CNS: Better awareness and treatment compliance needed in Thai diabetes control

Diabetes control in Thailand is improving, but better awareness and patients’ treatment compliance is needed to fully tackle the health issues. So says Professor Wannee Nitiyanant, vice president of the Diabetes Association of Thailand under the Patronage of Her Royal Highness Princess Maha Chakri Sinrindhorn in reaction to a recently published international study. The study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington showed that millions of people worldwide may be at risk of early death from diabetes and related cardiovascular illnesses because of poor diagnosis and ineffective treatment.

The researchers examined diabetes diagnosis, treatment, and management in Thailand, Colombia, Iran, Mexico, England, Scotland, and the United States. The results show among others that 62% of men in Thailand are underdiagnosed and untreated. And only in Thailand do the poor and lower educated have more problems accessing diabetes diagnosis and care than the rest of the population.

Professor Wannee calls the study results ‘alarming’, yet underscores that the actual situation is likely to be rosier. The research uses data from 2004 for Thailand. “At that time treatment in Thailand was mainly targeted at blood sugar,” Wannee comments. “The other risk factors, blood pressure and cholesterol, were not emphasized. That has improved now.”

The percentage of patients who met all international treatment targets for blood pressure, blood sugar and cholesterol rose from 2 to 13% from 2004 to 2009 nationwide. “And in secondary and tertiary care centers up to 20% of patients have all three factors: blood sugar, blood pressure and cholesterol well controlled,” says Wannee. She emphasizes that especially Thailand’s remote rural areas lag behind in diabetes care: they lack equipment, laboratories, treatment facilities and medical personnel. New guidelines and mobile units ensure more people are getting tested and proper care when necessary.

In 2004 only nearly half of the Thai patients who had diabetes knew themselves that they suffer from the disease. In 2009 close to 70% of the patients was aware that they have diabetes, according to data of the national health survey. “It shows improvement yet treatment targets are still not yet reached in majority,” Wannee acknowledges.

Wannee sees several difficulties in reaching the targets: doctors not paying attention to guidelines, limited facilities, limited medications, and patients’ belief or cooperation in terms of treatment. “The patients are most difficult to educate,” she says. “The majority still doesn’t care if they get or are at risk of getting diabetes. When a doctor says they need medicine for high cholesterol, many patients take it for maybe a week, but then stop because they don’t feel anything. And I see patients who are obese, and so are their children, and I tell them to loose weight, but they don’t think it is important. It is alarming to see that Thai children are getting more and more obese.”

Although diabetes awareness campaigns have been around, more and extensive campaigning is needed, Wannee argues. To make people of all ages – young and old – aware of the risk factors for diabetes. In this regard, Wannee is delighted to see a growing interest from the government. While Thailand for years has been doing well in managing communicable diseases, especially HIV/AIDS, it ‘just started to pay attention to non communicable diseases’, she says.

“The government is alert on what the problem is now,” Wannee comments. “Diabetes and hypertension are the first two diseases listed for chronic care model. I hope that in the next three years this will result in much improvement. And I think with extensive awareness campaigning you can really see a difference up to five years from now.”

Babs Verblackt - CNS
(The author writes for Citizen News Service (CNS) and is based in Thailand. Email: babs@citizen-news.org, website: www.citizen-news.org)