Nationwide implementation of a diabetes self-management and network system improves outcomes in type 1 diabetes: real-world evidence from Thailand
Issued Date
2026-12-01
Resource Type
eISSN
14726823
Scopus ID
2-s2.0-105028205401
Pubmed ID
41387826
Journal Title
BMC Endocrine Disorders
Volume
26
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Endocrine Disorders Vol.26 No.1 (2026)
Suggested Citation
Tharavanij T., Dejkhamron P., Rawdaree P., Likitmaskul S., Santiprabhob J., Deerochanawong C., Reutrakul S., Nitiyanant W. Nationwide implementation of a diabetes self-management and network system improves outcomes in type 1 diabetes: real-world evidence from Thailand. BMC Endocrine Disorders Vol.26 No.1 (2026). doi:10.1186/s12902-025-02123-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114598
Title
Nationwide implementation of a diabetes self-management and network system improves outcomes in type 1 diabetes: real-world evidence from Thailand
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Currently, there is a lack of real-world studies examining the impact of diabetes self-management education for individuals with type 1 diabetes (T1D) in resource-limited countries. This study aimed to evaluate the clinical outcomes of the nationwide implementation of the Diabetes Self-Management Program and Network System (DSMP-NS) in Thailand in conjunction with Thai Type 1 Diabetes (T1D) and Diabetes Diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN). Methods: DSMP-NS provided free-of-charge intensive insulin treatment, Diabetes Self-Management Education, blood glucose monitoring (BGM) supplies, urine ketone strips, and established a network system across 37 hospitals. A prospective observational study was conducted after the implementation of DSMP-NS. The composite outcome was defined as achieving good glycaemic control (HbA1c meeting the goal: <7.5% in children aged < 18 years or < 7.0% in adults) or a ≥ 0.5% reduction if baseline HbA1c level was above the goal without diabetic ketoacidosis (DKA) and severe hypoglycaemia. Data were analyzed using an intention-to-treat approach. Results: Of 481 participants (median age of 15.8 years; interquartile range: 12.2, 20.5), 305 individuals (63.4%) were children. At baseline, 74 individuals (16.1%) were obese. A total of 412 participants completed the 12-month follow-up. The composite outcome achievement rose significantly compared with baseline (43.0% vs. 17.6%, p < 0.001). Adults had significantly lower mean HbA1c ± SD levels at the 12th month (8.2 ± 2.0% vs. 8.8 ± 2.3%, p = 0.005). The DKA incidence decreased from 22.1 (95%CI 18.6–26.3) to 10.2 (7.6–13.8) per person-year, p < 0.001. Older age at enrolment and BGM ≥ 3 times/day were positively associated with the composite outcome, whereas baseline obesity showed an inverse association. Conclusions: DSMP-NS implementation for T1D resulted in improved glycaemic control and a reduced occurrence of acute diabetes complications. Older age and frequent BGM monitoring (≥ 3 times/day) are positively associated with favourable outcomes, while baseline obesity was inversely associated. Trial registration: NA (a prospective real-world study).