[2026-01-29] Development of Care Guidelines for Type 2 Diabetes Remission and Prevention of Recurrence in the Mueang District Health Service Network, Surat Thani Province

Abstract

Background: Achieving type 2 diabetes remission has emerged as a critical therapeutic goal, shifting the focus from mere disease control to reversing the condition. Although remission is clinically achievable through intensive lifestyle modification, success rates in routine primary care remain low. A significant gap exists regarding context-specific care guidelines suitable for urban health service networks, where sustaining behavioral changes is particularly challenging due to socio-economic constraints.

Objectives: This study aimed to: 1) investigate the current situation and barriers to diabetes remission; 2) develop context-specific care guidelines; and 3) evaluate the effectiveness of these guidelines on clinical outcomes and patient satisfaction.

Methods: This study utilized an action research design conducted in three phases. Phase 1 involved a detailed situational assessment of diabetes-related issues within the target population. Phase 2 developed practice guidelines by identifying specific areas requiring attention based on Phase 1 findings. Phase 3 evaluated the guidelines by measuring clinical outcomes and patient satisfaction. Participants included 124 medical records and 10 key stakeholders for the situational analysis (Phase 1), and 12 pilot patients for the implementation phase (Phase 2). Instruments included medical record recording forms, semi-structured interview guidelines, clinical follow-up records, and a patient satisfaction questionnaire.

Results: The situational analysis in Phase 1 identified major diabetes-related challenges, specifically time constraints due to urban employment and lack of family support, alongside distinct gaps in existing care protocols. Consequently, context-specific guidelines were developed featuring digital monitoring and community support. The implementation of these guidelines demonstrated effectiveness in practice. Repeated Measures ANOVA revealed significant reductions in body weight (F = 23.65, p < .001) and finger-prick glucose (F = 21.95, p < .001). Additionally, HbA1c levels significantly decreased (Mean difference = 0.78, p < .001), and patient satisfaction significantly increased (p = .046). Based on these findings, it is recommended that urban health networks integrate flexible digital tools and community-based support systems to overcome socio-economic barriers and effectively promote diabetes remission.

Conclusions: The study demonstrates a coherent action research process where context-specific interventions effectively addressed identified urban barriers, leading to successful diabetes remission outcomes.