Effectiveness of a self-management support program for Thais with type 2 diabetes: Evaluation according to the RE-AIM framework.

Delivering diabetes self-management support is an enormous challenge for healthcare providers with limited human resources. We conducted a cluster randomized controlled trial to assess the effectiveness of a DSMS program incorporating the computer-assisted instruction. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was applied to evaluate the DSMS program. Ten Public Health Centers in Bangkok, Thailand were randomized into either DSMS program or usual care. Forty eligible patients with type 2 diabetes in each Public Health Center were randomly selected. Totally, 403 patients (200 controls and 203 interventions) participated. About 93.8% participants completed the six-month follow-up. Over six months, adjusted mean changes of hemoglobin A1c (-0.14%, 95% confidence interval = -0.02 to -0.26, fasting plasma glucose (-6.37 mg/dL, -1.95 to -10.78), health behaviors (3.31 score, 2.27 to 4.34), and quality of life (1.41 score, 0.69 to 2.12) were significantly improved in intervention compared to control group. In conclusion, the DSMS program facilitates Public Health Centers to accomplish their support for people with diabetes.

Prevalence of metabolic syndrome and its association with serum uric acid levels in Bangkok Thailand.

Metabolic syndrome (MetS) and hyperuricemia are important risk factors for cardiovascular disease, hypertension and renal disease. The relationship between serum uric acid (UA) levels and MetS remains unclear. In the present study we determined the presence of MetS and measured UA levels among personnel at the Thai Red Cross Society and Chulalongkorn University to evaluate the possible presence of an association between the two. We conducted this cross sectional study in 2009. A total of 2,804 persons, aged 35-60 years (628 men and 2176 women) filled out questionnaires, had laboratory testing and were included in the study. MetS was defined by criteria harmonized from six international expert groups. The association between MetS and UA levels was determined using multivariable logistic regression. The overall prevalences of MetS were 25.1, 21.1, and 18.2% when a BMI > or = 23 kg/m2, a BMI > or = 25 kg/m2 or waist circumference were used to classify abdominal obesity, respectively. Body mass index, waist circumference, blood pressure, and triglycerides significantly elevated in both men and women with elevated UA levels (all a p-value < 0.005). After adjustment for potential confounders, the odds ratio of having MetS in the fourth quartile compared with the first quartile of a UA level was 2.77 times for men (95% CI 1.60-4.79) and 8.04 times for women (95% CI 5.43-11.91). There wes a stronger association between the presence of MetS and UA in women than men. UA levels were associated with the presence of MetS.