This randomized controlled trial aims to develop and evaluate a telenursing-based Diabetes Self-Management Education and Support (DSMES) program with uncontrolled type 2 diabetes mellitus in Thailand. The program is designed to improve diabetes self-management through nurse-led education, behavioral support, and regular follow-up delivered via telecommunication technologies. Participants with type 2 diabetes and poor glycemic control will be randomly assigned to either an intervention group receiving a 12-week telenursing DSMES program or a control group receiving usual care. The intervention includes an initial in-person education session followed by structured video call follow-ups provided by nurse. The primary outcome of this study is the feasibility of implementing telenursing for DSMES in Thailand. Secondary outcomes include changes in glycemic control, body mass index, diabetes knowledge, self-care behaviors, coping behaviors, quality of life, healthcare costs, and frequency of acute care use. The findings from this study are expected to provide evidence to support the use of telenursing as an accessible and sustainable approach for diabetes self-management in the Thai healthcare context.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
128
This intervention is a nurse-led, telenursing-based Diabetes Self-Management Education and Support (DSMES) program delivered over a 12-week period. It includes an initial face-to-face diabetes education session followed by scheduled follow-up sessions conducted via video calls. The program focuses on improving diabetes self-management through education, behavioral support, goal setting, problem-solving, and ongoing monitoring tailored to individual patient needs.
Nong Pa Khrang Municipal Hospital
Chiang Mai, Thailand
Feasibility of telenursing for diabetes self-management education and support (DSMES)
Feasibility outcomes, including participation rate, completion rate, and adherence level, were analyzed using descriptive statistics under the per-protocol (PP) approach, which included only participants who completed all study assessments.
Time frame: at 12-week follow-up period after enrollment
Glycated hemoglobin (HbA1c) level
HbA1c (%) will be measured using standard laboratory methods obtained from health assessment records. Change from baseline will be calculated as the difference between baseline and 12-week HbA1c values.
Time frame: From baseline to 12 weeks after enrollment
Body Mass Index (BMI)
Body mass index (kg/m²) will be calculated from measured weight and height obtained from health assessment records. Change from baseline will be calculated as the difference between baseline and 12-week BMI values.
Time frame: From baseline to 12 weeks after enrollment
Change from baseline in diabetes knowledge score measured by the Diabetes Knowledge Scale (DIAKS)
Diabetes knowledge will be assessed using the Thai version of the Diabetes Knowledge Scale (DIAKS), consisting of 21 items with true, false, or don't know response options. Total scores will be calculated based on the number of correct responses. Change from baseline will be calculated using the 12-week assessment as the primary analysis time point; 6-week data will be used for interim descriptive analysis.
Time frame: From baseline to 6 weeks and 12 weeks after enrollment
Self-care behavior
Self-care behavior will be assessed using the Thai Diabetes Self-Management Questionnaire-Revised (T-DSMQ-R). Total scores will be calculated according to standard scoring procedures, with higher scores indicating better diabetes self-management. Change from baseline will be calculated using the 12-week assessment as the primary analysis time point; 6-week data will be used for interim descriptive analysis.
Time frame: From baseline to 6 weeks and 12 weeks after enrollment
Positive coping behavior
Positive coping behavior will be assessed using the Short Thai Stress Test (ST-5), a five-item questionnaire rated on a 0-3 Likert scale. Total scores range from 0 to 15, with higher scores indicating greater stress severity. Change from baseline will be calculated using the 12-week assessment as the primary analysis time point; 6-week data will be used for interim descriptive analysis.
Time frame: From baseline to 6 weeks and 12 weeks after enrollment
Quality of life (QoL)
Quality of life will be assessed using the Thai version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL19). The average weighted impact (AWI) score will be calculated, with scores ranging from -9 to +3. Change from baseline will be calculated using the 12-week assessment as the primary analysis time point; 6-week data will be used for interim descriptive analysis.
Time frame: From baseline to 6 weeks and 12 weeks after enrollment
Healthcare costs
Healthcare costs will be assessed through review of medical and financial records, including outpatient visits, inpatient admissions, medications, laboratory tests, and other diabetes-related expenses. Total healthcare costs per participant will be summarized for the 12-week follow-up period.
Time frame: at 12-week follow-up period after enrollment
Frequency of acute care use
Frequency of acute care use will be assessed using hospital records, including emergency department visits and hospital admissions. The total number of acute care events per participant will be recorded during the follow-up period.
Time frame: at 12-week follow-up period after enrollment
All-cause mortality
All-cause mortality will be assessed using hospital follow-up records. Mortality status will be recorded for each participant during the follow-up period.
Time frame: at 12-week follow-up period after enrollment
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