Nationwide implementation of a diabetes self-management and network system improves outcomes in type 1 diabetes: real-world evidence from Thailand

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).