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Journal of Health Science 2009 Vol. 18 No. 3

406

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∑’¡ À “¢“«‘™“™’æ¡“„™â ‡æ◊ËÕ‡æ‘Ë¡§ÿ≥¿“æ°“√¥Ÿ·≈ ·≈–

≈¥§à“„™â®à“¬„π°“√¥Ÿ·≈√—°…“ ‚¥¬π”√àÕß„π°“√¥Ÿ·≈

√—°…“ºŸâªÉ«¬‚√§‡∫“À«“π∑’Ë¡’Õ“°“√√–¥—∫πÈ”µ“≈„π

‡≈◊Õ¥µË” ·≈–»÷°…“‚¥¬¡’«—µ∂ÿª√– ß§å‡æ◊ËÕª√–‡¡‘π ª√– ‘∑∏‘º≈¢Õß°“√®—¥√–∫∫∫√‘°“√欓∫“≈¥—ß°≈à“«

«‘∏’°“√»÷°…“

°“√«‘®—¬§√—Èßπ’È ‡ªìπ°“√«‘®—¬°÷Ëß∑¥≈Õß (quasi-ex- perimental research) „π°“√®—¥√–∫∫∫√‘°“√

欓∫“≈ºŸâªÉ«¬‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–

·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‚√§‡∫“À«“π ™π‘¥∑’Ë 2 ∑’Ë

¡’Õ“°“√√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË” ‚¥¬∑’¡ À “¢“«‘™“™’æ

‚√ß欓∫“≈≈æ∫ÿ√’

ª√–™“°√∑’Ë„™â„π°“√»÷°…“§√—Èßπ’È §◊Õ ºŸâªÉ«¬∑’ˉ¥â√—∫

°“√«‘π‘®©—¬®“°·æ∑¬å«à“ ‡ªìπ‚√§‡∫“À«“π™π‘¥∑’Ë 2 ∑’Ë

¡’Õ“°“√√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË” ∑’ˇ¢â“√—∫°“√√—°…“„π

‚√ß欓∫“≈≈æ∫ÿ√’„πÀÕºŸâªÉ«¬Õ“¬ÿ√°√√¡ (ÀÕºŸâªÉ«¬

‡¡µµ“≈à“ß ‡¡µµ“∫π °√ÿ≥“≈à“ß °√ÿ≥“∫π·≈– ß¶å∫π) µ—Èß·µà 1 µÿ≈“§¡ 2550 - 31 ¡’π“§¡ 2551 ®”π«π 152

√“¬

°≈ÿࡵ—«Õ¬à“ß∑’Ë„™â„π°“√»÷°…“§√—Èßπ’È §◊Õ ºŸâªÉ«¬‚√§

‡∫“À«“π™π‘¥∑’Ë 2 ∑’Ë¡’Õ“°“√√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË”∑’Ë

‡¢â“√—∫°“√√—°…“„πÀÕºŸâªÉ«¬Õ“¬ÿ√°√√¡ ‚√ß欓∫“≈≈æ∫ÿ√’

√–À«à“߇«≈“¥—ß°≈à“«  ÿࡵ—«Õ¬à“ßÀÕºŸâªÉ«¬·∫∫°≈ÿà¡ ‰¥â ÀÕºŸâªÉ«¬‡¡µµ“≈à“ß·≈–°√ÿ≥“∫𠇪ìπ°≈ÿà¡∑¥≈Õß ·≈–

ÀÕºŸâªÉ«¬‡¡µµ“∫π·≈–°√ÿ≥“≈à“ß ‡ªìπ°≈ÿࡇª√’¬∫‡∑’¬∫

°≈ÿà¡≈– 30 √“¬

‡ª√’¬∫‡∑’¬∫√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥ ®”π«π«—π πÕπ‚√ß欓∫“≈ §à“„™â®à“¬„π°“√¥Ÿ·≈√—°…“·≈–°“√

‡¢â“√—∫°“√√—°…“´È”„π‚√ß欓∫“≈¿“¬„π 28 «—π¢Õß ºŸâªÉ«¬‚√§‡∫“À«“π™π‘¥∑’Ë 2 ∑’Ë¡’√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥

µË”√–À«à“ß°≈ÿà¡∑¥≈Õß∑’Ë ‰¥â√—∫°“√®—¥√–∫∫∫√‘°“√

欓∫“≈ ‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–

·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‚¥¬∑’¡ À “¢“«‘™“™’æ °—∫

°≈ÿࡇª√’¬∫‡∑’¬∫∑’ˉ¥â√—∫°“√¥Ÿ·≈·∫∫ª√°µ‘

‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√»÷°…“ ª√–°Õ∫¥â«¬

1. ‡§√◊ËÕß¡◊Õ¥”‡π‘π°“√«‘®—¬ ‰¥â·°à 1) §Ÿà¡◊Õ°“√

®—¥√–∫∫∫√‘°“√欓∫“≈ºŸâªÉ«¬‚√§‡∫“À«“π ‚¥¬

欓∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√¥Ÿ·≈

√—°…“ºŸâªÉ«¬ ‚¥¬∑’¡ À “¢“«‘™“™’æ 2) ·ºπ°“√Õ∫√¡

∑’¡ ÿ¢¿“æ ª√–°Õ∫¥â«¬ ‚§√ß°“√Õ∫√¡‡√◊ËÕß °“√®—¥

√–∫∫∫√‘°“√欓∫“≈ ºŸâªÉ«¬‚√§‡∫“À«“π ‚¥¬

欓∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√¥Ÿ·≈

√—°…“ºŸâªÉ«¬‚¥¬∑’¡ À “¢“«‘™“™’æ ·≈–·ºπ°“√ Õπ

‡√◊ËÕß °“√®—¥√–∫∫∫√‘°“√欓∫“≈ ºŸâªÉ«¬‚√§‡∫“À«“π

‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√

¥Ÿ·≈√—°…“ºŸâªÉ«¬‚¥¬∑’¡ À “¢“«‘™“™’æ

2. ‡§√◊ËÕß¡◊Õ‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈ ‰¥â·°à 1) ·∫∫«—¥

§ÿ≥¿“æ°“√¥Ÿ·≈ºŸâªÉ«¬ ª√–°Õ∫¥â«¬ ·∫∫∫—π∑÷°√–¥—∫

πÈ”µ“≈„π‡≈◊Õ¥ ·∫∫∫—π∑÷°®”π«π«—ππÕπ‚√ß欓∫“≈

·∫∫∫—π∑÷° √ÿª§à“„™â®à“¬„π°“√¥Ÿ·≈√—°…“ ·≈–·∫∫

∫—π∑÷°°“√‡¢â“√—∫°“√√—°…“´È”„π‚√ß欓∫“≈ ¿“¬„π 28

«—π

°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈

‚¥¬„™â‚ª√·°√¡§Õ¡æ‘«‡µÕ√å ”‡√Á®√Ÿª ¥—ßπ’È

¢âÕ¡Ÿ≈∑—Ë«‰ª¢ÕߺŸâªÉ«¬·®°·®ß‡ªìπ®”π«π

√âÕ¬≈–

‡ª√’¬∫‡∑’¬∫§«“¡·µ°µà“ß§à“‡©≈’ˬ¢Õß√–¥—∫

πÈ”µ“≈„π‡≈◊Õ¥ ·≈–§à“„™â®à“¬„π°“√¥Ÿ·≈√—°…“À≈—ß°“√

∑¥≈Õß√–À«à“ß°≈ÿࡇª√’¬∫‡∑’¬∫∑’Ë „Àâ°“√¥Ÿ·≈·∫∫

ª√°µ‘°—∫°≈ÿà¡∑¥≈Õß∑’Ë¡’°“√®—¥√–∫∫∫√‘°“√欓∫“≈

‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ ºŸâªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√

¥Ÿ·≈√—°…“ºŸâªÉ«¬ ‚¥¬∑’¡ À “¢“«‘™“™’æ ‚¥¬ ∂‘µ‘

∑¥ Õ∫§à“∑’ (independent-sample t-test)

‡ª√’¬∫‡∑’¬∫§à“‡©≈’ˬ≈”¥—∫∑’Ë¢Õß®”π«π«—π πÕπ‚√ß欓∫“≈ ·≈–®”π«πºŸâªÉ«¬∑’ˇ¢â“√—∫°“√√—°…“

´È”„π‚√ß欓∫“≈ ¿“¬„π 28 «—π À≈—ß°“√∑¥≈Õß

√–À«à“ß°≈ÿࡇª√’¬∫‡∑’¬∫∑’Ë„Àâ°“√¥Ÿ·≈·∫∫ª√°µ‘°—∫

°≈ÿà¡∑¥≈Õß∑’Ë¡’°“√®—¥√–∫∫∫√‘°“√欓∫“≈ ‚¥¬

欓∫“≈ºŸâ®—¥°“√ ºŸâªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√

¥Ÿ·≈√—°…“ºŸâªÉ«¬ ‚¥¬∑’¡ À “¢“«‘™“™’æ ‚¥¬„™â ∂‘µ‘

∑¥ Õ∫·¡ππå«‘∑π’¬å ¬Ÿ ‡∑  (Mann Whitney U test)

º≈°“√»÷°…“

°≈ÿࡵ—«Õ¬à“ߧ◊Õ ºŸâªÉ«¬∑’ˇªìπ‚√§‡∫“À«“π∑’Ë¡’

Õ“°“√√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË” ∑’ˇ¢â“√—∫°“√√—°…“„πÀÕ

ºŸâªÉ«¬Õ“¬ÿ√°√√¡ ‚√ß欓∫“≈≈æ∫ÿ√’  à«π„À≠à¡’Õ“¬ÿ 61 ªï ¢÷Èπ‰ª ´÷Ëßæ∫‰¥â∑—Èß°≈ÿࡇª√’¬∫‡∑’¬∫∑’ˉ¥â√—∫°“√¥Ÿ·≈

·∫∫ª√°µ‘ ·≈–°≈ÿà¡∑¥≈Õß∑’ˉ¥â√—∫°“√®—¥√–∫∫∫√‘°“√

欓∫“≈ ‚¥¬„™â欓∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–

·π«∑“ß°“√¥Ÿ·≈ºŸâªÉ«¬‚¥¬∑’¡ À “¢“«‘™“™’æ ®”π«π

°≈ÿà¡≈– 20 √“¬ §‘¥‡ªìπ√âÕ¬≈– 66.67  à«π„À≠à‡ªìπ

‡æ»À≠‘ß æ∫¡“°„π°≈ÿࡇª√’¬∫‡∑’¬∫ √âÕ¬≈– 70.00  à«π

„π°≈ÿà¡∑¥≈Õß √âÕ¬≈– 63.33  à«π ‘∑∏‘°“√√—°…“∑’Ëæ∫

¡“°‡ªìπ ∫—µ√ª√–°—π ÿ¢¿“æ∂â«πÀπâ“ √âÕ¬≈– 96.67 „π

°≈ÿࡇª√’¬∫‡∑’¬∫  à«π°≈ÿà¡∑¥≈Õß √âÕ¬≈– 86.67  à«π

√–¬–‡«≈“∑’ˇªìπ‚√§‡∫“À«“πæ∫¡“°„π™à«ß‡«≈“ 6-10 ªï „π°≈ÿà¡∑¥≈Õß √âÕ¬≈– 70.00  à«π„π°≈ÿࡇª√’¬∫‡∑’¬∫

√âÕ¬≈– 53.33 √Õß≈ß¡“ §◊Õ™à«ß‡«≈“ 0 - 5 ªï æ∫®”π«π 13 √“¬ §‘¥‡ªìπ√âÕ¬≈– 43.33 „π°≈ÿࡇª√’¬∫‡∑’¬∫·≈–

æ∫®”π«π 9 √“¬ §‘¥‡ªìπ√âÕ¬≈– 30.00 „π°≈ÿà¡

∑¥≈Õßµ“¡≈”¥—∫ (µ“√“ß∑’Ë 1)

§à “ ‡ © ≈’Ë ¬ √ – ¥— ∫ πÈ” µ “ ≈ „ π ‡ ≈◊ Õ ¥ ¢ Õ ß ºŸâ ªÉ « ¬ ‚ √ §

‡∫“À«“π°≈ÿࡇª√’¬∫‡∑’¬∫ ∑’Ë ‰¥â√—∫°“√¥Ÿ·≈µ“¡ª√°µ‘

(x 102.68 mg/dl, SD 11.36) ·µ°µà“ß°—∫§à“‡©≈’ˬ

√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥¢Õß°≈ÿà¡∑¥≈Õß∑’Ë ‰¥â√—∫°“√®—¥

√–∫∫∫√‘°“√欓∫“≈ ‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬-

°√≥’ ·≈–·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‚¥¬∑’¡ À “¢“

«‘™“™’æ (x 96.67 mg/dl, SD 10.92) Õ¬à“ß¡’π—¬ ”§—≠

∑“ß ∂‘µ‘∑’Ë√–¥—∫ 0.05 „π∑”πÕ߇¥’¬«°—π §à“„™â®à“¬„π

°“√¥Ÿ·≈√—°…“√–À«à“ß Õß°≈ÿà¡ ¡’§«“¡·µ°µà“ß°—π Õ¬à“ß

¡’π—¬ ”§—≠∑“ß ∂‘µ‘∑’Ë√–¥—∫ 0.05 (µ“√“ß∑’Ë 2)

ºŸâªÉ«¬‚√§‡∫“À«“π°≈ÿࡇª√’¬∫‡∑’¬∫ ¡’§à“‡©≈’ˬ

¢Õß≈”¥—∫∑’Ë¢Õß®”π«πºŸâªÉ«¬∑’ˇ¢â“√—∫°“√√—°…“´È”„π

‚√ß欓∫“≈ ¿“¬„π 28 «—𠇪ìπ 33.50 °≈ÿà¡∑¥≈Õß

‡ªìπ 27.50 ·≈–°“√‡¢â“√—∫°“√√—°…“´È”„π‚√ß欓∫“≈

¢Õß°≈ÿà¡∑¥≈Õß ·≈–°≈ÿࡇª√’¬∫‡∑’¬∫¡’§à“°≈“ß·µ°- µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘∑’Ë√–¥—∫ 0.05 „π∑”πÕß

‡¥’¬«°—π®”π«π«—ππÕπ‚√ß欓∫“≈√–À«à“ß Õß°≈ÿà¡ ¡’

§à“°≈“ß·µ°µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘∑’Ë√–¥—∫ 0.05 (µ“√“ß∑’Ë 3)

Journal of Health Science 2009 Vol. 18 No. 3

408

µ“√“ß∑’Ë 1 ¢âÕ¡Ÿ≈ª√–™“°√¢Õß°≈ÿࡇª√’¬∫‡∑’¬∫∑’ˉ¥â√—∫°“√¥Ÿ·≈µ“¡ª√°µ‘ ·≈–°≈ÿà¡∑¥≈Õß∑’ˉ¥â√—∫°“√®—¥√–∫∫∫√‘°“√欓∫“≈ ‚¥¬

欓∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‚¥¬∑’¡ À “¢“«‘™“™’æ

°≈ÿà¡∑¥≈Õß (n = 30 √“¬) °≈ÿࡇª√’¬∫‡∑’¬∫ (n = 30 √“¬) √«¡∑—ÈßÀ¡¥ (n = 60 √“¬)

¢âÕ¡Ÿ≈ª√–™“°√ ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈–

Õ“¬ÿ (ªï)

14 - 20 0 0 0 0 0 0

21 - 30 1 3.33 0 0 1 1.67

31 - 40 1 3.33 1 3.33 2 3.33

41 - 50 5 16.67 3 10.00 8 13.33

51 - 60 3 10.00 6 20.00 9 15.00

≥ 61 20 66.67 20 66.67 40 66.67

‡æ»

˭ԧ 19 63.33 21 70.00 40 66.67

™“¬ 11 36.67 9 30.00 20 33.33

 ‘∑∏‘°“√√—°…“

∫—µ√ª√–°—π ÿ¢¿“æ∂â«πÀπâ“ 26 86.67 29 96.67 55 91.66

 «— ¥‘°“√¢â“√“™°“√/ √—∞«‘ “À°‘® 4 13.33 0 0 4 6.67

ª√–°—π —ߧ¡ 0 0 1 3.33 1 1.67

√–¬–‡«≈“∑’ˇªìπ‚√§‡∫“À«“π (ªï)

0 - 5 9 30.00 13 43.33 22 36.67

6 - 10 21 70.00 16 53.33 37 61.66

11 - 15 0 0 1 3.33 1 1.67

µ“√“ß∑’Ë 2 ‡ª√’¬∫‡∑’¬∫√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥ ·≈–§à“„™â®à“¬„π°“√¥Ÿ·≈√—°…“¢Õß°≈ÿࡇª√’¬∫‡∑’¬∫ °—∫°≈ÿà¡∑¥≈Õß

µ—«·ª√ xxxxx S.D t p-value

√–¥—∫πÈ”µ“≈

°≈ÿࡇª√’¬∫‡∑’¬∫ 102.68 11.36 2.09 0.041*

°≈ÿà¡∑¥≈Õß 96.67 10.92

§à“„™â®à“¬„π°“√¥Ÿ·≈√—°…“

°≈ÿࡇª√’¬∫‡∑’¬∫ 6,375.53 2,414.12 3.97 0.000*

°≈ÿà¡∑¥≈Õß 4,195.40 1,801.04

*p < 0.05

«‘®“√≥å

‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥¢ÕߺŸâªÉ«¬

‚√§‡∫“À«“π √–À«à“ß°≈ÿࡇª√’¬∫‡∑’¬∫∑’ˉ¥â√—∫°“√¥Ÿ·≈

µ“¡ª√°µ‘ ·≈–°≈ÿà¡∑¥≈Õß∑’ˉ¥â√—∫°“√®—¥√–∫∫∫√‘°“√

欓∫“≈ ‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ √à«¡

°—∫·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‚¥¬∑’¡ À “¢“«‘™“™’æ æ∫«à“ √–¥—∫πÈ”µ“≈„π‡≈◊Õ¥¢ÕߺŸâªÉ«¬‚√§‡∫“À«“π °≈ÿà¡

‡ª√’¬∫‡∑’¬∫ ·≈–°≈ÿà¡∑¥≈Õß ·µ°µà“ß°—π Õ¬à“ß¡’π—¬-  ”§—≠∑“ß ∂‘µ‘∑’Ë√–¥—∫ 0.05 ‚¥¬§à“‡©≈’ˬ√–¥—∫πÈ”µ“≈

„π‡≈◊Õ¥¢ÕߺŸâªÉ«¬ °≈ÿà¡∑¥≈Õß≈¥≈ß°«à“ ºŸâªÉ«¬°≈ÿà¡

‡ª√’¬∫‡∑’¬∫ (µ“√“ß∑’Ë 2)  Õ¥§≈âÕß°—∫ Crawley W (1996)⁽²¹⁾ Whipple TW (2001)⁽²²⁾

®“°°“√«‘®—¬§√—Èßπ’ȺŸâ«‘®—¬æ∫«à“ ºŸâªÉ«¬‰¥â√—∫§”

·π–π”®“°æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–∑’¡

 À “¢“«‘™“™’æ µ“¡·ºπ°“√√—°…“  —߇°µÕ“°“√º‘¥

ª√°µ‘¢Õß√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË” À“ “‡Àµÿ·∑â®√‘ß

¢Õß°“√‡°‘¥Õ“°“√√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË” ‡æ◊ËÕªÑÕß°—π

·≈–·°â ‰¢‰¡à „Àâ¡’√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË”´È” ·≈–

ª√– “πß“π∑’¡ À “¢“«‘™“™’æ ‡æ◊ËÕ„À⧫“¡√ŸâºŸâªÉ«¬

µ“¡·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬ (Clinical pathway of Hypoglycemia in Lop Buri Hospital) ∑”„À⺟âªÉ«¬

 “¡“√∂ªØ‘∫—µ‘µ—«‰¥â∂Ÿ°µâÕß ∑—Èߥâ“π°“√ —߇°µÕ“°“√

º‘¥ª√°µ‘¢Õß√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥ Ÿß/µË” °“√°‘πÕ“À“√

‡∫“À«“πÕ¬à“ß∂Ÿ°«‘∏’ ∑—Èß®“°∑’Ë ‚√ß欓∫“≈®—¥„Àâ·≈–

®“°≠“µ‘´◊ÈÕ¡“„Àâ ‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’

µ‘¥µ“¡µ√«® Õ∫Õ“À“√∑’˺ŸâªÉ«¬°‘π∑ÿ°¡◊ÈÕ °“√µ‘¥µ“¡

„À⺟âªÉ«¬°‘𬓵“¡·ºπ°“√√—°…“¢Õß·æ∑¬åÕ¬à“ߧ√∫∂â«π

·≈–°“√∑”®‘µ„®„Àâ ∫“¬‰¡à‡§√’¬¥ ¡’º≈„Àâ√–¥—∫πÈ”µ“≈

„π‡≈◊Õ¥¢ÕߺŸâªÉ«¬Õ¬Ÿà„π‡°≥±å∑’Ë°”Àπ¥  “¡“√∂§«∫§ÿ¡

√–¥—∫πÈ”µ“≈‰¥â

®”π«π«—ππÕπ„π‚√ß欓∫“≈¢ÕߺŸâªÉ«¬°≈ÿà¡

‡ª√’¬∫‡∑’¬∫ ·≈–°≈ÿà¡∑¥≈Õß ¡’§à“‡©≈’ˬ·µ°µà“ß°—π Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ∑’Ë√–¥—∫ 0.05 (µ“√“ß∑’Ë 3) º≈

°“√«‘®—¬π’È Õ¥§≈âÕß°—∫√“¬ß“πÕ◊Ëπ Ê(16, 23-27)

®“°°“√

«‘®—¬§√—Èßπ’È æ∫«à“ ∑’¡ À “¢“«‘™“™’æ¡’°“√°”Àπ¥‡ªÑ“- À¡“¬ ·≈–·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬∑’Ë™—¥‡®π ‡™àπ º≈≈—æ∏å∑’˧“¥À«—ß °‘®°√√¡°“√¥Ÿ·≈ºŸâªÉ«¬„π·µà≈–«—π

‚¥¬°“√ —߇°µÕ“°“√√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË” ·≈–„Àâ

§”·π–π”ºŸâªÉ«¬„π°“√ —߇°µÕ“°“√º‘¥ª√°µ‘ °“√À“

 “‡Àµÿ ·∑â®√‘ߢÕß°“√‡°‘¥Õ“°“√√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥µË”

°“√·°â ‰¢·≈–ªÑÕß°—π°“√‡°‘¥Õ“°“√√–¥—∫πÈ”µ“≈„π

‡≈◊Õ¥µË” °“√„Àâ “√πÈ”·≈–πÈ”µ“≈°≈Ÿ‚§ ∑“ßÀ≈Õ¥

µ“√“ß∑’Ë 3 §à“‡©≈’ˬ¢Õß≈”¥—∫∑’Ë¢Õß®”π«π«—ππÕπ‚√ß欓∫“≈ ·≈–®”π«πºŸâªÉ«¬∑’ˇ¢â“√—°…“´È”„π‚√ß欓∫“≈ ¿“¬„π 28 «—π ¢Õß

°≈ÿࡇª√’¬∫‡∑’¬∫∑’ˉ¥â√—∫°“√¥Ÿ·≈·∫∫ª√°µ‘°—∫°≈ÿà¡∑¥≈Õß∑’ˉ¥â√—∫°“√®—¥√–∫∫∫√‘°“√欓∫“≈‚¥¬„™â欓∫“≈ºŸâ®—¥°“√ºŸâ ªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√¥Ÿ·≈ºŸâªÉ«¬‚¥¬∑’¡ À “¢“«‘™“™’æ

µ—«·ª√ ®”π«π Mean Rank Sum of Ranks p-value

®”π«π«—ππÕπ‚√ß欓∫“≈

°≈ÿࡇª√’¬∫‡∑’¬∫ 30 36.90 1,007.00

0.003*

°≈ÿà¡∑¥≈Õß 30 24.10 723.00

®”π«πºŸâªÉ«¬∑’ˇ¢â“√—°…“´È”„π‚√ß欓∫“≈

°≈ÿࡇª√’¬∫‡∑’¬∫ 30 33.50 1,005.00

0.024*

°≈ÿà¡∑¥≈Õß 30 27.50 825.00

*p < 0.05

Journal of Health Science 2009 Vol. 18 No. 3

410

‡≈◊Õ¥¥” µ“¡·π«∑“ß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬ ·≈–ª√– “π- ß“π∑’¡ À “¢“«‘™“™’æ‡æ◊ËÕ„À⧫“¡√ŸâºŸâªÉ«¬µ“¡ ¿“æ ªí≠À“ ·≈–‡¡◊ËÕ¡’§«“¡·ª√ª√«π‡°‘¥¢÷Èπ 欓∫“≈ºŸâ-

®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ∑’¡ À “¢“«‘™“™’æ ·≈–∑’¡

 ÿ¢¿“æ∑’ˇ°’ˬ«¢âÕß ª√–™ÿ¡·≈–·°âªí≠À“√à«¡°—π ®π∑”

„Àâ “¡“√∂¥”‡π‘π°“√µàÕ‰ª‰¥â ·≈–‰¡à‡°‘¥ªí≠À“‡¥‘¡´È”

§à“„™â®à“¬„π°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‚√§‡∫“À«“π¢Õß ºŸâªÉ«¬°≈ÿࡇª√’¬∫‡∑’¬∫·≈–°≈ÿà¡∑¥≈Õß·µ°µà“ß°—π Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘∑’Ë√–¥—∫ 0.05 ‚¥¬§à“„™â®à“¬„π

°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬°≈ÿà¡∑¥≈Õß≈¥≈ß°«à“ ºŸâªÉ«¬°≈ÿà¡

µ—«Õ¬à“ß∑’Ë ‰¡à ‰¥â „™â°“√®—¥√–∫∫∫√‘°“√欓∫“≈ ‚¥¬

欓∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ (µ“√“ß∑’Ë 2) º≈°“√

«‘®—¬π’È Õ¥§≈âÕß°—∫ º≈¢Õß√“¬ß“πÕ◊Ëπ Ê(16,25,26,28-31)

®“°

°“√«‘®—¬§√—Èßπ’È æ∫«à“ °“√∑’˺ŸâªÉ«¬‰¥â√—∫°“√¥Ÿ·≈√—°…“

µ“¡·π«∑“ß∑’Ë°”Àπ¥ ∑”„Àâ ‰¡à¡’°“√µ√«®∑“ßÀâÕß ªØ‘∫—µ‘°“√ À√◊Õ°“√ àßµ√«®æ‘‡»…Õ◊Ëπ Ê ‡°‘π‡°≥±å∑’Ë

°”Àπ¥ Õ’°∑—Èß°“√∑’Ë®”Àπà“¬ºŸâªÉ«¬‰¥â¿“¬„π 3 «—𠵓¡

∑’Ë°”Àπ¥ ∑”„Àâ “¡“√∂§«∫§ÿ¡§à“„™â®à“¬„π°“√¥Ÿ·≈

√—°…“ºŸâªÉ«¬‰¥â

®”π«πºŸâªÉ«¬∑’ˇ¢â“√—°…“´È”„π‚√ß欓∫“≈ ¿“¬„π 28 «—π¢ÕߺŸâªÉ«¬°≈ÿࡇª√’¬∫‡∑’¬∫ ·≈–°≈ÿà¡∑¥≈Õß ·µ°- µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘∑’Ë√–¥—∫ 0.05 (µ“√“ß∑’Ë 3) ®“°°“√«‘®—¬§√—Èßπ’È æ∫«à“ 欓∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬

√“¬°√≥’ ´÷Ë߇ªìπºŸâ∑’Ë„°≈♑¥ºŸâªÉ«¬¡“°∑’Ë ÿ¥ ª√–‡¡‘π  ¿“æªí≠À“À“ “‡Àµÿ·∑â®√‘ߢÕß°“√‡¢â“√—∫°“√√—°…“

„π‚√ß欓∫“≈  Õ¥§≈âÕß°—∫∑’Ë Foster AP⁽³²⁾ ‰¥â°≈à“«

‰«â«à“ °“√À“ “‡Àµÿ¢Õß°“√‡¢â“√—∫°“√√—°…“´È”„π‚√ß- 欓∫“≈®“°ºŸâªÉ«¬ √–∫∫∫√‘°“√ ÿ¢¿“æ ·≈–°“√

∫√‘°“√∑’Ë„Àâ°—∫ºŸâªÉ«¬ ®–∑”„Àâ≈¥‚Õ°“ ‡°‘¥°“√πÕπ‚√ß- 欓∫“≈´È”„πÕ𓧵‰¥â πÕ°®“°π—Èπ欓∫“≈ºŸâ®—¥°“√

ºŸâªÉ«¬√“¬°√≥’ ¬—߉¥â„À⧫“¡√Ÿâ„π°“√¥Ÿ·≈µπ‡Õß·°àºŸâªÉ«¬

∑—Èߢ≥–Õ¬Ÿà ‚√ß欓∫“≈·≈–‡¡◊ËÕ°≈—∫‰ªÕ¬Ÿà∑’Ë∫â“π ‰¥â ª√– “πß“π∑’¡ À “¢“«‘™“™’浓¡·π«∑“ß°“√¥Ÿ·≈

√—°…“  Õ¥§≈âÕß°—∫∑’Ë Gardner DB ·≈– Cary A⁽³³⁾

°≈à“«‰«â«à“ §«“¡√à«¡¡◊Õ¢Õß∑’¡ À “¢“«‘™“™’æ ∑”„Àâ

ºŸâªÉ«¬‰¥â√—∫°“√¥Ÿ·≈√—°…“Õ¬à“ߧ√Õ∫§≈ÿ¡ ·≈–‡°‘¥

º≈≈—æ∏å°“√¥Ÿ·≈∑’Ë¥’ ·≈–¥—ß∑’Ë Spooner SH ·≈– Yockey PS⁽²⁹⁾ ‰¥âæ∫«à“ ‚ª√·°√¡™à«¬„π°“√æ—≤π“§ÿ≥¿“æ ·≈–

ª√– “π°“√¥Ÿ·≈ºŸâªÉ«¬ ≈¥®”π«π°“√°≈—∫¡“√—°…“„π

‚√ß欓∫“≈´È” §à“„™â®à“¬≈¥≈ß ·≈–æ—≤𓧫“¡

™”π“≠¢Õß欓∫“≈ πÕ°®“°π—Èπ欓∫“≈ºŸâ®—¥°“√

ºŸâªÉ«¬√“¬°√≥’ ¬—߉¥âª√– “πß“π°—∫欓∫“≈‡¬’ˬ¡∫â“π

°≈ÿà¡ß“π‡«™°√√¡ —ߧ¡„π°“√µ‘¥µ“¡¥Ÿ·≈ ºŸâªÉ«¬Õ¬à“ß µàÕ‡π◊ËÕß∑’Ë∫â“π ∑”„À⺟âªÉ«¬¡’惵‘°√√¡°“√¥Ÿ·≈µπ‡Õß∑’Ë

∂Ÿ°µâÕß∑’Ë∫â“π‰¡à°≈—∫¡“πÕπ‚√ß欓∫“≈´È” ¿“¬„π 28

«—π

¢âÕ‡ πÕ·π–

1. §«√π”√–∫∫∫√‘°“√‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâ- ªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√¥Ÿ·≈√—°…“ ‚¥¬∑’¡ À-  “¢“«‘™“™’扪„™â¢¬“¬º≈ „π°“√‡æ‘Ë¡§ÿ≥¿“æ°“√

欓∫“≈„πÀÕºŸâªÉ«¬∑ÿ°·ÀàߢÕß‚√ß欓∫“≈≈æ∫ÿ√’ ·≈–

‚√ß欓∫“≈·ÀàßÕ◊Ëπ

2. „π°“√π”°“√®—¥√–∫∫∫√‘°“√¢â“ßµâπ‰ª„™â µâÕß æ‘®“√≥“∂÷ߧ«“¡æ√âÕ¡¢Õß ‘Ëßµà“ß Ê ‡™àπ °“√ π—∫ πÿπ

®“°ºŸâ∫√‘À“√ °“√ª√– “πß“π°—∫∑ÿ°Àπ૬ߓπ∑’ˇ°’ˬ«¢âÕß

°“√°”À𥫗µ∂ÿª√– ß§å ·≈–°≈«‘∏’°“√¥”‡π‘πß“π„Àâ

™—¥‡®π °“√‡µ√’¬¡§«“¡æ√âÕ¡¥â“π∫ÿ§≈“°√ ·≈–°“√

§—¥‡≈◊Õ°ºŸâªÉ«¬ ‡ªìπµâπ

3. §«√»÷°…“º≈®“°°“√®—¥√–∫∫∫√‘°“√欓∫“≈

‚¥¬æ¬“∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬√“¬°√≥’ ·≈–·π«∑“ß°“√

¥Ÿ·≈√—°…“ºŸâªÉ«¬ ‚¥¬∑’¡ À “¢“«‘™“™’æ∑’˧√Õ∫§≈ÿ¡

¡“°°«à“π’È ‡™àπ∑—Èß®“°ºŸâ∫√‘À“√√–∫∫ß“π º≈≈—æ∏å°—∫

ºŸâªÉ«¬∑’ˇªìπº≈√–¬– —È𠇙à𠧫“¡√Ÿâ ∑—»π§µ‘ ·≈–

惵‘°√√¡°“√¥Ÿ·≈ ÿ¢¿“æ §«“¡æ÷ßæÕ„®¢Õß∑’¡ À-  “¢“«‘™“™’æ·≈–ºŸâªÉ«¬ ·≈–º≈√–¬–¬“« ‡™àπ °“√‡°‘¥

¿“«–·∑√°´âÕπ ·≈–§ÿ≥¿“æ™’«‘µ ‡ªìπµâπ

°‘µµ‘°√√¡ª√–°“»

¢Õ¢Õ∫§ÿ≥ ¥√. ∑—»π’¬å ‡°√‘°°ÿ≈∏√ Õ“®“√¬åª√–®”

‡Õ° “√Õâ“ßÕ‘ß

1. WHO. Stop Global of Epidemic of Chronic Disease:

Quick Diabetes Facts; [cited 2008 November 11];

Available from: http://www.who.int/diabetes/en/

2. The National Health Security Office. More than 3 mil- lion Thais have diabetes and spent 80,000 million baht MoPH hurries to eliminate diabetes complication and seeks coorporation all agencies concerned (5 July 2007) 2008. [cited 2008 2 Janyuary ]; Available from:

www.NHSO news.mht

3. Aekplakorn W, Stolk R, Neal B, Suriyawongpaisal P, Chongsuvivatwong V, Cheepudomwit S, et al. The prevalence and management of diabetes in Thai adults.

Diabetes care 2003; 26:2758-63.

4.  ”π—°π‚¬∫“¬·≈–¬ÿ∑∏»“ µ√å  ”π—°ß“πª≈—¥°√–∑√«ß  “∏“√≥ ÿ¢. ¢âÕ¡Ÿ≈°≈ÿà¡‚√§À—«„®À≈Õ¥‡≈◊Õ¥·≈–‡∫“À«“π.

ππ∑∫ÿ√’:  ”π—°π‚¬∫“¬·≈–¬ÿ∑∏»“ µ√å; 2548.

5. Õ¿‘™“µ‘ «‘™≠“≥√—µπå. ‚√§‡∫“À«“π. „π:  ÿ∑‘π »√’Õ—…Ø“æ√,

«√√≥’ π‘∏‘¬“π—π∑å, ∫√√≥“∏‘°“√. À≈—°°“√√—°…“·≈–µ‘¥µ“¡ºŸâ ªÉ«¬‡∫“À«“π °√ÿ߇∑æ¡À“π§√: ‡√◊Õπ·°â«; 2548.

6. Strattron IM, Adler AI, Nice HAW, Matthews D, Manley SE, Cull CA. Association of glycemia with macrovascular and microvascular complication of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321:405-12.

7. º°“¡“» ß“¡ª√–¥‘…∞å°ÿ≈. ªí®®—¬∑’Ë¡’º≈µàÕ°“√§«∫§ÿ¡√–¥—∫

πÈ”µ“≈„π‡≈◊Õ¥¢ÕߺŸâªÉ«¬‡∫“À«“π ™π‘¥‰¡àæ÷ËßÕ‘π´Ÿ≈‘π: »÷°…“

‡©æ“–‚√ß欓∫“≈æÀ≈æ¬ÿÀ‡ π“ ®—ßÀ«—¥°“≠®π∫ÿ√’

(«‘∑¬“π‘æπ∏åª√‘≠≠“¡À“∫—≥±‘µ).  “¢“«‘∑¬“°“√√–∫“¥,

∫—≥±‘µ«‘∑¬“≈—¬. °√ÿ߇∑æ¡À“π§√: ¡À“«‘∑¬“≈—¬¡À‘¥≈; 2536.

8.  ÿπ∑√“ À‘√—≠«√√≥. ªí®®—¬∑’Ë¡’º≈µàÕ惵‘°√√¡°“√¥Ÿ·≈

µπ‡Õß·≈–¿“«–°“√§«∫§ÿ¡√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥¢ÕߺŸâªÉ«¬

‡∫“À«“π ™π‘¥‰¡àæ÷ËßÕ‘π´Ÿ≈‘π: °√≥’»÷°…“‡©æ“–‚√ß欓∫“≈

·°âߧ√âÕ ®—ßÀ«—¥™—¬¿Ÿ¡‘ («‘∑¬“π‘æπ∏åª√‘≠≠“¡À“∫—≥±‘µ).

 “¢“«‘∑¬“°“√√–∫“¥, ∫—≥±‘µ«‘∑¬“≈—¬. °√ÿ߇∑æ¡À“π§√:

¡À“«‘∑¬“≈—¬¡À‘¥≈; 2538.

9.  ÿ®‘µ√“  —πµ‘«ß»å‰™¬. ªí®®—¬∑’Ë¡’º≈µàÕ°“√惵‘°√√¡°“√ àß

‡ √‘¡ ÿ¢¿“æ·≈–惵‘°√√¡°“√√—°…“„πºŸâªÉ«¬‚√§‡∫“À«“π

™π‘¥‰¡àæ÷ËßÕ‘π´Ÿ≈‘π‚√ß欓∫“≈∫â“π‚ªÉß («‘∑¬“π‘æπ∏åª√‘≠≠“

¡À“∫—≥±‘µ).  “¢“ ÿ¢»÷°…“·≈–惵‘°√√¡»“ µ√å, ∫—≥±‘µ

«‘∑¬“≈—¬. °√ÿ߇∑æ¡À“π§√: ¡À“«‘∑¬“≈—¬¡À‘¥≈; 2544.

10. »‘√‘¡“ ‡π“«√—µπå. °“√ª√–¬ÿ°µå∑ƒ…Æ’§«“¡ “¡“√∂„πµπ‡Õß

√à«¡°—∫∫ÿ§§≈Õâ“ßÕ‘ßµàÕ°“√‡ª≈’ˬπ·ª≈ß惵‘°√√¡¢ÕߺŸâªÉ«¬

‚√§‡∫“À«“π ‚√ß欓∫“≈ «√√§åª√–™“√—°…å ®—ßÀ«—¥π§√ «√√§å («‘∑¬“π‘æπ∏åª√‘≠≠“¡À“∫—≥±‘µ).  “¢“ ÿ¢»÷°…“·≈–

惵‘°√√¡»“ µ√å, ∫—≥±‘µ«‘∑¬“≈—¬. °√ÿ߇∑æ¡À“π§√:

¡À“«‘∑¬“≈—¬¡À‘¥≈; 2541.

11. »ÿ≈’æ—π∏å ¡“· «ß. ª√– ‘∑∏‘º≈‚ª√·°√¡ à߇ √‘¡ ÿ¢¿“æ·≈–

 ÿ¢»÷°…“„π°“√ª√—∫‡ª≈’ˬπ惵‘°√√¡·≈–°“√§«∫§ÿ¡√–¥—∫

πÈ”µ“≈„π‡≈◊Õ¥¢Õß µ√’«—¬∑Õß∑’˪ɫ¬‡ªìπ‚√§‡∫“À«“π ™π‘¥∑’Ë 2 («‘∑¬“π‘æπ∏åª√‘≠≠“¡À“∫—≥±‘µ).  “¢“ ÿ¢»÷°…“·≈–

惵‘°√√¡»“ µ√å, ∫—≥±‘µ«‘∑¬“≈—¬. °√ÿ߇∑æ¡À“π§√:

¡À“«‘∑¬“≈—¬¡À‘¥≈; 2544.

12. √æ’æ√ ‡æÁß®—π∑√å. °“√ à߇ √‘¡°“√§«∫§ÿ¡µπ‡Õ߇æ◊ËÕ≈¥√–¥—∫

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®—ßÀ«—¥ ¡ÿ∑√ª√“°“√ («‘∑¬“π‘æπ∏åª√‘≠≠“¡À“∫—≥±‘µ).  “¢“

 ÿ¢»÷°…“·≈–惵‘°√√¡»“ µ√å, ∫—≥±‘µ«‘∑¬“≈—¬. °√ÿ߇∑æ-

¡À“π§√: ¡À“«‘∑¬“≈—¬¡À‘¥≈; 2545.

13. «‘∑¬“ »√’¡“¥“, «™‘√“ ∏π“ª√–∑ÿ¡. ¿“«–·∑√°´âÕπ¢Õß‚√§

‡∫“À«“π. „π: «‘∑¬“ »√’¡“¥“. ∫√√≥“∏‘°“√. ‚√§µàÕ¡‰√â∑àÕ

·≈–‡¡µ–∫Õ≈‘ ¡. æ‘¡æå§√—Èß∑’Ë 1. °√ÿ߇∑æ¡À“π§√: 21

‡´Áπ®Ÿ√’Ë; 2540. Àπâ“ 360-75.

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®‘µ√  ‘∑∏‘Õ¡√, Õπÿ«—≤πå »ÿ¿™ÿµ‘°ÿ≈,  ß«π ‘π √—µπ‡≈‘», ‡°’¬√µ‘

»—°¥‘Ï √“™∫√‘√—°…å. ∫√√≥“∏‘°“√. Clinical practice guide- lines: °“√®—¥∑”·≈–°“√𔉪„™â. ππ∑∫ÿ√’:  ∂“∫—πæ—≤π“

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√“™¿—؇∑æ µ√’ ≈æ∫ÿ√’ 𓬷æ∑¬å ¡§‘¥ ‡Õ◊ÈÕÕ¿‘ ‘∑∏‘Ï«ß»å ºŸâ Õ”π«¬°“√‚√ß欓∫“≈≈æ∫ÿ√’ π“ß∫ÿ≠»√’ »‘≈ª ¡∫Ÿ√≥å Õ¥’µ À—«Àπâ“欓∫“≈ ‚√ß欓∫“≈≈æ∫ÿ√’ ∑’¡ À “¢“«‘™“™’æ Õ“¬ÿ√°√√¡ À—«Àπâ“ÀÕºŸâªÉ«¬Õ“¬ÿ√°√√¡ 欓∫“≈ºŸâ®—¥°“√ºŸâªÉ«¬

√“¬°√≥’ ·≈–ºŸâ‡°’ˬ«¢âÕß∑ÿ°∑à“π∑’Ë„Àâ°“√ π—∫ πÿπ „À⧫“¡

√à«¡¡◊Õ „Àâ¢âÕ¡Ÿ≈ ·≈–‡Õ° “√Õâ“ßÕ‘ßµà“ß Ê Õ—π‡ªìπª√–‚¬™πå µàÕ°“√»÷°…“«‘®—¬§√—Èßπ’È ®π∑”„Àâ°“√«‘®—¬ ”‡√Á®≈ÿ≈à«ß≈߉¥â¥â«¬¥’

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∑”ß“π‡ªìπ∑’¡¢Õß∑’¡ ÿ¢¿“æ §à“„™â®à“¬„π°“√√—°…“欓∫“≈

·≈–®”π«π«—ππÕπ‚√ß欓∫“≈ («‘∑¬“π‘æπ∏åª√‘≠≠“¡À“

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§«“¡ —¡æ—π∏å„π∑’¡ À “¢“: °√≥’»÷°…“„π‚√ß欓∫“≈

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Abstract Effects of Nurse Case Manager and Multidisciplinary Clinical Pathway for Type 2 Dia- betic Patients, Lop Buri Hospital

Valai Boonploy, Ananya Manit Nursing Section, Lop Buri Hospital Journal of Health Science 2009; 18:404-13.

This quasi-experimental research was aimed at testing effects of nursing service system coor- dinated by nurse case manager and multidisciplinary care followed the clinical pathway for type 2 diabetic patients with hypoglycemia on quality of diabetes care including blood sugar, length of hospital stay, cost of diabetes care and readmission. The samples included sixty type 2 diabetes patients with hypoglycemia admitted in Lop Buri Hospital. Thirty subjects were randomly assigned to each an experimental group and a comparative one. The experimental group received the multidisciplinary care that followed the clinical pathway for diabetic patients with hypoglycemia and coordinated by a nurse case manager. The control group received only routine care. The pa- tients profile and diabetes care quality data were recorded on diabetes care quality form by nurse case managers. Data was analyzed using descriptive statistic, independent t-test and Mann Whitney U test

The finding revealed that the experimental group had significantly lower mean blood sugar level than that of the control group (96.67 mg% vs 102.68 mg%, p<0.05). The mean rank of length of hospital stay of the experimental group was significantly lower than that of the control group (24.10 days vs 36.90 days, p<0.05). Diabetic care cost of the experimental group was significantly lower than that of the control group (4,195.40 baht vs 6,375.53 baht, p<0.05). In addition, mean rank of patients who were readmitted within 28 days of the experimental group was significantly lower than that of the comparison group (27.50 vs 33.50, p<0.05)

This study suggests that the nursing service system coordinated by nurse case manager and the multidisciplinary care followed the clinical pathway for type 2 diabetic patients with hypoglycemia can improve quality of diabetic care.

Key words: nurse case manager, clinical pathway, multidisciplinary team, hypoglycemia, quality of diabe- tes care