Effects of a Health Promotion Program Conducted by
Nurses on Stabilization of HbA1C in Subjects at Risk for
Diabetes: A Phase III Randomized Controlled Trial
Yuwarat Moungngern RN, MSc1, Supaporn Sanguanthammarong RN, MEd1, Piyanun Teparak RN1,
Apiradee Sriwijitkamol MD2
Affiliation :
1 Prevention and Health Promotion Nursing Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Background : Although pre-diabetes subjects are at increased risk for developing type 2 diabetes, several studies have shown that
lifestyle modi(cid:976)ication can decrease the number of cases that progress to diabetes. Data from Thai pre-diabetes population relative
to the effect of medium-term intervention to lower hemoglobin [HbA1C] and prevent the onset of diabetes are scarce.
Objective : To investigate the effect of a nurse-managed 6-month health promotion program designed to lower HbA1C and other
risk factors for diabetes, and to prevent the onset of diabetes among Thai persons diagnosed with pre-diabetes.
Materials and Methods : This 6-month randomized controlled trial was conducted at the outpatient department of the Siriraj
Hospital, Thailand’s largest national tertiary referral center-during the 2012 to 2014 study period. Subjects at risk for diabetes
were recruited and randomly assigned to either the intervention group or the control group. Study group subjects participated in
the study’s health promotion protocol, with control group subjects receiving only routine self-care recommendations for preventing
diabetes. Clinical and laboratory characteristics in both groups were recorded at baseline and at preestablished time points.
Results : One hundred twenty-(cid:976)ive pre-diabetes subjects were included, with 61 and 64 subjects assigned to the study and control
groups, respectively. At the 6-month time point, 9.3% in the study group and 8.6% in the control group could reduce their HbA1C
level by more than 0.5%. Increase of HbA1C at the end of study was less frequent in the study group than in the control group
(16.7% vs. 36.2%, respectively; p = 0.025). Diet and exercise behavior with self-ef(cid:976)icacy improved more in the study group than in
the control group. Prevalence of metabolic syndrome was signi(cid:976)icantly reduced from 50% to 23.8% in the study group (p<0.001).
Conclusion : The nurse-managed health promotion program investigated among Thai pre-diabetes subjects in the present study
improved HbA1C, several risk behaviors, and the incidence of metabolic syndrome. Implementation of this program may bene(cid:976)it
both patients and health care systems by increasing patient health and lowering diabetes-related costs.
Keywords : Thailand Health promotion program, Nurses, HbA1C reduction, Diabetes, Health belief model
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