United NationsDepartment of Economic and Social Affairs Sustainable Development

PUWADOL Diabetes Academy (PDA)

Strategy and Planning Division, Office of the permanent secretary, Ministry of public health, Thailand (
Government
)
#SDGAction33615
    Description
    Intro

    What is PUWADOL Diabetes Academy (PDA)? PUWADOL Diabetes Academy is a program for treatment(reverse) type2 diabetes by nutritional and lifestyle changing practice. The optimal goal is remission of type2 diabetes (HbA1c <6.5% and could stop medicine) and prolong in remission status. The program requires patient to stay in program for minimum 3 months then follow up in one year. Brief description of background: Nowadays (2021) Thailand prevalence of diabetes is 8.9% and tend to increase every year as world diabetic prevalence, and also the increasing the complications of diabetes include cardiovascular disease which include stroke, acute coronary syndrome, chronic kidney disease or diabetic retinopathy. Bangrakam is the district in Phitsanulok province. Thailand has diabetic prevalence raised each year in 2016(7.94%) ,2017(7.99%) and 2018(8.82%). The number of diabetic incidences include the complications in Bangaram have grown every year 2016(349:100,000),2017(350:100,000) and 2018(600:100,000) stroke incidence 2016(125:100,000), 2017(131:100,000) and 2018(148:100,000) acute coronary syndrome incidence 2016(17:100,000), 2017(12:100,000) and 2018(12:100,000). Therefore, Bangaram Hospitals addressed this problem (Diabetes and complications) as challenges that need to be decelerated and mitigated by nutritional and lifestyle changing programs name “Puwadol diabetes academy “equip with the model program name “PUWADOL model”.

    Implementation of the Project/Activity

    Health data year 2020 report that there are 5,957 (9.85%prevalence) Diabetic patients in Bangrakam district Phitsanulok, Thailand 10% of diabetic patients around 600 are the targets group. Planning: distribute targets group to 20 subdistrict area. Each place were 30 Patients. These all were attended and practiced the program use concept “PUWADOL model” The process 1. diabetic patients who volunteer to participate the program 2. physical (BW, BMI, BP) exam And blood test and evaluate (Fbs, HbA1c,lipid profiler, eGFR, AST,ALT,fasting insulin ) 3.nutritional assessment 4.nutritional planning with nutritionist. 5.SMBG monitoring 2days/week (at home) 6. Set up Social networking service group for communication between staff and patients. Patients requested send the food, meal, blood sugar level to the group. Doctors, dietitians, nurses would give them comments and advices for proper type of food, meal (patients can learn from themself and the other) 7.follow up period is 1 month (every month) (meet doctor adjust SMBG and nutritional plan, medication) 8. Blood sugar were measured at 3rd month, 6th month and 12th month. (Fbs A1c,lipid profile,cr,eGFR, AST,ALT,fasting insulin ) Both offline group and online group. Monitoring 1.SMBG monitor at patients home.and on line evaluate trend and patterns SMBG for adjust medicine. 2. Blood sugar were measured at 3rd month, 6th month and 12th month. (Fbs A1c,lipid profile,cr,eGFR, AST,ALT,fasting insulin ) Both offline group and online group. Resource Glucometer(with online program for evaluate SMBG pattern) and dextro strip. 4,000/pts/1yr. *600pateints Human Resources:doctors,dietitians, nurses,publichealth personnel In Bangrakam district health.

    Results/Outputs/Impacts

    There are indicators that set to monitor patient’s health status before and after (0,3,6,12 months.) as below. 1. HbA1c 2.Medication’s usage (decrease, not change, increase) 3.Body weight In year 2018 we published research “Development of sustainable health promotion model for diabetic pateints” in Buddhachinaraj medical journal. The program had been implemented in year 2018 and 2019, the result showed in year 2018 from 210 pittances who enrolled the program for three months 74.02 % of them could manage to reduce HbA1c level, while 7.35 % their HbA1c level raised. In addition, in year 2019 from total 305 patients practiced the model for three months 84.59 % of them could manage to reduce HbA1c level, while 7.2 % their HbA1c level raised. In 2020, the Puwadol program has been elevated its intensity of nutritional change by use Low-carb carbohydrate/ketogenic diet and intermittent fasting more than 2 months before and target group are the patients who need urgent reverse diabetes. The patients separated into two groups. 1.off line (patients in Bangrakam district) this group would enroll face to face program 2.on line (patients from other provinces in Thailand) this group would participate the program via on line technology. The result after 3-6 months follow up indicated that among 42 off line participants 95.24 % of this group could lower their HbA1c level, moreover, 52.38 % could stop diabetic medication their HbA1c level were less than 6.5 mg%. Likewise, on line group form 32 participants 98.3 % of this group could lower their HbA1c level, moreover, 71.88 % could stop diabetic medication their HbA1c level were less than 6.5 mg%

    Enabling factors and constraints

    Enabling factor: educated patients, patients age under 60 years old, Teamwork (health personnel) Constraint factor: loss follow up , patients age over 60 years old, Workload and limited on health workforce

    Sustainability and replicability

    The program processes, activities and materials have been documented and published. There are various health centers from many provinces in Thailand have been visit and pay attention on this program, this could be said that Bangrakam hospital now is well-known for their hard-work and PUWADOL model, as a learning center. Chonburi province is one of the visitors who interest to adopt this model and implement in the hospital within the province. In addition, staff of Bangrakam hospital has generated the protocol and video clip for demonstrate the tool for other health center or communities could follow and implement the program and aim to reduce burden on Diabetes.

    Other sources of information

    Website: www.DietDoctor.com Book: - Diabetes epidemic & you (Joseph R.Kraft) - Eat rich long live (Ivor cummins and Jeffery Gerber) - The art and science of low carbohydrate living (Jeff S.Volek,Stephen D.Phinney) - The diabetes code (Jason fung) - The complete guideline to fasting (Jason fung) Facebook and website: PUWADOL DIABETES ACADEMY Youtube : https://www.youtube.com/channel/UCg1-LtVd3RKhhZxBnPSIwIw

    COVID-19 Impact

    The patients that participated program by online study can use internet and social media for communication, so no close contact between doctors and patients.

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    This initiative does not yet fulfil the SMART criteria.
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    Timeline
    01 May 2018 (start date)
    31 July 2021 (date of completion)
    Entity
    Bangrakam Hospital, Phitsanulok province, Thailand
    Ongoing
    No
    SDGs
    Other beneficiaries

    Partnership Patients: optimal goal is remission in diabetes (HbA1c <6.5%, no medication) Decrease in diabetic and cardiovascular complications Save cost for medication and weight loss Family and relatives could save cost, time since they don’t have to care the patients. Public health system Save cost for medication and treatment of Diabetes and could lower cardiovascular complications (stroke, acute coronary syndrome).

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    Countries
    Thailand
    Thailand
    Contact Information