Effectiveness of a Diabetes Self-Management Program Among Ethnic Minority Elderly in Rural Thailand

Summary

Type 2 diabetes is a serious health condition that affects many older adults from ethnic minority communities in Northern Thailand. These populations, often referred to as hill tribes, include groups such as Akha, Lahu, Hmong, and Lisu who live in remote mountainous areas of Chiang Rai Province. Previous research has found that the prevalence of type 2 diabetes among ethnic minority elderly in Thailand is 16.8%, which is higher than the general Thai population. Many of these individuals have difficulty managing their diabetes because of low literacy, limited access to healthcare, language barriers, and poverty.

The purpose of this study was to test whether a structured Diabetes Self-Management (DSM) program could help ethnic minority older adults (aged 60 years or older) improve their blood sugar control, increase their ability to manage diabetes on their own, and reduce emotional distress related to diabetes.

This study used a cluster randomized controlled trial design. Villages in Chiang Rai Province were randomly assigned to either the DSM intervention group or the usual care group. A total of 108 participants (54 per group) were enrolled. Participants in the intervention group attended a 6-week education program with weekly interactive sessions covering diabetes knowledge, healthy eating, physical activity, medication management, problem solving, risk reduction, and emotional coping. Two home visits were also provided at Weeks 8 and 10. Participants in the usual care group received standard brief discharge education and routine follow-up visits.

The main outcome measured was the change in HbA1c (a blood test that shows average blood sugar levels over the past 2 to 3 months) from the start of the study to 12 weeks later. Additional outcomes included changes in diabetes self-management behaviors and diabetes-related psychological distress, measured using validated questionnaires.

Conditions

• Type 2 Diabetes Mellitus (T2DM)
• Psychological Distress
• Hyperglycemia

Interventions

BEHAVIORAL

Diabetes Self-Management Education (DSME) Program

A culturally tailored 6-week diabetes self-management education program grounded in the Chronic Care Model and the seven core self-management skills defined by the American Association of Diabetes Educators. The program consisted of six weekly interactive group sessions: Week 1 covered diabetes fundamentals and symptom management; Week 2 addressed culturally appropriate healthy eating using the plate model and hand method for portion control; Week 3 introduced safe physical activities adapted for elderly participants; Week 4 focused on medication adherence and blood glucose self-monitoring with hands-on glucometer practice; Week 5 addressed problem solving and risk reduction through role-play scenarios for hypoglycemia management and daily foot care; Week 6 covered healthy coping strategies, stress management, and effective use of local healthcare services. Sessions were delivered by endocrinologists, nurse practitioners, dieticians, and village health volunteers who provided native-la

OTHER

Usual Care

Standard guideline-based discharge education for type 2 diabetes consisting of a one-time 10 to 15 minute face-to-face verbal education session delivered by a nurse practitioner not involved in the study intervention. Content included basic knowledge of type 2 diabetes, general dietary advice, exercise recommendations, risk factor awareness, complication prevention guidance, and self-monitoring instructions. A hospital-provided leaflet was given if available. No interactive activities, teach-back method, structured follow-up education, or home visits were included. Participants attended routine outpatient follow-up visits as scheduled by the hospital system.

Sponsors & Collaborators

• Mae Fah Luang University

  collaborator OTHER

• Chiang Rai Public Health Office

  collaborator OTHER_GOV

• Taipei Medical University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

60 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-11-20

Primary Completion

2026-02-19

Completion

2026-02-19

Countries

• Thailand

Study Locations