การพัฒนารูปแบบการปรับเปลี่ยนพฤติกรรมตามแนวทางเวชศาสตร์วิถีชีวิต สู่โรคเบาหวานระยะสงบในผู้ป่วยเบาหวานชนิดที่ 2 จังหวัดกาฬสินธุ์

Tipaphon  Rachagai; Nanthiya  Mekchim; Yuwadee  Kdeevee

Authors

Tipaphon Rachagai Kalasin Provincial Public Health Office
Nanthiya Mekchim Kalasin Provincial Public Health Office
Yuwadee Kdeevee Khao Wong Hospital

Keywords:

Lifestyle Medicine, Type 2 Diabetes Mellitus, Diabetes Remission, Behavior Change Model

Abstract

Purposes: To examine the current situation, identify problems, assess needs, and determine the related factors; to develop a model and evaluate the effects of the developed model on lifestyle medicine-based health behaviors, clinical outcomes, reduction or discontinuation of antihyperglycemic medication, and the attainment of preliminary diabetes remission.

Study design: This study employed a research and development approach combined with a one-group pretest-posttest quasi-experimental design.

Materials and Methods: The study was conducted from March 2025 to April 2026 among 60 patients with type 2 diabetes receiving care in primary healthcare settings in Kalasin Province. Participants were selected using purposive sampling. The developed model consisted of individualized health and behavioral assessments, collaborative goal setting, behavioral modification based on the six pillars of Lifestyle Medicine, including healthy nutrition, physical activity, restorative sleep, stress management, social connection, and avoidance of risky substances, together with motivational interviewing and continuous follow-up. Data were analyzed using descriptive statistics, paired t-test, and Wilcoxon signed-rank test.

Main findings: Following implementation, participants demonstrated improvement in all six Lifestyle Medicine behavioral domains. The overall behavioral score increased from 1.51 to 2.62 points, with the greatest improvement observed in stress management, followed by nutrition, physical activity, and social connection. Significant improvements were also observed in clinical outcomes. Mean body weight decreased from 61.59 to 60.45 kilograms, body mass index from 24.90 to 24.44 kilograms per square meter, waist circumference from 87.02 to 85.78 centimeters, capillary blood glucose from 144.03 to 120.52 milligrams per deciliter, and glycated hemoglobin from 7.27% to 6.34% (p<0.05). After the intervention, 85.0% of participants achieved glycated hemoglobin levels below 7.0%, 56.7% achieved levels below 6.5%, and 51.7% met the criteria for preliminary type 2 diabetes remission. Among 26 participants receiving oral glucose-lowering medications at baseline, 21 (80.8%) successfully discontinued medication.

Conclusion and Recommendations: The Lifestyle Medicine-based care model effectively improved health behaviors, reduced glycemic levels, body weight, and waist circumference, and supported medication reduction or discontinuation among appropriate patients. The model also demonstrated potential to promote preliminary type 2 diabetes remission in primary healthcare settings. Long-term follow-up studies are recommended to confirm the sustainability of remission and evaluate safety after medication reduction or discontinuation.

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