Diabetes management in Thailand: a literature review of the burden, costs, and outcomes

Abstract

Management of diabetes represents an enormous challenge for health systems at every level of development. The latter are tested for their ability to continuously deliver high quality care to patients from the day they are diagnosed throughout their life. In this study, we review the status of diabetes management in Thailand and try to identify the key challenges the country needs to address to reduce the current (and future) medical and economic burden caused by the disease.We conducted a literature review on the burden, costs, and outcomes of diabetes in Thailand. This information was complemented by personal communication with senior officials in the Thai Ministry of Health.We identified the following priorities for the future management of diabetes in Thailand. First, increasing screening of diabetes in high risk population and promoting annual screening of diabetes complications in all diabetic patients. Second, identifying and addressing factors affecting poor treatment outcomes. Third, policy should specify clear targets and provide and use a monitoring framework to track progress. Fourth, efforts are needed to further improve data availability. Up-to-date data on the medical and economic burden of diabetes representative at the national level and at least the regional level are essential to identify needs and monitor progress towards established targets. Fifth, promotion of a healthy lifestyle for prevention of diabetes through education and quality information delivered to the public.

Figure 1

Prevalence of diabetes mellitus in Thailand, 1991-2009. Source: 1991, 1997, 2004, 2009 NHES I-IV. Notes: M: males, F: females. All estimates refer to people aged 15 and over. Diabetes was defined as FPG ≥ 126 mg/dl or previous diagnosis of diabetes and use of medication during the past two weeks.

Figure 2

Incidence of diabetes mellitus type 1 in children aged 0-15. Sources [22-26]:. Secondary results from Tuchinda et al. 2002. Notes: Results from a study in Bangkok were not included as they were not comparable with the other studies due to the different methodology employed [24]. There was another study looking at the seasonal variation in DMT1 which was not included because it did not report incidence rates but only total number of cases in one hospital which made it unsuitable to calculate population incidence rates [20]. Incidence was calculated by dividing the total number of cases reported by hospitals with the total child population in the hospitals’ catchment area. Data were obtained from retrospective postal survey or medical record analysis and no information on the diagnostic criteria used was provided. A study summarising the results of the regional studies mentions that the criteria in the 1997 Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus were used.

Figure 3

Prevalence of gestational diabetes. Notes: 1987-1989: gestation week not specified, NDDG criteria; 1994-95: 24-28 week of gestation, 1.4% NDDG criteria, 15.7% WHO criteria; 2001: 5.3% before 20 week of gestation, NDDG criteria; 2001: 4.9% additional at 28-32 weeks of gestation, NDDG criteria; March 2003-January 2005: mean gestational age 26.8 weeks, NDDG criteria, only women aged 30-34.