Comparison of Self-Management between Glycemic Controlled and Uncontrolled Type 2 Diabetic Elderly in Thailand: A Qualitative Study

BACKGROUND: For the past few decades, there have not been many studies done regarding diabetic patients’ perspectives. Diabetes mellitus is serious long-term care required for older patients. The facilitators have an important role in supporting diabetes patients.

AIM: The study aimed to assess and compare patients’ and caregivers’ perception of diabetes self-monitoring (DSM) and affects the Diabetes Self-Management Instrument (DSMI) of type-2 diabetic patients in both glycemic controlled and uncontrolled patients.

MATERIALS AND METHODS: The descriptive cross-sectional qualitative method was used to gather data from 25 participants among type II diabetes patients. Patients were recruited from the outpatient diabetes clinics in southern Thailand. Data were collected using a semi-structured in-depth interview guide and the focus group discussion. A thematic analysis approach was used to process the data.

RESULTS: From this study, 60% of the participants were among the uncontrolled glycemic group while 40% were the controlled group. The controlled group was found to have better self-management in the five themes of a healthy diet, regular exercise, medication taking, and risk prevention than the uncontrolled group. T2DM elderly in a controlled group has self-awareness and diabetic management intention higher than the uncontrolled group. The patient’s attitudes revealed five themes described fours themes of diabetic self-management intentions as reasoning, deciding, acting, and evaluating to perform self-management of older T2DM patients.

CONCLUSION: The elderly T2DM in the glycemic control group had self-awareness and intended to manage their diabetes and received more family support than those who were unable to control their blood sugar levels. Perceptions of elderly diabetic patients, their caregivers, and health workers revealed a common concern for behavioral intentions: obtaining self-care support from healthcare professionals and their families were the most important aspect of glycemic control in the elderly

1. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-281. doi: https://doi.org/10.1016/j.diabres.2018.02.023

2. International Diabetes foundaration. Diabetes Atlas 9TH edition 2019. [Internet]. 2019. Available from: https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html

3. Rowe DS. Barriers to the Prevention and Treatment of Geriatric Diabetes. Fed Pract. 2015;32(S11):16S-20S.

4. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40-50. doi: https://doi.org/10.1016/j.diabres.2017.03.024

5. Pamungkas R, Chamroonsawasdi K, Vatanasomboon P. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients. Behav Sci (Basel). 2017;7(4):62. doi: https://doi.org/10.3390/bs7030062

6. Sanghamitra P, Eunice L, Sandipana P, et al. Type 2 diabetes and physical activity: barriers and enablers to diabetes control in Eastern India. Prim Health Care Res Dev. 2019;20:e44. doi: https://doi.org/10.1017/S146342361800097X

7. Wu F-L, Tai H-C, Sun J-C. Self-management Experience of Middle-aged and Older Adults With Type 2 Diabetes: A Qualitative Study. Asian Nurs Res (Korean Soc Nurs Sci). 2019;13(3):209-215. doi: https://doi.org/10.1016/j.anr.2019.06.002

8. American Diabetes Association. Improving care and promoting health in populations: Standards of Medical Care in Diabetes – 2019. Diabetes Care. 2019;42(1):S7–S12. doi: https://doi.org/10.2337/dc19-S001

9. Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of Diabetes and Relationship with Socioeconomic Status in the Thai Population: National Health Examination Survey, 2004–2014. J Diabetes Res. 2018;2018:1-8. doi: https://doi.org/10.1155/2018/1654530

10. Clinical Practice Guideline for Diabetes [Internet]. Thai Diabetes Association In the royal patronage of HRH Princess Maha Chakri Sirindhorn. 2017 [cited 2022 Mar 31]. Available from: https://www.dmthai.org/attachments/article/443/guideline-diabetes-care-2017.pdf

11. Reutrakul S, Deerochanawong C. Diabetes in Thailand: Status and Policy. Curr Diab Rep. 2016;16(3):28. doi: https://doi.org/10.1007/s11892-016-0725-7

12. Wichit N, Mnatzaganian G, Courtney M, et al. Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with Type 2 diabetes. Diabetes Res Clin Pract. 2017;123:37-48. doi: https://doi.org/10.1016/j.diabres.2016.11.013

13. Wongrith P. Predicting diabetic self-care management based on the theory of planned behavior among elderly with type 2 diabetes in Thailand. Diabetes Mellit. 2019;22(4):367-376. doi: https://doi.org/10.14341/DM10290

14. Pamungkas RA, Chamroonsawasdi K, Vatanasomboon P, Charupoonphol P. Barriers to Effective Diabetes Mellitus Self-Management (DMSM) Practice for Glycemic Uncontrolled Type 2 Diabetes Mellitus (T2DM): A Socio Cultural Context of Indonesian Communities in West Sulawesi. Eur J Investig Heal Psychol Educ. 2019;10(1):250-261. doi: https://doi.org/10.3390/ejihpe10010020

15. Gupta L, Khandelwal D, Rishi Lal P, et al. Factors Determining the Success of Therapeutic Lifestyle Interventions in Diabetes – Role of Partner and Family Support. Eur Endocrinol. 2019;15(1):18-24. doi: https://doi.org/10.17925/EE.2019.15.1.18

16. Mogre V, Johnson NA, Tzelepis F, Paul C. Barriers to diabetic self‐care: A qualitative study of patients’ and healthcare providers’ perspectives. J Clin Nurs. 2019;28(11-12):2296-2308. doi: https://doi.org/10.1111/jocn.14835

17. Fai EK, Anderson C, Ferreros V. Role of attitudes and intentions in predicting adherence to oral diabetes medications. Endocr Connect. 2017;6(2):63-70. doi: https://doi.org/10.1530/EC-16-0093

18. Oakes AH, Garmo VS, Bone LR, et al. Identifying and Prioritizing the Barriers and Facilitators to the Self-Management of Type 2 Diabetes Mellitus: A Community-Centered Approach. Patient - Patient-Centered Outcomes Res. 2017;10(6):773-783. doi: https://doi.org/10.1007/s40271-017-0248-6

19. Freeman-Hildreth Y, Aron D, Cola PA, Wang Y. Coping with diabetes: Provider attributes that influence type 2 diabetes adherence. PLoS One. 2019;14(4):e0214713. doi: https://doi.org/10.1371/journal.pone.0214713

20. Whittemore R, Vilar-Compte M, De La Cerda S, et al. Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study. Int J Equity Health. 2019;18(1):133. doi: https://doi.org/10.1186/s12939-019-1035-x