Hybrid digital lifestyle medicine program and glycemic trends in type 2 diabetes: a pilot study in a Thai primary care setting

Abstract

Background: To align with Thailand’s 2025 “non-communicable diseases Remission” policy, the researchers developed the Hybrid Digital Lifestyle Medicine Program.

Objective: To evaluate the effectiveness of this program on glycemic and metabolic outcomes in patients with type 2 diabetes mellitus (T2DM) within a primary care setting.

Methods: This quasi-experimental pilot study enrolled patients with T2DM at primary care unit of Bangplee Hospital. Participants self-selected into the intervention (LM) or control groups. Both received standard care, motivational interviewing, and Lifestyle Medicine counselling. The LM group received an additional hybrid digital lifestyle medicine program. A follow-up was conducted over six months, with the primary endpoint being 3-month HbA1c change. Data were analyzed using modified Intention-to-Treat method and analysis of covariance.

Results: Forty-six participants were enrolled (LM = 22, control = 24). At 3 months, the primary endpoint did not demonstrate between-group superiority (P = 0.17). However, the LM group demonstrated a significant within-group HbA1c reduction of 0.65% (P = 0.012). By month 6, the LM group achieved a sustained within-group HbA1c decrease of 0.8% (P = 0.031) and a significant reduction in antihypertensive pill burden (P = 0.026). Inter-group analysis showed superior improvements in LM group for body mass index (P = 0.001), systolic blood pressure (P = 0.038) and triglycerides (P = 0.049). Behavioral analysis revealed 65.0% of LM group were progressors in their stages-of-change (P = 0.007) with zero regression.

Conclusion: The hybrid digital LM program is feasible and effective for enhancing metabolic profiles and behavioral change in Thai primary care. It facilitates NCD remission without escalating pharmacotherapy, offering high scalability for resource-constrained clinical settings.