Effects of Behavior Change on Glycemic Control in Type 2 Diabetes Patients with Uncontrolled Blood Sugar


  • Teeraparp Saotong Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
  • Panan Pichayapinyo Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
  • Sunee Lagampan Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand


diabetes type 2, Transtheoretical model, HbA1c, medication, food consumption, physical activity


     This quasi-experimental study aimed to investigate the effect of behavior change on glycemic control among poor controlled type-2 diabetes patients with HbA1c above 8%. They all had oral glycemic control medication and received care in non-communicable care diseases units, Surin province. The experimental group consisted of 31 poor controlled diabetes patients and the comparison group consisted of 32 participants. By using the Transtheoretical model as the conceptual framework, the experimental group received 4 sessions including: 1) self-awareness enhancement; 2) motivation boost; 3) skill development and self-confident; and 4) positive reinforcement. Meanwhile, the comparison group received routine nursing care. Data were collected using questionnaires prior to the intervention, at the eighth week after the intervention, and at the twelfth week as a follow-up period. Data were analyzed using independent t-test and paired samples t-test.

     Results revealed that the experimental group reported higher mean score in behavior change at week 8 and week 12 (p<.05), and mean difference scores in the experimental group was greater than those in the comparison group at week 12 when compared to the comparison group. The mean score of self-efficacy in the experimental group was higher at week 8 and week 12., The mean difference score between the two groups was not statistically significant difference at week 8 and week 12 (p<.05).  There was no statistically significant difference in HbA1c level between two groups. 

      Results of the study suggest that the study duration should be increased to follow up behavior maintenance and HbA1c level. Therefore, the community nurse practitioners and healthcare providers should apply this program to change patients’ behavior on glycemic control among poor controlled type-2 diabetes patients with HbA1c above 8%  in community.


Download data is not yet available.


1. World Health Organization. Global status report on noncommunicable diseases 2014 (No. WHO/NMH/NVI/15.1). World Health Organization. 2014.

2. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus. Diabetes Care 2007;30(1):162-72.

3. Chatchalit R. The diabetes epidemic and impact on Thailand 2013 [Internet]. 2016 [cited 2016 April 17]. Available from: http://www.dmthai.org/briefingbook.pdf. (in Thai).

4. American Diabetes Association. Standard of medical care in diabetes. Diabetes Care 2016; 39(1):6-72.

5. American Diabetes Association. 6. Glycemic Targets. Diabetes Care 2017;40 (Supplement 1):S48-S56.

6. American Diabetes Association. Standards of medical care in diabetes-2017: Abridged for primary care providers. Clinical Diabetes 2017;35(1):5-26.

7. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. Diabetes Care 2009;32(1):193-203.

8. Diabetes Association of Thailand under The Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn. Guidelines for Diabetes Mellitus 2017. Bangkok: Aroonprinting; 2017. (in Thai).

9. Miller CK, Kristeller JL, Headings A, Nagaraja H, Miser WF. Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Journal of the Academy of Nutrition and Dietetics 2012;112(11):1835-42.

10. Al-Shookri A, Khor G, Chan Y, Loke S, Al-Maskari M. Effectiveness of medical nutrition treatment delivered by dietitians on glycaemic outcomes and lipid profiles of Arab, Omani patients with type 2 diabetes. Diabetic Medicine 2012;29(2):236-44.

11. Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean
diet improves cardiovascular risk factors and diabetes control among overweight patients
with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes,Obesity and Metabolism 2010;12(3):204-209.
12. Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. Journal of the American Medical Association 2011;305(17):1790-99.

13. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes. Diabetes Care 2010;33(12):e147-e67.

14. Prochaska JO, Diclemente CC, Norcross JC. In search of how people change: Applications to addictive behaviors. American Psychologist 1992;47(9):1102-14.

15. Arafat Y, Mohamed Ibrahim MI, Awaisu A. Using the transtheoretical model to enhance self-management activities in patients with type 2 diabetes: a systematic review. Journal of Pharmaceutical Health Services Research 2016;7(3):149-56.

16. Guicciardi M, Lecis R, Anziani C, Corgiolu L, Porru A, Pusceddu M, et al. Type 2 diabetes mellitus, physical activity, exercise self-efficacy, and body satisfaction. An application of the transtheoretical model in older adults. Health Psychology and Behavioral Medicine 2014;2(1):748-58.

17. Holmen H, Torbjornsen A, Wahl AK, Jenum AK, Smastuen MC, Arsand E, et al. A mobile health intervention for self-management and lifestyle change for persons with type 2 diabetes, part 2: one-year results from the Norwegian randomized controlled trial renewing health. JMIR mHealth and uHealth 2014;2(4):e57.

18. Partapsingh VA, Maharaj RG, Rawlins JM. Applying the Stages of Change model to type 2 diabetes care in Trinidad: A randomised trial. Journal of Negative Results in BioMedicine2011;10(1):13:1-8.

19. Yardley L, Morrison L, Bradbury K, Muller I. The person-based approach to intervention development: application to digital health-related behavior change interventions. Journal of Medical Internet Research 2015;17(1):e30.

20. Polit DF, Hungler BP. Nursing research principles and methods. Philadelphia. Lippincott Williams and Wilkins. 1999.

21. Hathaiporn C. Effects of program to promote diet and yoga-based exercise on glycemic control of patients with type 2 diabetes mellitus in Samutprakarn Province [thesis]. Bangkok; Mahidol University; 2013. (in Thai).

22. Bandura A. Social foundations of thought and action : A Social Cognitive Theory. Prentice-Hall : United States of America, 1986.

23. Kiernan M, Schoffman DE, Lee K, Brown SD, Fair JM, Perri MG, Haskell WL. The Stanford leisure-time activity categorical item (L-Cat): a single categorical item sensitive to physical activity changes in overweight/obese women. International Journal of Obesity 2013:37(12):1597-602.



How to Cite

Saotong ธ, Pichayapinyo ป, Lagampan ส. Effects of Behavior Change on Glycemic Control in Type 2 Diabetes Patients with Uncontrolled Blood Sugar. JHNR [Internet]. 2020 Nov. 28 [cited 2022 Jun. 26];36(3):19-32. Available from: https://he01.tci-thaijo.org/index.php/bcnbangkok/article/view/246233



Research articles