Beacon of hope in diabetes fight

Bangkok Post

13-07-2025

Nestled in the heart of the Northeast, the small district of Phon Sawan may seem an unlikely battleground in the country's fight against chronic illness.
But over the past two months, this quiet community has become a beacon of hope in a struggle against diabetes, a disease that is quietly costing the nation its health and a big share of its budget.
At the centre of this transformation is a pilot programme known as the "Urban Primary Healthcare Project: Proactive Diabetes Prevention and Control," launched by the Thai Health Promotion Foundation (ThaiHealth) and a research team from Nakhon Phanom University.
Its aim is as ambitious as it is urgent: to prevent diabetes at the community level, reduce dependence on medication, and ease the growing financial burden on the universal healthcare system.
What began with just 62 volunteers in Ban Sao Lao, a four-village cluster in Phon Sawan district, is now being closely watched by public health experts across the country.
Where change begins
Inside Ban Sao Lao, change is happening one meal, one walk and one group chat at a time.
"I didn't even realise sticky rice was a form of sugar," said Amnuay Suwanmajo, one of the participants. "Now, I eat more vegetables and lean meat, and I've lost several kilogrammes already."
Mr Amnuay's story is far from unique. Among the 62 people enrolled in the project -- 50 at risk of diabetes and 10 already diagnosed -- clear signs of improvement emerged within just six weeks.
Residents reported weight loss, lower body mass index, and, perhaps most significantly, a shift in attitude towards diet and exercise.
Wimolrat Sahat, a 47-year-old farmer, joined not only for health reasons but for a touch of vanity. "I still want to look good," she laughed. "But more importantly, I don't want to end up like some neighbours who have diabetes and suffer serious complications."
Indeed, the numbers are alarming. In this community, 60% of residents fall into risk groups for diabetes -- 20% already diagnosed and the rest at risk.
The reasons are familiar across rural Thailand: diets heavy in sticky rice and sweet snacks, a lack of physical activity, and limited understanding of how food affects health.
But thanks to a highly personalised support system, residents are now learning how to manage their bodies before it's too late.
A team behind every step
The engine behind this success is a multidisciplinary team drawn from Phon Sawan Hospital. Instead of focusing solely on treatment, they're reimagining healthcare as a partnership between professionals and villagers.
Each week, participants join community-based activities guided by dietitians, physiotherapists, sports scientists and even psychologists -- helping people not just lose weight, but gain strength, confidence, and understanding.
"The goal isn't just weight loss," said Asst Prof Benjayamas Pilayon, Assistant Dean for Educational Quality Assurance of Nakhon Phanom University, one of the project's lead researchers. "We're looking at building muscle, improving mental health and changing how people live. That's where real prevention begins."
To keep participants motivated, the team set up a Line group where villagers share daily updates -- what they ate, how they exercised, how they felt. There's even friendly competition: whose body fat dropped, whose muscle mass increased?
Still, there are challenges. "Some people struggle to afford protein-rich food like meat," said Kwanyuen Kamonruean, a nurse at the hospital. "And others don't like being told what to eat. So we focus on education and encouragement, not rules."
That approach is working. Even sceptics are starting to see results on their weighing scales and in their medical charts, she said.
The cost of doing nothing
What's happening in Ban Sao Lao isn't just a feel-good story -- it's a financial strategy.
Assoc Prof Dr Soranit Siltharm, a board member of ThaiHealth, said diabetes is one of the country's most expensive and deadly chronic conditions.
From 1997 to 2020, the prevalence of diabetes in Thailand doubled from 4.8% to 9.5%. Factoring in modern diagnostic methods, actual rates could be as high as 11%.
Under the universal healthcare scheme, also known as the gold card scheme, diabetes treatment is consuming an ever-growing share of the budget.
In fiscal year 2026, the scheme's total budget rose to 272 billion baht, with more than 204 billion allocated for per capita payments. That's an average of 4,298 baht per person per year, covering more than 47 million Thais. But despite budget increases, more than 84% still goes to treatment, not prevention.
"Diabetes isn't just about sugar," said Dr Soranit. "It's about kidneys, blindness, amputations. These complications are devastating, but also preventable, if we act early and wisely."
That's why ThaiHealth and public health officials are closely monitoring the Nakhon Phanom model. If the project can be scaled nationally, the savings could be massive, not just in baht, but in lives spared and suffering avoided.
A path forward
At Phon Sawan Hospital, head nurse Patcharaporn Kavansu explains how the hospital adapted its diabetes clinic into a proactive prevention unit.
Inspired by ThaiHealth's approach, they integrated multiple disciplines and redesigned care around lifestyle, not just medical prescriptions.
"We've always treated diabetes," Ms Patcharaporn said. "But now we're preventing it. And the community feels seen, heard and supported."
Each week, residents gather at a communal activity space where their progress is measured -- weight, muscle mass and glucose levels -- and menus reviewed.
Experts provide hands-on guidance, helping participants plan meals that are healthy, affordable, and culturally familiar.
But as Ms Patcharaporn notes, the model's true strength lies in trust. "Villagers trust us because we show up. We walk with them, eat with them, and listen to them. That makes all the difference."
And it's not just about individuals. Families are changing how they cook. Local vendors are adapting what they sell. Neighbours are encouraging each other. What started as a health initiative has become a movement.
Still, the road ahead is long. The pilot will continue in Phon Sawan until 2026, with hopes to expand to other districts. But its message is clear: prevention works, and it pays.
In a country where healthcare budgets are being stretched to their limit and chronic diseases are on the rise, the Nakhon Phanom model offers more than a health solution. It offers a national strategy rooted in local strength.
And as Thailand looks for sustainable ways to care for its people, a small rural village may have already found the answer.