1. Page 1 Factors associated with glycemic control in type 2 diabetes patients at Primary Care Unit, Pathumrat District, Thailand 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 ปัจจัยที่มีความสัมพันธ์ต่อการควบคุมระดับน้ำตาลในเลือดของผู้ป่วยเบาหวานชนิดที่ 2 ในหน่วยบริการปฐมภูมิอำเภอปทุมรัตต์ จังหวัดร้อยเอ็ด ประเทศไทย

2. Page 2 Diabetes is a chronic illness and major public health problem worldwide. Risk of microvascular and macrovascular complications; such as blindness, kidney damage, cardiovascular disease, and lower – limb amputation. Short – term complication ; Hypoglycemia, Hyperglycemia, etc

3. Page 3 20102030 Total world population (billions)7.08.4 Adult population (20-79 years, billions)4.35.6 Diabetes and IGT (20-79 years)IGT Diabetes Global prevalence (%) 6.67.8 Comparative prevalenceComparative prevalence (%) 6.47.7 Number of people with diabetes (millions) 285438 IGT Global prevalence (%)7.98.4 Comparative prevalence (%)7.88.4 Number of people with IGT (millions)344472 Table 1: Global Burden: Prevalence and Projections, 2010 and 2030

4. Page 4 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 diabetes mellitus that some 285 million in 2010. American Diabetes Association(ADA): the number of deaths attributable to diabetes in 2010 shows 5.5% increase over the estimates for the year 2007.

5. Page 5 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 Prevalence Male 6.4Female 7.3 (Rate per 100 thousand) Pre-diabetes in Thailand (FPG 100-125 mg/dl)

6. Page 6 Number of caseRate Total7,72512.22 Roi et37328.52 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

7. Page 7 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. Page 8 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. Page 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,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

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11. Page 11 Conceptual Framework Conceptual Framework Glycemic control (FPG, HbA 1 C)

12. Page 12 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.

13. Page 13 Objective General Objective To determine the factors associated with glycemic control in type 2 diabetes mellitus patients.

14. Page 14 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.)

15. Page 15 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.)

16. Page 16 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 (HbA 1 C) HbA1C ≤ 7 are considered as good glycemic control HbA1C ≥ 7 indicates poor control. The A1C goal for patients in general is an A1C goal of <7%. (ADA, 2009).

17. Page 17Definition Knowledge of diabetes mellitus Healthcare behaviors Family support Stress Body Mass Index Dietary Physical activity Drug compliance Primary Care Unit

18. Page 18 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

19. Page 19 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.

20. Page 20 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

21. Page 21 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.

22. Page 22 Primary care unitType 2 patients Sample 1. Buadaeng 391 100 2. Nongkaen 3. Sabua 4. Dorglam 5. Suanpor 6. Jantai 7. Samkhar 8. Kealeg 9. Nonsawan 10. Namkham 11. Buakhaow 172 99 91 101 89 26 49 117 57 76 43 25 23 25 22 7 12 30 14 19 12. Nongsuay 13. Tajoi 79 78 20 Total 1,425 360 Table 4 : The samples were chosen from 13 Primary Care Unit in Pathumrat district, Roi Et province

23. Page 23 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

24. Page 24 Validity and reliability 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.

25. Page 25 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.

26. Page 26 Statistical analytical used: 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.

27. Page 27Limitation Researcher is the interviewer ; bias information The laboratory examine for the accuracy of glycemic control should be difference when they change the machine.

28. Page 28 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.

29. Page 29 Research Activities Time 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 Schedule

30. Page 30 Budget Equipment 15,000 Travel 3,000 Materials and Supplies 7,500 Consultant 2,500 Printing 2,000 Total Direct Costs30,000

31. Page 31 The end & Thank you for your kindness