Effects of the First Line Diabetes Care (FiLDCare) self-management education and support project on knowledge, attitudes, perceptions, self-management practices and glycaemic control: a quasi-experimental study conducted in the Northern Philippines

Abstract

ObjectivesTo investigate the effects of implementing a context-adapted diabetes self-management education and support (DSME/S) project based on chronic care models in the Philippines, on knowledge, attitudes, self-management practices, adiposity/obesity and glycaemia of people with diabetes.DesignProspective quasi-experimental before–after study.Participants203 people with type 2 diabetes mellitus from two local government units in the Northern Philippines fulfilling set criteria.Outcome measuresContext-adapted DSME/S was given to a cohort of people with diabetes by trained pre-existing local government healthcare personnel. Changes in knowledge, attitudes and self-management practices, body mass index, waist circumference, waist-hip ratio (WHR) and glycosylated haemoglobin (HbA1c) were measured 1 year after full project implementation. Non-parametric and parametric descriptive and inferential statistics including logistic regression analysis were done.ResultsComplete data were collected from 164 participants. Improvements in glycaemia, waist circumference, WHR, knowledge, some attitudes, adherence to medications and exercise, and an increase in fear of diabetes were significant. Reductions in HbA1c, regardless of level of control, were noted in 60.4%. Significant increase in knowledge (p<0.001), positive attitude (p=0.013), perceived ability to control blood glucose (p=0.004) and adherence to medications (p=0.001) were noted among those whose glycaemia improved. Significant differences between the subgroups whose HbA1c improved and those whose HbA1c deteriorated include male gender (p=0.042), shorter duration of diabetes (p=0.001) and increased perceived ability to control blood glucose (p=0.042). Significant correlates to improved glycaemia were male gender (OR=2.655; p=0.034), duration of diabetes >10 years (OR=0.214; p=0.003) and fear of diabetes (OR=0.490; p=0.048).ConclusionsContext-adapted DSME/S introduced in resource-constrained settings and making use of established human resources for health may improve knowledge, attitudes, self-management practices and glycaemia of recipients. Further investigations on addressing fear of diabetes and tailoring DSME/S to females with diabetes and those who have had diabetes for a longer period of time may help improve glycaemia.

Effect of the Consultation of Nursing on Knowledge, Quality of Life, Attitude Towards Disease and Self-Care Among Persons With Diabetes

“…Ressalta-se que o conhecimento sobre o diabetes mellitus tipo 2 e a atitude frente a ele, assim como a adoção de ações de autocuidado, podem diminuir seu impacto na qualidade de vida das pessoas. 5 O modelo de atenção às condições crônicas propõe o desenvolvimento de ações que melhorem o controle da doença, e o autocuidado apoiado constitui uma das ferramentas que orientam o cuidado/assistência a partir de problemas identificados e metas estabelecidas conjuntamente entre os profissionais de saúde e os próprios indivíduos doentes. 6 Nesse sentido, intervenções voltadas para a promoção do autocuidado pelo indivíduo com diabetes mellitus tipo 2 são consideradas fundamentais para alcançar resultados positivos no controle e gestão da doença.…”

Nursing appointment and cardiometabolic control of diabetics: a randomized clinical trial

“…Glycemic rate combined with inadequate lipid levels and blood pressure decompensation are the most involved variables in the etiology of DM2 acute and chronic complications. Although the control of these rates is essential to reduce the consequences of the disease in medium and long terms (4) , national data show that relative frequency of individuals with DM2 that present a satisfactory control of glycated hemoglobin (HbA1c) is only 27% (5) . The individual's behavior regarding the disease, therefore, must be the main focus of assistance, since inadequate habits of life and presence of comorbidities are among the factors that most affect glycemic decontrol (6) .…”

Educational program to promote the self-care of people with diabetes mellitus

“…The problem solving education allows the person to practice the autonomy to transform behavior or not. The professional should know how to recognize and to respect the diabetic person's right to be the protagonist of their care plan, which can include or not the non-adherence to proposed recommendations (29-32), the adoption of pedagogical resources using principles of participatory education, emancipating and co-responsible for stimulating the adoption of self-care (6,10,34). This aspect reinforces the need and the challenge of keeping updates, exchanges of experiences and knowledge among team members in the area of diabetes education (31,32).…”