การพัฒนารูปแบบการดูแลผู้ป่วยโรคเบาหวานชนิดที่ 2 ที่ควบคุมระดับน้ำตาลในเลือดไม่ได้ โดยใช้การปรับเปลี่ยนพฤติกรรมสุขภาพและระบบเทคโนโลยีการแพทย์ทางไกล

Jedsada Boonyanupapong; Puwadol Polpuak; Thapanan Amarangkul; Sira Panyam; Nipawan Nernpermpisooth

Authors

Jedsada Boonyanupapong Bangrakam Hospital, Phitsanulok Province
Puwadol Polpuak Bangrakam Hospital, Phitsanulok Province
Thapanan Amarangkul Bangrakam Hospital, Phitsanulok Province
Sira Panyam Bangrakam Hospital, Phitsanulok Province
Nipawan Nernpermpisooth Bangrakam Hospital, Phitsanulok Province

Keywords:

low carbohydrate diet, telemedicine, intermittent fasting

Abstract

Background: The Ministry of Public Health has realized improving quality of diabetes care in response to the escalating global burden of diabetes. This study aimed to develop an integrated chronic care model promoting dietary behavior changes through a low-carbohydrate diet and strengthening self-care engagement via telemedicine. The intervention aimed to enhance self-management capacities, achieve glycemic control.

Methodology: The study employed a research and development design divided into three phases: problem situation analysis, model development, and evaluation of the model’s effectiveness. In phase 1, a qualitative study was conducted involving 7 service providers from the noncommunicable clinic and 15 uncontrolled type 2 diabetes patients purposively selected. Phase 2 focused on developing an integrated diabetes care model based on phase 1 findings, incorporating elements of the chronic care model, health literacy principles, and motivational theory. In phase 3, a quasi-experimental study was conducted among uncontrolled type 2 diabetes patients at four pilot sub-district health promoting hospitals. Participants were systematically allocated into two groups: an experimental group receiving the health behavior modification interventions and a comparison group receiving standard usual care. Each group consisted of 20 participants. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using descriptive statistics, Fisher’s exact test, independent t-test, and multivariable regression analysis.

Results: The standard usual care service was ineffective in assessing patients’ self-management needs and providing individualized advice, resulting in service overcrowding and persistent inappropriate health behaviors among patients with diabetes. To address these issues, an integrated care system was developed, offering personalized self-management support, data transfer, and telemedicine-based follow-up at sub-district health promoting hospitals. Following implementation, patients demonstrated improved self-care behaviors, significant reductions in HbA1C levels, improved lipid profiles, and decreased use of glucose-lowering medications.

Conclusion: The integrated diabetes care model was effective in better glycemic and lipid control among uncontrolled type 2 diabetes patients. Scaling the implementation of this model to additional community hospitals could enhance effective diabetes care delivery at the local level. Furthermore, the model could be adapted as a diabetes remission model at sub-district health promoting hospitals.

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