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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. ปัจจัยที่มีความสัมพันธ์ต่อการควบคุมระดับน้ำตาลในเลือดของผู้ป่วยเบาหวานชนิดที่ 2 ในหน่วยบริการปฐมภูมิอำเภอปทุม รัตต์ จังหวัดร้อยเอ็ด ประเทศไทย.

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

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  1. Factors associated with glycemic control in type 2 diabetes patients at Primary Care Unit, Pathumrat District, Thailand ปัจจัยที่มีความสัมพันธ์ต่อการควบคุมระดับน้ำตาลในเลือดของผู้ป่วยเบาหวานชนิดที่ 2 ในหน่วยบริการปฐมภูมิอำเภอปทุมรัตต์ จังหวัดร้อยเอ็ด ประเทศไทย Submitted by Mrs. Niyom Pragosuntung LWP_5279135853 Advisor : Prathurng Hongsranagon; Ph.D

  2. Background&Rational Diabetesis a chronicillness and major public health problem worldwide. Riskofmicrovascular and macrovascularcomplications; suchasblindness, kidneydamage, cardiovasculardisease, andlower – limbamputation. Short – term complication ; Hypoglycemia, Hyperglycemia, etc

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

  4. Background&Rational WHO estimates people in the world with diabetes are increase to 366 million by the year 2030. International Diabetes Federation (IDF) estimatesoftheprevalenceofdiabetesmellitusthat some 285 millionin 2010. American Diabetes Association(ADA): thenumberofdeathsattributabletodiabetesin 2010 shows 5.5% increaseovertheestimatesfortheyear 2007.

  5. Background&Rational Diabetes mellitus in Thailand ;data from Bureau of Non communicable Disease showed that ; Table 2. The prevalence of diabetes patients in Thailand ;2009. (Rate per 100 thousand) Pre-diabetes in Thailand (FPG 100-125 mg/dl) Data from Bureau of Non communicable Disease, 2009

  6. Background&Rational 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

  7. Background&Rational 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)

  8. Background&Rational 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)

  9. Review of related literature 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,ChatraonNgamukos, PongamornBunnag. 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 PattananikomHospital. 2005 4. Vitoollohsoontorn , VirojJiamjarasrangsi. 2008. “Epidemiology of diabetes Mellitus in Thailand. HSRI

  10. Conceptual Framework • Glycemic control • (FPG, HbA1C)

  11. Research 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.

  12. Objective • General Objective To determine the factors associated with glycemic control in type 2 diabetes mellitus patients.

  13. Objective (cont.) • Specific Objective • 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.

  14. 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.

  15. Definition • 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. The A1C goalforpatientsingeneralisan A1C goalof <7%. (ADA , 2009) .

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

  17. Research Methodology • 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

  18. Research Methodology 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.

  19. Sample & Sample size • 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

  20. Sampling 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.

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

  22. Measurement 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

  23. Validity and reliability • Research’s expert and advisor to examine the content validity that are; Mr.WatcharaEiumrasameekul, Mrs.LamaiChangtom, 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.

  24. Data Collection • Data collection will be use during the working hours • Researcher interview the participant by using the questionnaire,25-30 minutes per one participant.

  25. Statistical analytical 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.

  26. Limitation • Researcher is the interviewer ; bias information • The laboratory examine for theaccuracyofglycemic control should be difference when they change the machine.

  27. Expected Benefit & Application For healthcare teams are provide effective strategies for understand and take control of diabetes mellitus patients. Furthermore, how to avoid or delay its complications.

  28. Administration  & Time Schedule

  29. Budget • Equipment 15,000 • Travel 3,000 • Materials and Supplies 7,500 • Consultant 2,500 • Printing 2,000 • Total Direct Costs 30,000

  30. The end & Thank you for your kindness

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