Combination of Diabetes Self-Management Education and Support Through Telehealth and Hypnotherapy Optimizes Self-Care Behaviors and Lowering HbA1c Levels in Patients with Type 2 Diabetes Mellitus: Combination of Diabetes Self-Management Education and Support

Paulus Subiyanto; Muhammed Saifulaman; Ratna Sitorus

doi:10.11594/jtls.15.01.03

Authors

Paulus Subiyanto Department of Medical-Surgical Nursing, Panti Rapih Institute of Health Science, Yogyakarta 55281, Indonesia
Muhammed Saifulaman Department of Health Applied Science, LUC Malaysia, Petaling Jaya 47301, Malaysia
Ratna Sitorus Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok 16424, West Java, Indonesia

DOI:

https://doi.org/10.11594/jtls.15.01.03

Keywords:

HbA1c, DSMES, Hypnotherapy, T2DM, Telehealth

Abstract

This study aims to explore the effectiveness of the combination of Diabetes Self-Management Education and Support (DSMES) through telehealth and hypnotherapy in optimizing self-care behavior and reducing hemoglobin A1c (HbA1c) levels in patients with type 2 diabetes mellitus (T2DM). The study used a quasi-experimental approach and comparative study with a pretest-posttest design and a 3-month cohort design. This study was conducted after obtaining a letter of ethical eligibility involving 40 T2DM patients divided into two groups. The control group received conventional medical services face-to-face. The intervention group received a DSMES program of seven self-care behaviors via telehealth with additional hypnotherapy sessions. The respondents in this study are women (60%) with an average age of 55.3 (31–65) years, who are highly educated (80%). A significant increase in DSM scores before and after the intervention occurred in the intervention group, (49.35–81.20) or (+31.85), and in the control group, (55.70–55.52) or (−0.18). The decrease in A1c in the intervention group (8.9%–7.37%) was (−1.53) and in the control group (8.12%–8.10%) was (−0.02). There were significant differences in DSM attainment and HbA1c levels in both types of interventions (p = 0.000; p = 0.030 with alpha 5%). DSMES, through telehealth combined with hypnotherapy, can provide a synergistic effect with medical treatment commonly given to patients with T2DM during and after the COVID-19 pandemic. This approach not only improves healthcare accessibility but also addresses the psychological barriers associated with lifestyle change.

References

1. WHO (2020) HEARTS D: Diagnosis and management of type 2 diabetes. Geneva, WHO.

2. International Diabetes Federation (IDF) (2013) Five questions on the IDF Diabetes Atlas. Diabetes Research and Clinical Practice 102 (2): 147–148. doi: 10.1016/j.diabres.2013.10.013.

3. American Diabetes Association (2020) 5. Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes—2020. Diabetes Care 43 (Supplement_1): S48–S65. doi: 10.2337/dc20-S005.

4. Powers MA, Bardsley JK, Cypress M et al. (2020) Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care 43 (7): 1636–1649. doi: 10.2337/dci20-0023.

5. Davis J, Fischl AH, Beck J et al. (2022) 2022 National standards for diabetes self-management education and support. The Science of Diabetes Self-Management and Care 48 (1): 44–59. doi: 10.1177/26350106211072203.

6. Allen M (2018) Telehealth and diabetes self-management education and support for improving health outcomes in adults with type 2 diabetes: An integrative review. Graduate Student Projects and Scholarship 1–99.

7. Putri AM, Mulyani S, Agustin A, Fitri SUR (2022) Telehealth potential to optimize self-management, education, and support for diabetes mellitus patients during COVID-19 pandemic. International Journal of Nursing and Health Services (IJNHS) 5 (2): 138–149. doi: 10.35654/ijnhs.v5i2.557.

8. Alexandre K, Campbell J, Bugnon M et al. (2021) Factors influencing diabetes self-management in adults: An umbrella review of systematic reviews. JBI evidence synthesis 19 (5): 1003–1118. doi: 10.11124/JBIES-20-00020.

9. Kolb L (2021) An effective model of diabetes care and education: The ADCES7 self-care behaviorsTM. The Science of Diabetes Self-Management and Care 47 (1): 30–53. doi: 10.1177/0145721720978154.

10. Pereira M da G (2017) Changing the mind: Hypnosis and diabetes. Revista Latino-Americana de Enfermagem 25 e2868. doi: 10.1590/1518-8345.0000.2868.

11. Trumm A (2018) Effectiveness of hypnotherapy in anxiety disorders: A systematic review. Master thesis, Middlesex University.

12. Khazraee H, Bakhtiari M, Kianimoghadam AS, Ghorbanikhah E (2023) The effectiveness of mindful hypnotherapy on depression, self-compassion, and psychological inflexibility in females with major depressive disorder: A single-blind, randomized clinical trial. International Journal of Clinical and Experimental Hypnosis 71 (1): 63–78. doi: 10.1080/00207144.2022.2160257.

13. Candra IW, Sumirta IN, Mustika IW (2021) Effect of self-hypnosis therapy with positive self-talk on stress levels of COVID-19 mutual cooperation task force. International Journal of Health Sciences 5 (3): 441–447.

14. Deswita D, Sahar J, Mulyono S (2019) Impact of coaching and self-hypnosis intervention on blood glucose levels of older adults in Indonesia. Enfermería Clínica 29 146–150. doi: 10.1016/j.enfcli.2019.04.022.

15. Juanamasta IG, Aungsuroch Y, Gunawan J et al. (2021) Holistic care management of diabetes mellitus: An integrative review. International Journal of Preventive Medicine 12 69. doi: 10.4103/ijpvm.IJPVM_402_20.

16. Rahayu HT, Chen C-M (2020) Psychometric testing of an Indonesian-version diabetes self-management instrument. Journal of Nursing Research 28 (6): e127. doi: 10.1097/jnr.0000000000000403.

17. Sherifali D, Berard LD, Gucciardi E et al. (2018) Self-management education and support. Canadian Journal of Diabetes 42 S36–S41. doi: 10.1016/j.jcjd.2017.10.006.

18. De Groot J, Wu D, Flynn D et al. (2021) Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes: A meta-analysis. World Journal of Diabetes 12 (2): 170–197. doi: 10.4239/wjd.v12.i2.170.

19. Susilo DH, Kusbaryanto K, Kusumo MP (2021) Diabetes mellitus management during the Coronavirus disease-19 pandemic: Literature review. Open Access Macedonian Journal of Medical Sciences 9 (F): 541–548. doi: 10.3889/oamjms.2021.6597.

20. Lian X, Dalan R, Seow CJ et al. (2021) Diabetes care during COVID-19 pandemic in Singapore using a telehealth strategy. Hormone and Metabolic Research 53 (3): 191–196. doi: 10.1055/a-1352-5023.

21. Batalha APDB, Ponciano IC, Chaves G et al. (2021) Behavior change interventions in patients with type 2 diabetes: A systematic review of the effects on self-management and A1c. Journal of Diabetes & Metabolic Disorders 20 (2): 1815–1836. doi: 10.1007/s40200-021-00846-8.

22. Nkhoma DE, Soko CJ, Banda KJ et al. (2021) Impact of DSMES app interventions on medication adherence in type 2 diabetes mellitus: systematic review and meta-analysis. BMJ Health & Care Informatics 28 (1): e100291. doi: 10.1136/bmjhci-2020-100291.

23. Damhudi D, Kertia N, Effendy C (2021) The effect of modified diabetes self-management education and support on self-care and quality of life among patients with diabetic foot ulcers in rural area of Indonesia. Open Access Macedonian Journal of Medical Sciences 9 (G): 81–87. doi: 10.3889/oamjms.2021.6614.

24. Miller-Rosales C, Rodriguez HP (2021) Interdisciplinary primary care team expertise and diabetes care management. The Journal of the American Board of Family Medicine 34 (1): 151–161. doi: 10.3122/jabfm.2021.01.200187.

25. Beck J, Greenwood DA, Blanton L et al. (2020) 2017 National standards for diabetes self-management education and support. The Diabetes Educator 46 (1): 46–61. doi: 10.1177/0145721719897952.

26. Hoogendoorn CJ, Schechter CB, Llabre MM et al. (2021) Distress and type 2 diabetes self-care: Putting the pieces together. Annals of Behavioral Medicine 55 (10): 938–948. doi: 10.1093/abm/kaaa070.

27. Horigan G, Davies M, Findlay-White F et al. (2017) Reasons why patients referred to diabetes education programmes choose not to attend: A systematic review. Diabetic Medicine 34 (1): 14–26. doi: 10.1111/dme.13120.

28. Garba MH, Mamman M (2020) Hypnosis and hypnotherapy: The role of traditional versus alternative approach. In: Mordeniz C ed Hypnotherapy and Hypnosis. London, UK, IntechOpen. pp 21-38.

29. Gunawan AW (2018) The miracle of mindbody medicine: How to use your mind for better health. 2nd ed. Jakarta, PT Gramedia Pustaka Utama.

30. Ramondo N, Gignac GE, Pestell CF, Byrne SM (2021) Clinical hypnosis as an adjunct to cognitive behavior therapy: An updated meta-analysis. International Journal of Clinical and Experimental Hypnosis 69 (2): 169–202. doi: 10.1080/00207144.2021.1877549.

31. Kim Y, Lee H, Seo JM (2022) Integrated diabetes self-management program using smartphone application: A randomized controlled trial. Western Journal of Nursing Research 44 (4): 383–394. doi: 10.1177/0193945921994912.

32. Kumah E, Abuosi AA, Ankomah SE, Anaba C (2021) Self-management education program: The case of glycemic control of type 2 diabetes. Oman Medical Journal 36 (1): e225. doi: 10.5001/omj.2021.01.

Combination of Diabetes Self-Management Education and Support Through Telehealth and Hypnotherapy Optimizes Self-Care Behaviors and Lowering HbA1c Levels in Patients with Type 2 Diabetes Mellitus