Effects of hybrid-theory based individual and family self-management program on glycated haemoglobin and sleep quality among adults with type 2 diabetes mellitus in Indonesia

Abstract

Approximately 10.9% of the population aged ≥15 years old have type 2 diabetes in Indonesia. Several studies reported poor sleep quality in adults with type 2 Diabetes. Family supports have essential roles to improve sleep quality and maintain HbA1c level. The study aimed to 1) compare glycated haemoglobin (HbA1c) levels and sleep quality before and after participating in the hybrid theory based individual and family self-management programs, and 2) compare HbA1c levels and Sleep quality between adults with T2DM who received the program and those who received usual care. This randomized controlled trial was conducted from January 2026 to May 2026 among participants recruited from 3 Public Health centres in Malang City. A two-stage sampling technique was applied to recruit 106 adults with T2DM aged 18-59 years old who have an HbA1c level > 7% and poor sleep quality. The participants were matched by age, gender, educational level, and diabetes duration. Participants were randomly assigned to an intervention group (n=53) and a control group (n=53). Those in the intervention arm received routine care and the hybrid-theory based IFSM program through face-to-face and online training which consisted diabetes knowledge, self-management training, sleep education, family participation, and delivering infographics through WhatsApp groups; while the control group received routine care. Each participant was accompanied by one family member. The research instruments consisted of the demographic data form, the Indonesian version of Insomnia severity index, PSQI, Xiaomi smart band 10 smartwatch, and HbA1c levels were measured using High-Performance Liquid Chromatography (HPLC). The diabetes self-management questionnaire-revised (DSMQ-R) was used for monitoring diabetes self-management behaviors. The Indonesian versions of the PSQI and DSMQ-R had Cronbach's alpha values of 0.72 and 0.85, respectively. Outcomes of the study were sleep quality (PSQI score, TST, WASO) and HbA1c level. Data were analysed using descriptive statistics one-way repeated measure ANOVA, one-way repeated measure MANOVA, and one-way MANCOVA. The results showed that the experimental group experienced a significant reduction in subjective sleep quality measured by PSQI from baseline, week 8, week 12, and week 16. Meanwhile, in the control group, PSQI scores also decreased significantly from baseline to week 8, but not clinically meaningful. There was a statistically significant effect of time on the mean of TST and WASO across groups [(F1,104=62.89, p< .001, partial η2=.38), (F1,104=14.56, p< .001, partial η2=.12), respectively]. Participant in the experimental group had significantly longer total sleep and experienced less wakefulness after sleep onset. The finding showed that there was a statistically significant effect of time on the mean of HbA1c level across groups (F1,104=37.57, p< .001, partial η2=.27). The result showed that there was a statistically significant difference in the mean PSQI score across different time points when considering the interaction with the group (F (1.51, 157.079) = 29.622, p < .001, ηp2 = .222). After controlling for baseline TST, there was a statistically significant multivariate effect of group on the combined week 16 outcomes with F (4, 100= 18.635, p < .001, partial η² = .427). This finding indicates that the experimental and control groups differed significantly in the linear combination of post-test PSQI, TST, WASO, and HbA1c after adjustment for baseline TST. The results provide compelling evidence that the hybrid-theory based Individual and Family Self-Management (IFSM) program is effective in simultaneously enhancing sleep quality and reducing HbA1c levels in adults with Type 2 Diabetes Mellitus in Malang City. Conducting multi-site RCTs across diverse geographic, incorporating follow-up assessments at 6 and 12 months, and adding greater number of participants should be considered by future study to strengthened the finding.