

Independent Variable Dependent Variable Figure 1. Conceptual framework of the factors associated with glycemic control in type 2 diabetes patients in Primary Care Unit.

Part I : Demographic characteristics

1.1 Age 1.2 Gender 1.3 Marital status 1.4 Education 1.5 Occupation 1.6 Family Income 1.7 Family history 1.8 Duration of

disease 1.9 Body mass index 1.10 Co- morbidities

Part III : Healthcare behaviors

3.1 Dietary habit 3.2 Physical activities 3.3 Drug compliance 3.4 Family support

1. …….

Glycemic control (FPG, HbA1C)

Part II : Knowledge of diabetes mellitus

Part IV : Psychological characteristics

ConceptualFramework

ConceptualFramework

Glycemic control (FPG, HbA1C)

Research Research

questions(Hypothesis )questions(Hypothesis )• 1. Demographic characteristics are associated

with glycemic control in type 2 diabetes patients.

• 2. Knowledge of type 2 diabetes mellitus is associated glycemic control in type 2 diabetes patients.

• 3. Healthcare behavior factors (dietary habit, physical activity and drug compliance ) are associated and glycemic control in type 2 diabetes patients.

• 4. Psychosocial characteristics are associated glycemic control in type 2 diabetes patients.

ObjectiveObjective

• General Objective

To determine the factors associated with glycemic control in type 2 diabetes mellitus patients.

Specific Objective

1. To determine the associated between demographic characteristics and glycemic control in type 2 diabetes

patients who were referred to Primary Care Unit.

2. To determine the associated between knowledge of type 2 diabetes mellitus and glycemic control in type 2 diabetes patients who were referred to Primary Care Unit.

3. To determine the associated between healthcare behavior and glycemic control in type 2 diabetes patients who were referred to Primary Care Unit.

Objective (cont.)

Specific Objective

4. To determine the associated between psychosocial characteristics and glycemic control of type 2 diabetes patients who were referred to Primary Care Unit

5. To compare the difference of glycemic control levels in

type 2 diabetes patients who were referred to each

Primary Care Unit in Pathumrat District.

Objective (cont.)

DefinitionDefinition

• Type 2 diabetes mellitus patients ; diagnosed by the physician, oral glycemic medication at PCU

• Glycemic control: the level of fasting; plasma glucose (FPG ) and glycosylated hemoglobin (HbA1C)

HbA1C ≤ 7 are considered as good glycemic control

HbA1C ≥ 7 indicates poor control.

1The A C goal for patients in general , 1<7 %.( , 2009)

.

DefinitionDefinition

• Knowledge of diabetes mellitus • Healthcare behaviors • Family support • Stress • Body Mass Index • Dietary • Physical activity • Drug compliance • Drug compliance • Primary Care Unit

Research Research MethodologyMethodology

• Research Design A cross-sectional analytical study

• Study Area To study with type 2 diabetes patients at 9

Primary Care Unit in Pathumrat District, Roi et province, Thailand

Research Research MethodologyMethodology

Study Population Type 2 diabetes patients 1,425 who were referred from Pathumrat community hospital to Primary Care Unit in Pathumrat district, Roi et province, Thailand.

Sample & Sample Sample & Sample sizesize

• A simplified formula for proportions of the sample size can be use to calculate by Yamane ( 1967:886 ).

n =

Which is valid where n is the sample size

N is the population size

e is the significant level (0.05)

n = 1,425

1 + 1,425 (0.05)2

= 302.5 >>>360 for prevent lossing data

2)(1 eN

N

Sampling TechniqueSampling Technique

• The systematic sampling • Type 2 diabetes patients, aged 20 years

and over were arranged by identification diabetes number. The sampling interval is 4 and then 360 patients were chosen by the systematic sampling procedure was carried out for each Primary Care Unit.

• Inclusion criteria and exclusion criteria.

Primary care unit Type 2 patients Sample1. Buadaeng 391 1002. Nongkaen3. Sabua4. Dorglam5. Suanpor6. Jantai7. Samkhar 8. Kealeg9. Nonsawan10. Namkham 11. Buakhaow

172 99 91 101 89 26 49 117 57 76

43 25 23 25 22 7 12 30 14 19

12. Nongsuay13. Tajoi

79 78

20 20

Total 1,425 360

Table 4 : The samples were chosen from 13 Primary Care Unit in Pathumrat district, Roi Et province

Measurement ToolsMeasurement Tools

• The tools of this study use to collect data is the questionnaires compose of 5 parts

Part I : Demographic characteristics questionnaire

Part II : Knowledge of diabetes questionnaires

Part III : Health behavior questionnaire

Part IV : Psychosocial questionnaires Part V : Medical Record

Validity and Validity and reliabilityreliability

• Research’s expert and advisor to examine the content validity that are; Mr.Watchara Eiumrasameekul, Mrs.Lamai Changtom, Miss Piyarak.

• Try out the questionnaires 30 case at Kasetwisai District, Roi Et province.

• Prove the completeness of all questionnaires• Put the data in SPSS Version 17.0 will use

to tests reliability by Cronbach’s coefficient. and KR-20 for Knowlegde questionnaire.

Data CollectionData Collection

• Data collection will be use during the working hours

• Researcher interview the participant by using the questionnaire,25-30 minutes per one participant.

Statistical analytical Statistical analytical used:used:• Statistical significance was set at alpha=0.05 (P-value <=

0.05). in the following steps :1. Descriptive Statistics were used to explain the distribution of demographic data of the study participants and presented as frequency, percentage, mean and standard deviation.2. Analytical statistics were used

2.1 Chi-square Test, odds ratio, 95% confidence interval of odds ratio and p-value were used to measure the crude association between variables

2.2 Pearson product moment Correlation analysis was used to find the factors predicting outcome and adjusted odds ratios.

• •

LimitationLimitation

• Researcher is the interviewer ; bias information

• The laboratory examine for the accuracy of glycemic control should be difference when they change the machine.

Expected Benefit & Expected Benefit &

ApplicationApplication For healthcare teams are provide

effective strategies for understand and take control of diabetes mellitus patients.

Furthermore, how to avoid or delay its complications.

Research ActivitiesTime Frame (month in the year 2010-2011)

Oct. Nov. Dec. Jan. Feb. Mar. April

Literature review

Conduct draft tool for data collecting

Content validity by experts

Ethical Consideration

Tool development for data collecting

Try out research tool

Field preparation and data collection

Data analysis and interpretation

Report writing

Presentation/publication

Administration & Time Administration & Time

ScheduleSchedule

BudgetBudget

• Equipment 15,000• Travel 3,000• Materials and Supplies 7,500• Consultant 2,500• Printing 2,000• Total Direct Costs

30,000

The end&

Thank you for your kindness

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