Purpose:
Diabetes mellitus (DM) is one of the most common chronic diseases and costly conditions in the world. It is also associated with serious complications and comorbidities. Globally, the prevalence of type 2 diabetes continues to increase, 425 million people in 2017. It is estimated that 380 million adults will develop diabetes in 2025, this will rise to 629 million by 2045. Diabetes mellitus requires continuous care and successful management of this disease cannot be achieved without patients involvement. The effect of educational interventions on self care is particularly important for glycemic control. Traditionally, insulin was titrating by physician during each visit, so patients often failed to make the necessary insulin titration response when hyper or hypo-glycemia was occurred on their self-monitor blood glucose (SMBG).Therefore, the aim of this study was to evaluate the effects of an insulin self-titration education program on glycemic control, self-efficacy and self-care behaviors in hospital-based type 2 diabetes out-patients.
Methods:
A quasi-experimental design was used to examine the effects of self-titration program on insulin treated type 2 diabetes. 120 DM patients were recruited from one district hospital in Central Taiwan, 60 patients were either in the insulin self-titration or in the routine care. Insulin Diabetes Management Self-Efficacy (IMDSE) questionnaire and Diabetes Self-Care (DSC) questionnaire were used as self-efficacy indicators. Outcomes were determined by changes in glycated hemoglobin, fasting blood sugar, self-efficacy and glycaemic control behavior of type 2 insulin treated diabetes patients
Results:
The average glycated hemoglobin (HbA1C) in the interventional group was significantly lower than that in the control group at the third and sixth months after intervention. The difference in hemoglobin (HbA1C) over time was analyzed by GEE. The results showed that the interaction between group and time was statistically significant (Wald X2 =15.16, p = 0.001).The slope parameter (ß) showed a change in the average hemoglobin, from the baseline to the sixth month, the interventional group was significantly reduced by -53 (95% CI: -.92 ~ -.14) compared with the control group. From the basic test to third month, the interventional group was also significantly reduced compared with the control group -.75 (95% CI: -.75). In the sixth month, The self-efficacy and self-care behavior score of the interventional group was significantly higher than the control group (t=7.131, p<.001；t=8.122, p<.001 ).
Conclusion:
These results indicate that insulin self-titration education program was an effective tool in glycemic control, self-efficacy and self-care behavior in insulin treated type 2 diabetes patients, without increasing adverse events (hyper or hypoglycemia). The results of this study could be used by the professional care providers for improving clinical outcomes as an additive education program for insulin treated type 2 diabetes patients.