• Health Policy and Management
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• v.33 no.1
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• pp.3-18
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• 2023

Background: A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea. Methods: We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen's medical use model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region. Conclusion: The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

• Proceedings of the KSCN Conference
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• 2005.10a
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• pp.96-96
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• 2005

• Korean Journal of Adult Nursing
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• v.17 no.3
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• pp.444-451
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• 2005

Purpose: The purpose of this study was to evaluate whether the effect of the Internet diabetic education on plasma glucose in people with hyperglycemic diabetes. Method: A randomized design with control and experimental groups being assessed pre- and post-intervention was used. Twenty-two patients were randomly assigned to an intervention group and 21 to a control group. Participants were requested to input the blood glucose level weekly in http://www.biodang.com by cellular phone or wire Internet for 3 months. The researcher sends optimal recommendations to each patient using short message service(SMS) of cellular phone and wire Internet weekly. Results: Patients in the intervention group had a mean decrease of 1.3% in glycosylated haemoglobin ($HbA_1c$) levels and those in the control group had no significant difference. There was a significant mean change in 2-hour postprandial blood glucose(2HPPG) for the intervention group, with a mean change of-75.2mg/dl. The mean change in the control group was, however, not significant. Conclusion: These findings indicated that a web-based intervention using SMS of cellular phone improved $HbA_1c$ and 2HPPG.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.13 no.2
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• pp.235-241
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• 2006

Purpose: The purpose of this study was to evaluate the effect of a six month web-based diabetic education on plasma glucose in people with diabetes. Method: A randomized design with control and experimental groups being assessed pre- and post-intervention was used. Seventeen patients were randomly assigned to a control group and 18 to an experimental group. Participants were requested to input the blood glucose level weekly to http://www.biodang.com by cellular phone or wire Internet for 6 months. The researcher sent optimal recommendations to each patient using the short message service (SMS) for cellular phone and wire Internet. Messages were sent weekly for 6 months. Results: Glycosylated hemoglobin ($HbA_1c$) decreased 1.5 percentage points at 3 months and 1.4 percentage points at 6 months compared with baseline in the intervention group. Patients in the intervention group had a decrease in 2 hours post meal glucose (2HPMG) of 94.3mg/dl at 3 months and 82.5mg/dl at 6 months compared with baseline. Conclusion: This web-based intervention using SMS for cellular phone improved HbAlc, and 2HPMG for six months in patients with type 2 diabetes.

• Journal of Nutrition and Health
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• v.41 no.2
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• pp.147-155
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• 2008

Medical nutrition therapy (MNT) is considered a keystone of medical treatment of chronic diseases. However, only few studies have evaluated medical and economical outcome of MNT. The study was performed on the patient with type 2 diabetes mellitus to evaluate the effect of clinical and cost-effective outcomes of MNT. Subjects from two general hospitals were randomly assigned to two different groups; One receiving basic nutritional education (BE) (n = 35), and the other receiving intensive nutritional education (IE) (n = 32) for a 6-month clinical trial. The group which received BE had a single visit with a dietitian, while the other group which received IE had an initial visit with a dietitian addition to two visits during the first 4 weeks of the study periods. Anthropometric parameters, blood components, and dietary intake were measures at the beginning of study period and after 6 month. Cost-effective analysis included direct labor costs, educational materials and medication cost difference during 6 months. After 6 month, subjects from IE group showed significant reduction of body weight (p <0.05) and systolic blood pressure (p <0.05), whereas BE group did not show any significant changes. Result from biochemical indices showed glycated hemoglobin concentration was significantly reduced by 0.7% (p <0.05) only in the IE group. The ratio of energy intake to prescribed energy intake decreased significantly in both groups (p <0.05). Mean time taken for a dietitian to educate the subject was 67.9 ${\pm}$ 9.3 min/person for BE group, while 96.4 ${\pm}$ 12.2 min/person for IE group. Mean number of educational materials was 1.9 ${\pm}$ 0.7/person for BE group and 2.5 ${\pm}$ 0.7/person for IE group. Change in glycated hemoglobin level along the 6 month period of study can be achieved with an investment of \88,510/% by implementing BE and \53,691/% by implementing IE. Considering the net cost-effect of blood glucose control and HbA Ic, IE which provides MNT by dietitian had a cost efficiency advantage than that of BE. According to this study, MNT provided by dietitian had a significant improvements in medical and clinical outcomes compared to that of BE intervention. Therefore, MNT protocol should be performed by systemic intensive nutrition care by dietitian in clinical setting to achieve good therapeutic results of DM with lower cost.

• Journal of agricultural medicine and community health
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• v.42 no.4
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• pp.234-243
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• 2017

Objective: This study was aimed to evaluate the effectiveness of the diabetes education program implemented in a community hypertension and diabetes education center. Methods: Participants were thirty nine diabetic patients who received the education program in the center from May 2014 through May 2015. The education program consisted of two sessions for 2 days (45 minutes per session) regarding clinical information, nutrition and exercise for type 2 diabetes patients. Initially, they were assessed for general characteristics, knowledge on diabetes, self-efficacy and self-care behaviors. Reassessment was performed on their knowledge and self-efficacy directly after the program, and on self-care behaviors at 12 weeks after the program. Results: The mean score of diabetes knowledge was significantly increased from $5.27{\pm}2.10$ to $8.21{\pm}1.20$ (p<0.001) between before and after the program. The self-efficacy score was also significantly increased from $6.88{\pm}1.72$ to $8.16{\pm}1.47$ (p<0.001). The self-care behavior score was significantly increased from $3.59{\pm}1.89$ before the program to $4.35{\pm}1.29$ (p<0.001) at 12 weeks after the program. Conclusion: The diabetes education program may be effective on the improvement of knowledge, self-efficacy and self-care behaviors in type 2 diabetic patients.

• Journal of Korean Academy of Nursing
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• v.23 no.2
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• pp.170-186
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• 1993

This study evaluated the effect of diabetic group teaching programs in one university hospital in Seoul to predict when re-education would be needed. This study examined the patients’ knowledge at four points (before, directly after, three months and six months after the teaching program) and self-care performance related to diabetes twice (three months and six months after the teaching program). The subjects of the study were 24 admitted diabetic patients who participated in four-day teaching programs. Data were gathered from January to October, 1992 by means of an instrument developed from two diabetic knowledge tests which were equivalent in item differentiation and item discrimination coefficients. Collected data were analyzed by paired t-test, Pearson correlation, t and F tests. The results of study were as follows. 1. The analysis of the effect of the diabetic group teaching program and the duration of the effect of teaching. 1) The first hypothesis, that the diabetes knowledge score directly after the teaching program would be higher than before, was rejected (t=-1.40 ; p=.172). 2) The second hypothesis, that the diabetes knowledge score directly after teaching would be higher than three months later, was rejected(t= -4.27 ; p=.000). 3) The third hypothesis, that the diabetes knowledge score three months after teaching would be higher than six months later, was supported(t=2.43 : p=.020). 2. The relation of knowledge and self-care performance 1) The forth hypothesis, that the level of self-care performance related to diabetes three months later would be higher than six months later, was rejected( t=1.49 ; p=.146). 2) The fifth hypothesis, that the higher the diabetes knowledge, the higher the level of self-care performance, was rejected(r=.2086 ; p=.118). 3. The relation of diabetes knowledge and self-care performance according to demographic variables and structural variables of diabetes. 1) Diabetic knowledge scores varied according to the educational levels of the clients directly after the teaching. Three months after the teaching program higher educational levels and higher economic status were related to higher diabetic knowledge scores and men had higher knowledge scores than women. 2) Self-care performance scores of men were higher than those of women at three months and six months after the teaching program. 3) Before the diabetes teaching, the diabetic knowledge scores of subjects who had a diabetic patient in the family were higher than those who did not have patient in their family. Six months after the teaching, the diabetic knowledge scores of subjects who read the distributed books about diabetes were higher than those who did not read them. 4) No significance differences were found be-ween self-care performance and structural variables of dialetes. The results of this study indicated that the levels of diabetes knowledge and self-care performance incense of three months after the teaching program but decrease of six months. Reeducation would be needed between three and sir months. The investigator thinks that a study of the content and teaching methodology is needed to increase the education effect. The subjects want to hear patient histories of diabetic management. Group discussion would be helped after the teaching sessions.

• The Journal of Korean Academic Society of Nursing Education
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• v.19 no.2
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• pp.127-136
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• 2013

Purpose: The aim of the study was to evaluate the effect of self-monitoring of blood glucose (SMBG)-based Diabetes Self-Management Education (DSME) on glycemic control in type 2 diabetes. Methods: This study was designed to compare changes in glycemic control over 12months in SMBG-based DSME group (n=65) versus control group (n=65). Data were obtained from medical records type 2 diabetic patients treated with oral antidiabetic agents and above HbA1c 7.0% from June 2006 to August 2008. All participants completed DSME defined as informational intervention of lifestyle habits and reinforcement of educational Monthly News letter delivered by the diabetes nurse educator. SMBG-based DSME group requested to measure blood glucose 7 times a day for a week and to record their diary and received counseling with a focus on diet and lifestyle during the education. Assessments were conducted baseline, 3, 6 and 12 months. HbA1c was used as an index of glycemic control. Results: 12 months later, the level of HbA1c was reduced by $1.28{\pm}1.68%$ in experimental group and $0.49{\pm}1.05%$ in the control group. We found a significant effect of $Time^*$ Group interaction (p=.013). Conclusion: SMBG-based DSME for patients with type 2 diabetes with oral antidiabetic agents was effective in improving glycemic control and maintaining long-term glycemic control.

• Journal of agricultural medicine and community health
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• v.38 no.2
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• pp.108-115
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• 2013

Objective: This study aimed to examine the effects of chronic disease management program based on clinics for blood pressure control or glycemic control in patients with hypertension or type 2 diabetes mellitus in Incheon. Methods: An observational follow up study was done on 11,501 patients registrated at clinics from January 1st to December 31st, 2010 in Incheon. Experience of education and mandatory laboratory tests were assessed with the registration data and income status was identified by National Health Insurance data. The odds ratio and 95% confidence intervals were derived from logistic regression models. Results: The experience of education has a positive effect for blood pressure control in the non-control group with hypertension at the time of registration (Odds ratio 1.357, confidence intervals: 1.112~1.655). The experience of mandatory laboratory tests has a positive effect for blood pressure control in the control group with hypertension at the time of registration (Odds ratio 1.738, confidence intervals: 1.387~2.178). But the effects of the experience of education and mandatory laboratory test in patients with type 2 diabetes mellitus were not identified. Conclusions: This study revealed the relationship between the experience of education or mandatory laboratory testing and blood pressure control in patients with hypertension.

• Journal of Korean Academy of Nursing
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• v.39 no.5
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• pp.720-730
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• 2009

Purpose: The purpose of this study was to test the effects of tailored diabetic education on blood glucose control and self-care for patients with type 2 diabetes on insulin therapy. Methods: The participants were 60 patients (experimental group: 30, control group: 30) with type 2 diabetes on insulin therapy. The patients were being seen at a university hospital in Seoul, Korea. Group diabetic education and tailored diabetic education were given to the experiment group while group diabetic education only was given to the control group. Data were collected before and three months after the education. $X^2$ test, t-test, and ANCOVA were used to analyze the data. Results: No significant differences in postprandial (PP2hrs) glucose and HbA1c levels were found between the two groups. Participants in the experiment group showed statistically significant differences in the area of self-glucose test, management of insulin injection, and life style change compared to those in the control group. Conclusion: The results indicate that tailored education for patients with diabetes on insulin therapy improve self-glucose test, management of insulin injection, and life style. Therefore it is suggested that tailored education can be applied in diabetic education to improve self-care.