A scalable solution for delivery of Diabetes Self-Management Education in Thailand

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Type 2 diabetes is a leading health problem in Thailand, with over 4 million adults living with the chronic condition in 2015. If the disease is not managed properly, it can lead to severe complications (e.g. heart disease, kidney disease, loss of sight) and even death. In addition, there are steep costs to the Thai economy - treating diabetes and its complications consumes over 10% of all healthcare spending, and many people with diabetes have to stop work due to the condition. To successfully manage diabetes and prevent its negative consequences, education and lifestyle counselling are prescribed as standard in many countries, supported by research evidence. Such programs (known as Diabetes Self-Management Education, DSME) help people by giving them motivation and skills to lead a healthier lifestyle, monitor warning signs for complications, follow complex medication regimes, and manage the stress of having diabetes. In Thailand, people suffering from diabetes are not currently offered any DSME services by the national health system, which means that management of diabetes is poor and rates of complications are high. The reason for this gap in service is partly the lack of a DSME program proven to work in Thailand, but also government concerns over affordability and feasibility of offering such a program at national level.To overcome these barriers, we propose to develop a new low-cost DSME program for people living with diabetes in Thailand, test that it works in a trial, and also find out how it can be made affordable for the government to provide it to everyone. The DSME program will be delivered as monthly meetings led by community health volunteers and nurses, aided by a short films about living with diabetes, to introduce key topics. These films will be produced in Thailand featuring real patients, in collaboration with award-winning charity Medical Aid Films (www.medicalaidfilms.org). The education and skills training will be followed by an open discussion session to discuss common challenges and solutions, set lifestyle goals and seek advice. We will develop the content of the DSME program through working closely with health care workers and patient groups, testing our initial version and refining it, based on observing what works and what doesn't work. Then we will test its effectiveness in a trial, by randomly assigning 15 community hospitals to offer all newly diagnosed persons either a) DSME program delivered by community health volunteers, b) DSME program delivered by nurses, or c) usual care (no DSME program). After one year, we will compare the control of blood glucose and risk of heart disease between patients of hospitals with and without the DSME program. We predict that in hospitals receiving the DSME program, management of diabetes will be better than in those without any program, and that both nurses and community health volunteers will be able to deliver it effectively. Alongside the main trial, we will collect data from participants and health care workers (through interviews) on their responses to the program and why and how it helped to improve diabetes management. Understanding these processes is vital to be able to adapt the program for other countries, making use of lessons learnt in Thailand. We will collect data on the costs involved with each part of the DSME program, and use it to identify the most affordable way of providing DSME in the Thai health system (we suspect it will be DMSE provided by community health volunteers). We will summarize all these results into policy recommendations, to be used by our collaborators at the Ministry of Public Health to decide whether and how to deliver the DSME program to the whole country. If adopted, the program has huge potential to improve the lives of people with diabetes and contribute to Thailand's continued economic growth and development.