BACKGROUND. Gyeonggi province, the largest province in Korea, was developing integrated interventions for elderly patients with diabetes at five HDRM(Hypertension/Diabetes Registration and Management) centers and 10 community public health centers in Gyeonggi province since 2017.

PURPOSE. The purpose of this pilot study is to assess the feasibility of a community-based integrated diabetes self-management program(IDSMP) for elderly patients with diabetes comparing treatment participants to a randomized usual-care control group at 12-weeks. This IDSMP was consisted of two lectures on principles of diabetes management, self-monitoring blood glucose level for 12 weeks and five times face-to-face lifestyle counseling delivered by registered nurses and dieticians at five HDRM centers in Gyeonggi province, Korea.

METHODS. A total of 284 elderly patients with type 2 diabetes were randomized to a usual-care control group or 12-weeks integrated diabetes self-management program(IDSMP) for elderly patients at five HDRM centers in 2019. Randomized participants were compared at 12 weeks. HbA1C, blood pressure and BMI were measured at baseline and 12-weeks. All other data about diabetes knowledge, self-efficacy and self-management were collected by standardized questionnaires. Usual-care which local hypertension/diabetes registration and education centers at five HDRM centers carry on for diabetes care included two lectures on principles of diabetes management and self-monitoring blood glucose level for 12 weeks.

RESULTS.  At baseline, no significant differences in baseline characteristics were observed between the intervention and control groups. HbA1C of patients allocated to the intervention group were higher than controls however the difference was not significant statistically. Within-group comparisons showed weight, BMI, systolic blood pressure, diastolic blood pressure and HbA1C improved at 12-weeks in the intervention group(p<0.05). No significant difference was found in diastolic blood pressure in the control group. However, weight, BMI, systolic blood pressure and HbA1C improved at 12-weeks in the controls (p<0.05). Between-group comparisons at 12-week showed that systolic blood pressure was improved in the intervention group compared to that in the controls (P<0.05). However, no between-group differences were seen in weight, BMI, diastolic blood pressure and HbA1C at 12-weeks. 

CONCLUSION. In this pilot study, IDSMP participants and usual-care controls made improvements in weight, BMI, systolic blood pressure and HbA1C. These findings suggest that both IDSMP and usual-care of local hypertension/diabetes registration and education centers may effective to help people with diabetes without elevated A1C until 12-weeks in the community. However for the more concrete conclusion longer than 12-weeks follow-up test needed and at the time of 6-months follow-up will be carry on in this pilot study. It is anticipated that study results will become available in early 2020.

Community-based integrated diabetes self-management program(IDSMP) for elderly patients in Gyeonggi province, Korea