A Pilot Test for Implementing Precision Healthcare Program in Patients with Diabetes in Indonesia

Satriya Pranata; Shu-Fang Vivienne Wu; Tsae-Jyy Tiffany  Wang; Shu-Yuan  Liang; Difran Nobel  Bistara; Yeu-Hui  Chuang; Kuo-Cheng  Lu; Hadi Kusuma  Atmaja

doi:10.5937/scriptamed54-42230

Satriya Pranata Universitas Muhammadiyah Semarang
Shu-Fang Vivienne Wu National Taipei University of Nursing and health Sciences
Tsae-Jyy Tiffany Wang National Taipei University of Nursing and health Sciences
Shu-Yuan Liang National Taipei University of Nursing and health Sciences
Difran Nobel Bistara Department of Nursing, Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Surabaya City, East Java, Indonesia
Yeu-Hui Chuang Taipei Medical University
Kuo-Cheng Lu Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
Hadi Kusuma Atmaja Department of Nursing, Poltekkes Kemenkes Mataram, Mataram, West Nusa Tenggara, Indonesia

DOI: https://doi.org/10.5937/scriptamed54-42230

Keywords: Precision health, Strategy, Personalised, Patient preference, Genetic

Abstract

Background/Aim: An evaluation of precision healthcare interventions among patients with diabetes in a small sample through a pilot test before being tested in a larger sample is needed. Thus, the purpose of this study was to evaluate the feasibility of a precision healthcare program. It also assesses the program's outcome among patients with diabetes in Indonesia.

Methods: Data were collected during December 2020. The researchers first gathered data about participant characteristics. Furthermore, the strategies of precision healthcare were implemented in sixty respondents to evaluate the feasibility and outcome of the program in a month.

Results: The participants mention that they can follow all procedures of precision healthcare. However, they asked the researcher to provide a guide and monitoring book which provides safe choices information on diet, exercise, glucose monitoring and drug medication. Moreover, participants mentioned that they could complete all questionnaires but needed a company of a research assistant. The benefits of a month of precision healthcare were improved diabetes self-care activity, blood pressure and blood glucose level. However, the body weight, body mass index (BMI), triglyceride, cholesterol and triglyceride glucose index were not significantly improved.

Conclusion: A pilot test is needed to ensure the feasibility of the implementation strategy with the culture and background of diabetic patients in Indonesia. Improving diabetes self-care activity stabilised blood pressure and blood glucose during a month, so it can be assumed that precision healthcare approaches were potentially being applied in Indonesia. On the other hand, it is needed more than a month to improve body weight, body mass index (BMI), triglyceride, cholesterol and triglyceride glucose index. Thus, testing the precision healthcare approach in a larger sample with long time series for patients with diabetes in Indonesia through a randomised controlled trial (RCT) is needed.

References

1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019 Nov;157:107843. doi: 10.1016/j.diabres.2019.107843.

2. WHO. Diabetes, 2016. [Internet][Cited: 14-Oct-2018]. Available at: http://www.who.int/diabetes/en/.

3. Panagioti M, Richardson G, Small N, Murray E, Rogers A, Kennedy A, et al. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res 2014 Aug 27;14:356. doi: 10.1186/1472-6963-14-356.

4. Sassen, B. Nursing: Health education and improving patient self-management. New York, USA: Springer Cham; 2018. doi:10.1007/978-3-319-51769-8.

5. Pranata S, Huang XY. Self-management experience of patient with diabetes mellitus type 2. Int J Psychosoc Rehabil 2020;24:7792–801.

6. Bittencourt MS. From evidence-based medicine to precision health: using data to personalize care. Arq Bras Cardiol 2018 Dec;111(6):762-3.

7. Ginsburg GS, Phillips KA. Precision medicine: from science to value. Health Aff (Millwood) 2018 May;37(5):694-701.

8. Bierman AS, Tinetti ME. Precision medicine to precision care: managing multimorbidity. Lancet 2016 Dec 3;388(10061):2721-3.

9. Glasgow RE, Kwan BM, Matlock DD. Realizing the full potential of precision health: The need to include patient-reported health behavior, mental health, social determinants and patient preferences data. J Clin Transl Sci 2018 Jun;2(3):183-5.

10. Pranata S, Wu SV, Alizargar J, Liu JH, Liang SY, Lu YY. Precision health care elements, definitions and strategies for patients with diabetes: a literature review. Int J Environ Res Public Health 2021 Jun 17;18(12):6535. doi: 10.3390/ijerph18126535.

11. Vorderstrasse AA, Hammer MJ, Dungan JR. Nursing implications of personalized and precision medicine. Semin Oncol Nurs 2014 May;30(2):130-6.

12. Pranata S, Wu S-FV, Chu C-H, Nugroho KH. Precision health care strategies for older adults with diabetes in Indonesia: a Delphi consensus study. Med J Indones 2021;30(3):221-7.

13. Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes 2013 Aug 13;11:138. doi: 10.1186/1477-7525-11-138.

14. Bansal P, Chaudhary A, Wander P, Satija M, Sharma S, Girdhar S, et al. Cardiovascular risk assessment using WHO / ISH risk prediction charts in a rural area of North India. J Med Dent Sci 2016;4(2):127-31.

15. Otgontuya D, Oum S, Buckley BS, Bonita R. Assessment of total cardiovascular risk using WHO / ISH risk prediction charts in three low and middle income countries in Asia. BMC Public Health 2013;13:539. doi:10.1186/1471-2458-13-539.

16. Sh S, Hsu YY, Toobert DJ, Wang ST. The validity and reliability of the summary of diabetes self-care activities questionnaire: An Indonesian version. Indones Nurs J Educ Clin 2019;4:25–36.

17. Abedini MR, Bijari B, Miri Z, Shakhs Emampour F, Abbasi A. The quality of life of the patients with diabetes type 2 using EQ-5D-5 L in Birjand. Health Qual Life Outcomes 2020 Jan 30;18(1):18. doi: 10.1186/s12955-020-1277-8.

18. Farm BAS, Perwitasari DA, Thobari JA, Cao Q, Krabbe PFM, Postma MJ. Translation, revision and validation of the diabetes distress scale for Indonesian type 2 diabetic outpatients with various types of complications. Value Health Reg Issues 2017 May;12:63-73.

19. [Ministry of Health of the Republic of Indonesia. Stay productive, prevent and overcome diabetes mellitus. Data and information centre of the Ministry of Health of the Republic of Indonesia,2020]. [Internet]. [Cited: 14-Oct-2021]. Available at: https://www.kemkes.go.id/article/view/20120100005/infodatin-tetap-produktif-cegah-dan-atasi-diabetes-melitus-2020.html. Indonesian.

20. Heianza Y, Arase Y, Kodama S, Hsieh SD, Tsuji H, Saito K, et al. Effect of postmenopausal status and age at menopause on type 2 diabetes and prediabetes in Japanese individuals: Toranomon Hospital Health Management Center Study 17 (TOPICS 17). Diabetes Care 2013 Dec;36(12):4007-14.

21. Kim C. Does menopause increase diabetes risk? Strategies for diabetes prevention in midlife women. Womens Health (Lond) 2012 Mar;8(2):155-67.

22. Paschou SA, Papanas N. Type 2 diabetes mellitus and menopausal hormone therapy: an update. Diabetes Ther 2019 Dec;10(6):2313-20.

23. Scacchi M, Pincelli AI, Cavagnini F. Growth hormone in obesity. Int J Obes Relat Metab Disord 1999 Mar;23(3):260-71.

24. Kreitschmann-Andermahr I, Suarez P, Jennings R, Evers N, Brabant G. GH/IGF-I regulation in obesity--mechanisms and practical consequences in children and adults. Horm Res Paediatr 2010;73(3):153-60.

25. WHO. World Health organization / International Society of Hypertension ( WH0 / ISH ) risk prediction charts. Geneva: World Health;2014:1–40.

26. de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, et al. Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes Care 2017 Sep;40(9):1273-84.

27. Tsimihodimos V, Gonzalez-Villalpando C, Meigs JB, Ferrannini E. Hypertension and diabetes mellitus: coprediction and time trajectories. Hypertension 2018 Mar;71(3):422-8.

28. Hood KK, Hilliard M, Piatt G, Ievers-Landis CE. Effective strategies for encouraging behavior change in people with diabetes. Diabetes Manag (Lond) 2015;5(6):499-510.

29. Mertig R. The Nurse’s guide to teaching diabetes self-management. USA: Springer Publishing Company; 2007.

30. Koetsenruijter J, van Lieshout J, Vassilev I, Portillo MC, Serrano M, Knutsen I, et al. Social support systems as determinants of self-management and quality of life of people with diabetes across Europe: study protocol for an observational study. Health Qual Life Outcomes 2014 Mar 4;12:29. doi: 10.1186/1477-7525-12-29.

31. Permatasari SN, Mita, Herman. [The Correlation Between The role of the function of health workers and taking medicine compliance in patients with type 2 diabetes mellitus in the working area of the community Health Center Of Gang Sehat Pontianak]. Tanjungpura J Nurs Prac Edu 2020;2(1). Doi:10.26418/tjnpe.v2i1.42014. Indonesian.

32. Sadhana W, Jiin-Ru R. Self-management behaviors of diabetes control among diabetic patients in Indonesia. Int J Nurs Stud 2021;6(18):18-26.

33. Widayanti AW. Understanding health-seeking behaviours of people in Indonesia; and developing, piloting and evaluating a culturally appropriate intervention for people with diabetes. Thesis, Doctor of Philosophy. University of Otago, 2018. Available at: http://hdl.handle.net/10523/8965.>

34. Ligita T, Wicking K, Francis K, Harvey N, Nurjannah I. How people living with diabetes in Indonesia learn about their disease: A grounded theory study. PLoS One 2019 Feb 22;14(2):e0212019. doi: 10.1371/journal.pone.0212019.

35. Gallucci G, Tartarone A, Lerose R, Lalinga AV, Capobianco AM. Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis 2020 Jul;12(7):3866-76.

36. 36. Keto J, Ventola H, Jokelainen J, Linden K, Keinänen-Kiukaanniemi S, Timonen M, et al. Cardiovascular disease risk factors in relation to smoking behaviour and history: a population-based cohort study. Open Heart 2016 Jul 12;3(2):e000358. doi: 10.1136/openhrt-2015-000358.

37. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020 Mar 3;141(9):e139-e596.

38. Choi TST, Walker KZ, Palermo C. Culturally tailored diabetes education for Chinese patients: a qualitative case study. J Transcult Nurs 2017 May;28(3):315-23.

39. Pranata S, Wu SFV, Wang TJT, Liang SY, Chuang YH, Lu KC, et al. Discovering elements and developing strategies to implement the tailored care education for patients with diabetes through a systematic review. Nurse Media J Nur 2022;12:75–87.

40. Pranata S, Shing LC, Vranada A, Chun LY, Armiyati Y. The implementation of precision personalized care to improve diabetes patients ’ self-management at taipei veteran general hospital : an observational study. Bali Med J 2021;10:1304–7.

41. Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators and the Academy of Nutrition and Dietetics. Clin Diabetes 2016 Apr;34(2):70-80.

42. Patel RM, Misra R, Raj S, Balasubramanyam A. Effectiveness of a group-based culturally tailored lifestyle intervention program on changes in risk factors for type 2 diabetes among Asian Indians in the United States. J Diabetes Res 2017;2017:2751980. doi: 10.1155/2017/2751980.

43. Sherifali D. Diabetes management in older adults: seeing the forest for the trees. Can J Diabetes 2016 Feb;40(1):10-1.

44. Sherifali D. Diabetes coaching for individuals with type 2 diabetes: A state-of-the-science review and rationale for a coaching model. J Diabetes 2017 Jun;9(6):547-54.