Effectiveness of a Collaborative Community-Based Diabetes Remission Clinic in Ubolrat District, Khon Kaen Province
ประสิทธิผลของคลินิกเบาหวานระยะสงบในชุมชน โดยการมีส่วนร่วมของภาคีเครือข่าย อำเภออุบลรัตน์ จังหวัดขอนแก่น
Abstract
Introduction and Objective : Diabetes is a major public health issue with continuously rising prevalence. Ubolrat District has 2,845 registered diabetic patients, representing a prevalence of 8.2%, with only 36.5% achieving glycemic control. The objective of this study was to evaluate the effectiveness of a collaborative community-based diabetes remission clinic model on clinical outcomes, self-care behaviors, and quality of life.
Methodology : This study employed a quasi-experimental one-group pretest-posttest design. The sample consisted of 66 Type 2 diabetes patients with HbA1c levels between 6.5-8.5%. The study duration was 6 months. The intervention consisted of 1) Intensive lifestyle modification education via an online system, conducted weekly for 12 weeks, focusing on health behavior changes and 2) Community-based follow-up by network partners and the use of telemedicine for 12 weeks. Data collection tools included general information and laboratory record forms, self-care behavior questionnaires, and the World Health Organization Quality of Life (WHOQOL-BREF) assessment. Data were analyzed using descriptive statistics, Paired t-test, and One-way Repeated Measures ANOVA. Factor associations were analyzed using Pearson correlation and Multiple Linear Regression.
Results : After 6 months of intervention, clinical outcomes showed significant decreases in HbA1c levels, fasting blood sugar, body weight, Body Mass Index (BMI), and waist circumference (p < 0.001). Regarding treatment outcomes, 27.3% of patients were able to discontinue diabetes medication, and 34.8% were able to reduce their dosage. Self-care behaviors significantly improved, and patients' quality of life increased. Factors significantly affecting HbA1c levels at 6 months included baseline HbA1c and BMI. The only factor significantly associated with medication reduction or cessation was the baseline quality of life score.
Conclusion : This model is effective in significantly improving clinical outcomes, self-care behaviors, and quality of life. Over 60% of patients were able to stop or reduce their medication, demonstrating the potential of an integrated service model with network participation. This supports the concept of diabetes remission and suggests that this model can be effectively applied within the Thai community context.
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References
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021; 44(Suppl 1): S15–33. DOI: 10.2337/dc21-ad09
Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care. 2021; 44(10): 2438–44. DOI: 10.2337/dci21-0034
Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018; 391(10120): 541-51. DOI: 10.1016/S0140-6736(17)33102-1
Taylor R, Al-Mrabeh A, Zhyzhneuskaya S, Peters C, Barnes AC, Aribisala BS, et al. Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery. Cell Metab. 2018; 28(4): 547-56. DOI: 10.1016/j.cmet.2018.07.003
Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019; 7(5) :344–55. DOI: 10.1016/S2213-8587(19)30068-3
พิชิต สุขสบาย . ประสิทธิผลการดูแลผู้ป่วยโรคเบาหวานชนิดที่ 2 ให้เข้าสู่โรคเบาหวานระยะสงบการปรับเปลี่ยนพฤติกรรมอย่างเข้มงวด จังหวัดสุราษฎร์ธานี. วารสารวิชาการแพทย์ เขต 11. 38(1): 27-43.
Korsmo-Haugen HK, Brurberg KG, Mann J, Aas AM. Carbohydrate quantity in the dietary management of type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2019; 21(1): 15-27. DOI: 10.1111/dom.13499
Babikr W, Alshahrani A, Hamid H, Abdelraheem A, Shalayel M. The correlation of HbA1c with body mass index and HDL-cholesterol in type 2 diabetic patients. Biomed Res. 2016; 27(4): 1280–3.
Gillani SM, Raghavan R, Singh BM. A 5-year assessment of the epidemiology and natural history of possible diabetes in remission. Prim Care Diabetes. 2021; 15(4):688-92.
DOI: 10.1016/j.pcd.2021.04.007
Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012; 308(23): 2489–2496. DOI: 10.1001/jama.2012.67929
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001; 20(6): 64–78.
DOI: 10.1377/hlthaff.20.6.64
ประสิทธิ์ โฉมวงศ์, พรรณี บัญชรหัตถกิจ, ทัศพร ชูศักดิ์. ผลของโปรแกรมการจัดการตนเองของผู้ป่วยเบาหวานชนิดที่ 2 ที่ควบคุมระดับน้ำตาล ในเลือดไม่ได้ตำบลโคกสลุง อำเภอพัฒนานิคม จังหวัดลพบุรี. วารสารวิจัยและพัฒนาระบบสุขภาพ. 2567; 17(2): 240–253.
Sattayasomboon Y, Jiamjarasrungsi W, Lohsoonthorn V, Lertmaharit S. Effectiveness of a Self-Management Support Program for Type 2 Diabetes Mellitus in Public Health Centers in Bangkok, Thailand: Randomized Controlled Trial. J Health Res. 2017; 31(4): 269-76.
อณัญญา ลาลุน, บษพร วิรุณพันธ์. ผลของโปรแกรมการจัดการตนเองต่อระดับน้ำตาลสะสมในเลือดและคุณภาพชีวิตผู้ป่วยโรคเบาหวานชนิดที่ 2 ในเขตรับผิดชอบโรงพยาบาลแก้งคร้อ จังหวัดชัยภูมิ. ราชาวดีสาร วิทยาลัยพยาบาลบรมราชชนนี สุรินทร์. 2563; 11(1): 66-80.
Powers MA, Bardsley JK, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report. Diabetes Care. 2020; 43(7): 1636-49. DOI: 10.2337/dci20-0023
Tunsuchart K, Lerttrakarnnon P, Srithanaviboonchai K, Likhitsathian S, Skulphan S. Type 2 Diabetes Mellitus Related Distress in Thailand. Int J Environ Res Public Health. 2020; 17(7): 2329.
DOI: 10.3390/ijerph17072329
Wattana C, Srisuphan W, Pothiban L, Upchurch SL. 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. Nurs Health Sci. 2007; 9(2): 135–41. DOI: 10.1111/j.1442-2018.2007.00315.x
Armani Kian A, Vahdani B, Noorbala A, Nejatisafa A, Arbabi M, Abedini A, et al. The impact of mindfulness-based stress reduction on emotional wellbeing and glycemic control of patients with type 2 diabetes mellitus. J Diabetes Res. 2018;2018:1986820. DOI: 10.1155/2018/1986820
Zamani-Alavijeh F, Araban M, Koohestani HR, Karimy M. The effectiveness of stress management training on blood glucose control in patients with type 2 diabetes. Diabetol Metab Syndr. 2018; 10:39. DOI: 10.1186/s13098-018-0342-5
Rifkin SB, Muller F, Bichmann W. Primary health care: on measuring participation. Soc Sci Med. 1988;26(9):931–40. DOI: 10.1016/0277-9536(88)90413-3
Morgan MA, Lifshay J. Community engagement in public health [Internet]. Martinez (CA): Contra Costa Health Services, Public Health Division; 2006 [cited 2025 Dec 20]. Available from: https://www.schoolhealthcenters.org/wp-content/uploads/2011/09/community_engagement.pdf
Sieng S, Thinkamrop B, Laohasiriwong W, Hurst C. Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand. Diabetes Res Clin Pract. 2015; 108(2): 265–72.
DOI: 10.1016/j.diabres.2015.02.005
Somanawat J, Saramunee K, Chanasopon S. Process, quality and challenges of diabetes care in primary care: a study of district health network in Thailand. Prim Health Care Res Dev. 2020; 21: e46. DOI: 10.1017/S1463423620000468
สมาคมแพทย์เวชปฏิบัติทั่วไป, สมาคมโรคเบาหวานแห่งประเทศไทย, สมาคมผู้ให้ความรู้โรคเบาหวาน. แนวทางการดูแลผู้ป่วยเบาหวานให้เข้าสู่โรคเบาหวานระยะสงบด้วยการปรับเปลี่ยนพฤติกรรมอย่างเข้มงวดสำหรับบุคลากรทางการแพทย์และสาธารณสุข. กรุงเทพฯ: ราชวิทยาลัยแพทย์เวชศาสตร์ครอบครัวแห่งประเทศไทย; 2565.
World Health Organization. The triangle that moves the mountain: nine years of Thailand’s National Health Assembly (2008-2016) [Internet]. Geneva: World Health Organization; 2017 [cited 2025 Jun 26]. Available from: https://www.who.int/publications/i/item/WHO-UHC-HGF-HGS-2017.1
กฤษฎา โม้เวียง. การพัฒนาการมีส่วนร่วมของภาคีเครือข่ายในการดูแลผู้ป่วยเบาหวานและความดันโลหิตสูงในชุมชน กรณีศึกษาตำบลสีชมพู อำเภอสีชมพู จังหวัดขอนแก่น. วารสารสิ่งแวดล้อมและสุขภาพชุมชน [Internet]. 2024 [cited 2025 Nov 30]; 9(5): 307-15. Available from: https://he03.tci-thaijo.org/index.php/ech/article/view/3373
Akselrod D, Friger M, Biderman A. HbA1C variability among type 2 diabetic patients: a retrospective cohort study. Diabetol Metab Syndr. 2021; 13(1): 101. DOI: 10.1186/s13098-021-00717-5
Health Data Center. Report on Non-Communicable Diseases (NCDs), Ubolratana Hospital, Khon Kaen Province, Fiscal Year 2026 [Internet]. Nonthaburi: Ministry of Public Health; 2026 [cited 2026 Jan 10]. Available from: https://hdc.moph.go.th/center/public/kpi/9/2026
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