Hari Kusnanto, Fitriana, Wahyudi Istiono
Universitas Gadjah Mada, Yogyakarta, Indonesia
Abstract. People with diabetes are increasing in Indonesia to an estimated 16 million affected individuals in 2018. Diabetes is the leading cause of cardiovascular morbidities, stroke, blindness, kidney failure and lower limb amputation. Self-management of diabetes plays critical role in achieving blood glucose control and preventing complications. PACE-DIA questionnaire was developed to assess diabetes self-management activities, including medication adherence, dietary practices, physical activities, blood pressure control, and blood glucose monitoring.The objective of this study is to evaluate the ability of PACE-DIA questionnaire to predict HbA1C as a key indicator of blood sugar control among people with diabetes. The design of this study is cross-sectional, with a sample size of 79 individuals, non randomly selected from primary health centers located in Bantul, Gunung Kidul, Kulon Progo and Sleman, Yogyakarta Special Region. Participants living in these locations represent suburban, low-land, and high-land population. The PACE-DIA questionnaire was administered to each participant through face-to face interviews, followed by venipuncture to obtain 10 ml of blood from median cubital vein, for HbA1C measurement. Multiple linear regression analyses were carried out to estimate the crude and adjusted regression coefficients of items in the PACE-DIA questionnaire indicating the relative importance of these items in predicting blood sugar control. There were 7 participants who did not meet the criteria for diabetes diagnosis, leaving 72 individuals included in data analyses. All study participants were type-2 diabetics, with a mean of HbA1C levels 9.2%, ranging from 6.6% to 15%. Multiple linear regression demonstrated that participants who monitored their blood sugar more than once a month showed 2.3% less HbA1C (p = 0.016) compared to those who never or very rarely monitored their blood sugar. Those who took medication continuously and regularly had 1.7% HbA1C less than people who did not regularly take medication (p = 0.001). Study participants who avoided the consumption of sugary beverages and snack had 1.6% HbA1C less than those who did not change their diet after diabetes had been diagnosed (p = 0.003). People who did exercise or high intensity physical activities regularly at least twice a week showed 1.4% HbA1C less than those who never exercised or had low intensity of physical activities (p = 0.03). Normotensive individuals, without taking medication to reduce blood pressure, had 1% HbA1c less than study participants whose blood pressure had been 140/90 mmHg or higher (p = 0.01). The control of type-2 diabetes, suggested by acceptable level of HbA1C, could be achieved through self-monitoring of blood sugar, adherence to medication, exercise or physical activities, sugar free diet, and maintaining blood pressure less than 140/80 mmHg. PACE-DIA is a simple tool to assess the performance of diabetes self-management, so that active engagement with the control of blood sugar level could be continuously improved.
Keywords: PACE-DIA self-management diabetes HbA1C
