Background  
The learning management was based on a 5E stages learning cycle principle, namely, engagement, exploration, explanation, elaboration and evaluation. Explanation step to expand knowledge for learners to seek knowledge, practice thinking, practice and solve problems on their own with nurses as directing, giving advice, guiding, helping, encouraging and motivating encourage learners to think and self-learning.

Aim  
1. To develop the learning process of diabetic nephropathy with high glycemic value per self-care record. 

2. To improve self-care outcomes of diabetic nephropathy with high cumulative glucose levels on hyperglycemia.

Method  
This was a quasi-experimental study involving all people with diabetes in the 10th health service area. We developed questionnaire to collect data on demographic characteristics of participants, and their knowledge and experience in diabetes program. We used the Statistical Package for Social Sciences (SPSS), version 21, to analyses the data. Demographic characteristics of participants were summarized using descriptive statistics. Pre-test and post-test design was used to determine association between knowledge and one group demographic features, while the pair-t test was conducted to determine differences in level of knowledge based on the demographic features.

Results  
98.1% of the participants in this study had insufficient knowledge on diabetes management. Type 2 diabetes with nephropathy who have aged between 50-59 years old a statistically significantly higher level of knowledge at posttest (24.67 ± 2.79, p =.014) , compared to those pre-test (22.92 ± 4.56, p = .028) . Those who had a high glycemic control and those with post-learning had a statistically significantly higher knowledge than that pretest. Training in diabetes self-management program was associated with more knowledge in. In terms of experience, 55% of the participants in this study were not experienced in performing self-management diabetes. There were no differences in their level of experience based on their illness condition, during time of illness, and years of education as diabetes.

Discussion  
Diabetic patients with high hemoglobin A1C levels have been developed to increase knowledge, experience of self-care with skills meet the standards of care, to make self-care records. They understand to create a systematic thought process to modify behavior by applying it in daily life. The goal calendar using as a guideline for self-management in a chronic non-communicable disease clinic. To the service recipient with practice by thinking organizing lifestyle patterns such as medications, injecting on insulin, food choices exercise, etc. Get to know the psychosocial risk factors among chronic diabetic patients that affecting diabetes control for use in nursing planning. Extend the process results to other service units such as PCC in the health service network.

References  
1. Chatterjee, S., Riewpaiboon, A., Piyauthakit, P., Riewpaiboon, W., Boupaijit, K., Panpuwong, N., &amp; Archavanuntagul, V. (2011). Cost of diabetes and its complications in Thailand: A complete of economic burden. Health and social care in the community, 19 (3), 289-298.  
2. Glasgow, R. E., Funnell, M. M., Bonomi, A. E., Davis, C., Beckham, V., &amp; Wagner, E. H. (2002). Self-management aspects of the improving chronic illness care breakthrough series:Implementation with diabetes and heart failure teams. Annals of Behavioral Medicine , 24 (2),80-87. 



**Background**  
The learning management was based on a 5E stages learning cycle principle, namely, engagement, exploration, explanation, elaboration and evaluation. Explanation step to expand knowledge for learners to seek knowledge, practice thinking, practice and solve problems on their own with nurses as directing, giving advice, guiding, helping, encouraging and motivating encourage learners to think and self-learning.

**Aim**
1. To develop the learning process of diabetic nephropathy with high glycemic value per self-care record.
2. To improve self-care outcomes of diabetic nephropathy with high cumulative glucose levels on hyperglycemia.

**Method**  
This was a quasi-experimental study involving all people with diabetes in the 10th health service area. We developed questionnaire to collect data on demographic characteristics of participants, and their knowledge and experience in diabetes program. We used the Statistical Package for Social Sciences (SPSS), version 21, to analyses the data. Demographic characteristics of participants were summarized using descriptive statistics. Pre-test and post-test design was used to determine association between knowledge and one group demographic features, while the pair-t test was conducted to determine differences in level of knowledge based on the demographic features.

**Results**  
98.1% of the participants in this study had insufficient knowledge on diabetes management. Type 2 diabetes with nephropathy who have aged between 50-59 years old a statistically significantly higher level of knowledge at posttest (9.6 ± 1.68, p =0.00) , compared to those pre-test (8.4± 0.44, p = 0.00). Those who had a high glycemic control and those with post-learning had a statistically significantly higher knowledge than that pretest. Training in diabetes self-management program was associated with more knowledge in. In terms of experience, 55% of the participants in this study were not experienced in performing self-management diabetes. There were no differences in their level of experience based on their illness condition, during time of illness, and years of education as diabetes.

**Discussion**  
Diabetic patients with high hemoglobin A1C levels have been developed to increase knowledge, experience of self-care with skills meet the standards of care, to make self-care records. They understand to create a systematic thought process to modify behavior by applying it in daily life. The goal calendar using as a guideline for self-management in a chronic non-communicable disease clinic. To the service recipient with practice by thinking organizing lifestyle patterns such as medications, injecting on insulin, food choices exercise, etc. Get to know the psychosocial risk factors among chronic diabetic patients that affecting diabetes control for use in nursing planning. Extend the process results to other service units such as PCC in the health service network.

**References**
1. Chatterjee, S., Riewpaiboon, A., Piyauthakit, P., Riewpaiboon, W., Boupaijit, K., Panpuwong, N., & Archavanuntagul, V. (2011). Cost of diabetes and its complications in Thailand: A complete of economic burden. Health and social care in the community, 19 (3), 289-298.
2. Glasgow, R. E., Funnell, M. M., Bonomi, A. E., Davis, C., Beckham, V., & Wagner, E. H. (2002). Self-management aspects of the improving chronic illness care breakthrough series:Implementation with diabetes and heart failure teams. Annals of Behavioral Medicine , 24 (2),80-87.

Effectiveness of goal-oriented calendar based on 5Es learning with diabetes nephropathy