Self-management has no borders. It is as effective when applied in the U.S. with arthritis as it is in controlling HIV/AIDS in Africa. In an illustration of the worldwide appeal of self-management, Wattana and colleagues described its use in Thailand where uncontrolled diabetes is a major health problem. The objective of the study was to determine the effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life in 147 diabetic patients with an average age of 56.8 years. Type 2 diabetic patients who met the research criteria were randomized into two groups for a period of 6 months: the experimental group received the diabetes self-management program and the control group received the usual nursing care. Findings indicated that the experimental group demonstrated a significant decrease in the hemoglobin level and coronary heart disease risk, with an increase in quality of life compared to the control group. The diabetes self-management program was effective for improving metabolic control and the quality of life for individuals with diabetes.

COMMENT: Further studies with the approach should be replicated using larger groups over a longer time frame. However, it appears as if the approach taken by Wattana and colleagues proved effective in diabetic patients in Thailand. Thus far, most of the reported studies on self-management have came from developed countries. This is, perhaps, a reflection of the greater impact of chronic illness in these countries. However, the World Health Organization has described that the gulf between developed and developing countries with respect to the rate of chronic illness is narrowing. Now would be the best time to establish uses of self-management in all countries, but particularly in those where chronic disease is beginning to emerge as a serious problem.

C. Wattana et al. Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes. Nursing Health Science, 2007;9:135-141.

World Health Organization. The World Health Report, 1997: Conquering suffering, enriching humanity. Geneva: World Health Organization, 1997.