A Problem-based Health System Framework for Promoting Diabetes Remission: Systematic Outcomes of the Roi-Et Health Network

Abstract

Background and objectives: Diabetes mellitus is a chronic condition characterized by the body's inability to effectively regulate blood glucose levels, which, if left unmanaged, can lead to severe systemic complications. This study aimed to investigate operational problems, develop and implement a problem-based model, and evaluate the effectiveness of an intervention program designed to promote Diabetes Remission.

Methods: This study employed a Research and Development (R&D) design. The sample consisted of 220 multidisciplinary team members and health volunteers, along with 4,031 diabetic patients participating in the project. Data were collected using questionnaires, record forms, and semi-structured interview guides. Statistical analysis included frequency, percentage, mean, standard deviation, and paired t-test (at a 95% confidence interval), supplemented by content analysis for qualitative data.

Results: 1) The situational analysis of diabetes care in Roi-Et Province identified challenges across four dimensions: patient and social context, service providers, service management systems, and resources/medical supplies. 2) The developed "Problem-Based Diabetes Remission Model" comprised key activities: identifying eligible candidates, collaborative goal setting, skill-building schools, technology-assisted monitoring, clinical multidisciplinary teams for medication adjustment, motivation and network building, and intensive follow-up. 3) Post-intervention results showed that patients’ self-care behavior scores were significantly higher than pre-intervention levels across all domains (p<0.001). Among the participants who completed the 3-month evaluation (n = 2,261), 1,004 patients (24.91% of total participants) achieved Diabetes Remission, defined as maintaining an HbA1c < 6.5% without medication for at least 3 months. Furthermore, 30.22% (1,218 patients) achieved Medication Reduction. Regarding clinical stability and safety, 30.79% maintained stable medication levels, while only 0.45% required a dosage increase, and the loss-to-follow-up rate was remarkably low at 0.27%.

Conclusion: Promoting diabetes remission through intensive skill training and close monitoring significantly improves self-care behaviors. This approach effectively enables patients to achieve disease remission and reduce reliance on pharmacological treatments.