Purpose: This study aimed to examine the effects of a three-month mobile health diabetes self-management program (MHDSMP) on glycemic control, diabetes self-management (DSM) behaviors and patient satisfaction in adults with uncontrolled type 2 diabetes (T2DM) in Thailand.Design/methodology/approach: This was a three-arm, parallel-group, randomized controlled trial among 129 adults with uncontrolled T2DM who attended the medical outpatient department in a medical center. The participants were randomly assigned to the three study groups (n = 43 per group), including MHDSMP, telephone follow-up (TF) and usual care (UC). MHDSMP encompassed four components, including DSM engagement, DSM mobile application, motivational text messages and telephone coaching. Outcomes were evaluated at three-month end-of-study by using HbA1C and response to the Summary of Diabetes Self-Care Activities (SDSCA) and the Client Satisfaction Questionnaire (CSQ-8). Data were analyzed by using descriptive statistics and multivariate analysis of covariance (MANCOVA).Findings: The findings revealed that at the end-of-study, HbA1C decreased from 7.80 to 7.17% (p < 0.001) in MHDSMP group, from 7.72 to 7.65% (p = 0.468) in TF group, and from 7.89 to 7.72% (p = 0.074) in UC group. Significantly higher SDSCA and CSQ-8 scores were also observed in MHDSMP compared to TF and UC groups (F = 12.283, F = 19.541, F = 8.552, p < 0.001, respectively).Originality/value: This study demonstrated that MHDSMP adjunct with usual care is beneficial for patient outcomes in adults with uncontrolled T2DM in Thailand, compared to TF and UC groups.

Objective: To evaluate and synthesize evidence on the impact of educational interventions for individuals with insulin-treated type 2 diabetes mellitus (T2DM). Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases (Scopus, PubMed, Medline, CINAHL Plus with Full Text, and Web of Science) were systematically searched in February 2024. The search focused on studies published between 2019 and 2024 that investigated the impact of educational interventions on individuals with insulin-treated T2DM. Reference lists of the included studies were also manually searched. Titles and abstracts were screened for eligibility, and relevant full texts were assessed. Results: Out of 1,032 identified records, 11 studies met the inclusion criteria. According to the data synthesized using a convergent integrated analysis framework, five major themes have emerged: 1) Glycemic control (including subthemes improving HbA1C, decreasing postprandial plasma glucose, and decreasing fasting plasma glucose), 2) Insulin-related complications (including subthemes reducing hypoglycemic events and reducing the size of lipohypertrophy), 3) Knowledge, Attitude, and Practice (including subthemes engaging in self-management, improving insulin injection technique, improving knowledge, and improving attitude toward insulin treatment), 4) Optimal dose of insulin, and 5) Improving quality of life. Conclusion: Educational interventions are crucial for improving diabetes-related outcomes and reducing complications in individuals with insulin-treated T2DM. These interventions enhance knowledge, attitudes, and self-management practices, leading to better glycemic control and quality of life. Healthcare settings should develop and provide tailored educational programs for individuals with insulin-treated T2DM to optimize outcomes and minimize complications.

Introduction: Older people mostly found unable to adhere with warfarin treatment guidelines. The health service system is challenged in order to improve medication adherence in older population under limited health resources. The purpose of this study was to explore health systems factors on warfarin adherence in older population, particularly in resources constraint setting. Methods: This study was a cross-sectional predictive study that enrolled older people who experienced atrial fibrillation (AF) and treated by warfarin, aged 60 years and over, and followed up at the warfarin clinic. Results: A total of 197 participants with the mean age of 72.03 years (SD = 8.84) was recruited. Almost of them (85.8%) reported adhered to warfarin prescription. More than a half (60.5%) were able to report their targeted INR. Participants who stayed with the family had 5.54 times (95% CI 1.79– 19.33), took regular daily dose warfarin had 5.07 times (95% CI 1.05– 24.49), perceived targeted INR had 2.94 times (95% CI 1.04– 8.29), and received family support had 1.33 times (95% CI 1.11– 1.60) increased odds of warfarin adherence than those who did not. Participants who perceived a barrier to taking medication had 0.93 times decreased odds of warfarin adherence than those who did not (95% CI 0.86– 0.99). Conclusion: Healthcare system should encourage family to support the older population with AF in order to increase warfarin adherence. Future research should develop intervention combining family support to promote warfarin adherence.

Introduction: Insulin is an effective treatment for achieving glycemic control and delaying diabetes-related chronic complications. Even with receiving insulin therapy, adults with type 2 diabetes (T2DM) may still struggle to reach their glycemic targets. Objective: This study aimed to determine factors associated with glycemic control in Thai adults with insulin-treated T2DM. Methods: A cross-sectional study was conducted among adults with insulin-treated T2DM between July 2021 - May 2022. Glycemic control is measured by Hemoglobin A1C (HbA1C), and good glycemic control was defined as HbA1C < 7%. Characteristics of adults with T2DM were analyzed using descriptive statistics. Determinant factors of glycemic control, including diabetes self-management, attitude toward insulin treatment, social support, patient-healthcare providers communication, self-monitoring blood glucose (SMBG), insulin injection technique, self-reported hypoglycemia, and lipohypertrophy, were analyzed using binary logistic regression. Results: Of the 273 participants, the mean age was 62.1 (SD = 10.7) years, 60.8% were females, and 41.8% achieved good glycemic control. Binary logistic regression analyses after adjusting for gender, age, BMI, education level, and health benefits show that performing better diabetes self-management (Adjusted odds ratio (AOR) = 1.15; 95% CI: 1.10– 1.21, p < 0.001), had a less negative attitude toward insulin treatment (AOR = 0.92; 95% CI: 0.89– 0.96, p < 0.001), demonstrated better insulin injection techniques (AOR = 1.35; 95% CI: 1.13– 1.60, p < 0.001), and performed SMBG at least 3 times per week (AOR = 9.80; 95% CI: 2.88– 33.33, p < 0.001) were more likely to achieve good glycemic control in Thai adults with insulin-treated T2DM. Conclusion: Diabetes self-management, attitude toward insulin treatment, insulin injection technique, and SMBG were significantly associated with glycemic control in Thai adults with insulin-treated T2DM.

Self-management empowers non-communicable disease (NCDs) patients to improve health, enhance quality of life (QoL), and reduce adverse outcomes. This study aims to synthesize empirical evidence on the effectiveness of self-management interventions in improving QoL and health outcomes among patients with NCDs. Following the PRISMA guidelines, a systematic search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, ScienceDirect, and OVID databases was conducted to identify relevant studies published between 2019 and 2024. Studies were included if they evaluated the impact of self-management interventions on QoL among adults with NCDs using randomized controlled trials or experimental designs. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A random-effects meta-analysis was performed to calculate pooled standardized mean differences using Hedges' g. Heterogeneity was assessed using Cochran's Q test and the I² statistic. Sensitivity analyses and publication bias assessments were also conducted. Eleven studies involving 1,591 participants were included in the systematic review, and 10 studies were eligible for the meta-analysis. The pooled analysis demonstrated that self-management interventions significantly improved QoL compared with standard care (Hedges' g = 0.58; 95% CI: 0.34-0.81). Moderate-to-substantial heterogeneity was observed across studies (I² = 69.3%). Subgroup analysis indicated that intervention effects varied by country income level, with larger effect sizes observed in upper-middle-income countries. Sensitivity analysis confirmed the robustness of the findings. Funnel plot inspection and Egger's test indicated no statistically significant evidence of publication bias. Self-management interventions are associated with significant improvements in QoL among individuals with NCDs. These findings highlight the importance of integrating structured self-management programs into chronic disease care. Given the observed heterogeneity across studies, future research should focus on standardized intervention components, rigorous study designs, and evaluation across diverse healthcare settings to better understand the long-term effectiveness of self-management strategies. Not applicable.

BACKGROUND The co-occurrence of chronic illnesses and substance use presents complex challenges for health care systems. Understanding the interplay between these factors, compounded by the context of the COVID-19 pandemic, is essential for effective intervention strategies. OBJECTIVE This study aims to investigate the relationships among chronic illness, substance use, and COVID-19 infection in adults aged 50 years and older. METHODS Participants were 1196 adults aged 50 years and older. Descriptive statistics were used to describe demographic information. Logistic regressions and multiple regression analyses were used to determine associations between chronic illnesses, substance use, and COVID-19 infection. Mediation analysis was used to determine the effect of chronic illness mediators in the association between COVID-19 concerns and substance use. RESULTS The mean age was 68 (SD 10.3) years, with 58.6% (701/1196) being women. Adjusted analysis revealed that age and sex (women) significantly predicted a lower level of substance use (P<.05). However, marital status (separated or widowed) and chronic illness significantly predicted a higher level of substance use (P<.05). Furthermore, having dementia, arthritis, and high cholesterol significantly predicted a higher level of concern about the COVID-19 pandemic (P<.05). Logistic regression analysis indicated that individuals with hypertension (odds ratio [OR] 1.91, 95% CI 1.37-2.66; P<.001), lung disease (OR 2.42, 95% CI 1.23-4.75; P=.01), heart condition (OR 1.99, 95% CI 1.28-3.10; P=.002), stroke (OR 2.35, 95% CI 1.07-5.16; P=.03), and arthritis (OR 1.72, 95% CI 1.25-2.37; P=.001) were more likely to have their work affected by the COVID-19 pandemic. The mediation analysis showed a significant effect of COVID-19 concern on substance use through the mediation of chronic illness, with a 95% CI of –0.02 to –0.01 and an indirect effect of –0.01. CONCLUSIONS Our study reveals complex associations among chronic illnesses, substance use, and COVID-19 infection among adults aged 50 years and older. It underscores the impact of demographics and specific chronic conditions on substance use behaviors and COVID-19 concerns. In addition, certain chronic illnesses were linked to heightened vulnerability in employment status during the pandemic. These findings emphasize the need for targeted interventions addressing physical health and substance use in this population during the COVID-19 pandemic.