Jirarat Ruetrakul

Background: Type 2 diabetes mellitus (T2DM) is a major public health problem in Thailand, particularly in rural areas where individuals have limited access to structured diabetes care and education. Poor self-management contributes to uncontrolled glycemic levels and long-term complications. Objectives: This study evaluated the effectiveness of a community-based health care program on glycemic control and self-care behaviors among adults with uncontrolled T2DM. Methods: A quasi-experimental study was conducted among 80 patients with uncontrolled T2DM in Kalasin Province. Participants were assigned to either an intervention group (n = 40) or a comparison group (n = 40). The 12-week intervention consisted of diabetes self-management education, individualized lifestyle support, and community/family engagement. Diabetes self-care behavior and glycated hemoglobin (HbA1c) were assessed at baseline and Week 12. Statistical analyses included paired t-test, independent t-test, and 95% confidence intervals. Results: The intervention group demonstrated a significant improvement in self-care behavior (MD = 14.83; p < 0.0001), compared with a minimal change in the comparison group (0.80; p = 0.756). HbA1c levels significantly decreased in the intervention group (−0.47%; 95% CI: −0.61 to −0.33; p < 0.0001), while a slight nonsignificant increase was observed in the comparison group (0.11%; p = 0.210). The between-group analysis showed a significant reduction in HbA1c favoring the intervention (−0.92%; p < 0.0001), supported by a large effect size (Hedges’ g = 0.87). Conclusions: This community-based health care program effectively enhanced diabetes self-management behaviors and improved glycemic control. Integrating such behavioral support into primary health care services may strengthen long-term diabetes management and reduce complications among patients with uncontrolled T2DM.

Background: Individuals receiving intensive care are particularly vulnerable to developing pressure sores. This heightened risk necessitates a thorough understanding of relevant risk factors and the time at which these injuries manifest, facilitating effective prevention. Objective: This investigation, structured as a retrospective cohort study, aimed to assess the duration until pressure sore onset and identify contributing risk factors among 50 adult patients in an intensive care unit (ICU), observed over 12 weeks. Methodology: Our analysis employed the Kaplan–Meier approach for survival analysis. We then used the log-rank test to determine significant differences in survival curves. We utilized COX proportional regression analysis to explore the associations between various factors and the development of pressure injuries during the ICU stay. Results: Data from 50 adult ICU patients showed that 29 patients developed pressure sores. Coccyx (44%) and back (6%) were most affected. The median survival time from ICU admission to the final skin examination for pressure sore development was 3 days. The multivariable Cox regression analysis revealed that males with a high BMI, increased systolic blood pressure, elevated albumin levels, and a more extended ICU stay were at a significantly higher risk of developing pressure ulcers (p-value < 0.05). Conclusions: The research highlights the need to prioritize males with high BMI, high blood pressure, and high albumin patients in preventing pressure sores in the ICU, with an extended ICU stay significantly increasing the risk. This information can be utilized to develop clinical guidelines for reducing pressure sore incidence and improving patient care.