DiCE Program 2019 – Thailand (May)

TOPIC 1: THEPTARIN DIABETES STAGING:
A Systematic Individualized Care Plan for People with Diabetes

Ekgaluck Wanothayaroj, MD
Endocrinologist, Theptarin Hospital, Thailand

Each person with diabetes is different. Do we have different standard sets of care for each of them? Diabetes is so complicated; what one measurement can tell how well we do in controlling it? What one tool do we use to communicate the progression of diabetes between healthcare team members as well as person with diabetes and their care takers? Dividing diabetes into different stages has been discussed in the academic world for quite sometimes, but actual implementation in clinical practice has yet to be documented.

Starting more than 10 years ago, diabetes team at Theptarin Hospital has drafted its first “Theptarin Diabetes Staging (TDS)” version. Today, detail of TDS has been updated several times with additional clinical experiences and advancement in new medical knowledge. Today, TDS has turned into the backbone for all multidisciplinary care team members to base their care stands on. Today, quality of diabetes care is measured by monitoring TDS. Maybe, in the near future TDS could have a role in health care financing as well.

EKGALUCK WANOTHAYAROJ, MD

Endocrinologist, BA Med. (Thailand), Board of Internal Medicine (Thailand), Board of Endocrinology (Thailand)

Dr. Ekgaluck received his medical degree from Chulalongkorn University, Thailand in 2002. He completed his training in internal medicine from Khon Kaen University and fellowship in endocrinology from Ramathibodi Hospital, Mahidol University, Thailand in 2009

Dr. Ekgaluck was a lecturer at Khon Kaen University prior to joining Theptarin Hospital in 2011. At Theptarin, he is the leader in the implementation of Theptarin Diabetes Staging into practice for all multidisciplinary team members as well as the implementation of diabetes and cardiovascular screening process for early detection in hospital setting.

Dr.Ekgaluck is currently one of Thailand’s most-invited endocrinologist speakers, a subcommittee member of Thai Association of Diabetes Educator, and a subcommittee of the website of Thai Endocrine Society. He is the recipient of Etzwiler International Scholars 2018 from International Diabetes Center, Minnesota, USA.

TOPIC 2: Beyond the Randomized Control Trial: Why we have to do Real-World Evidence (RWE) in our population?

YOTSAPON THEWJITCHAROEN, M.D.
Endocrinologist, Theptarin Hospital, Thailand

Diabetes is a progressive disease that needs multiple drugs for achieving and maintaining good glycemic control. Despite advancement in the treatment of T2DM, optimal glycemic control has not been achieved in almost half of patients in the US or almost 70% in Southeast Asia including Thailand. Landmark clinical trials have shown that we can delay and possibly prevent the onset of diabetes in many individuals at high risk. Unfortunately, the magnitude of the effort we undertake might not be enough and sustainable especially in the context of Asian population. The screening tests for pre-diabetes are still debatable whether which test would be most sensitive and cost-effective for early detection of diabetes. Real-world evidence (RWE) can inform therapeutic development, outcome research, patient care, research on health care systems, quality improvement, safety surveillance, and well-controlled effectiveness studies. RWE can also provide information on how factors such as clinical setting and provider and health-system characteristics influence treatment effects and outcomes.

The first part of the lecture will discuss about our real-world data on performance of diagnostic tests (OGTT and A1C) to diagnose dysglycemic status in Thai patients. The later part will discuss effectiveness of novel anti-diabetic medications (SGLT2i and GLP1 receptor agonist) in Theptarin patients. There is a scarcity of real-world studies on these novel anti-diabetic medications conducted in Asian patients; however, these data could be beneficial for day-to-day clinical practice and for policy makers to plan strategies to reduce burden of diabetes in Southeast Asia.

Yotsapon Thewjitchareon

Endocrinologist and Head of Research Center, Theptarin Hospital

Dr. Yotsapon received his medical degree and completed his endocrinology training from Chulalongkorn University, Thailand in 2004. As a young researcher, he received the Servier Award for Distinguished Clinical Research in Diabetology from the Endocrine Society of Thailand in 2012. Internationally, he was a Japanese Government scholarship grant recipient and spent 2 years in world’s best-known incretin research lab at Department of Diabetes, Kyoto University, during 2015-2017.

Dr. Yotsapon joined Theptarin first as a general practitioner in 2006 and later as an endocrinologist in 2013. He is now the head of Theptarin Research Center and had led the team to produce prolific academic works included poster presentations in both local and international meetings, frequent oral presentations, and many publications in international medical journals during the past 5 years.

Dr. Yotsapon is not only the key driver in extracting learnings from Theptarin’s 34 year-experience in diabetes and thyroid clinical care through research and bring results to attention of clinicians. He is also the force that push and support interests in research to paramedical diabetes team members at Theptarin Hospital.

Theptarin Hospital

3850 Rama 4 Rd., Phra Khanong, Bangkok 10110 Thailand

From Clinic to Center of Excellence

Prof. Thep Himathongkam was ahead of his time when he founded Theptarin in 1985, initially as a small clinic. As far back as three decades ago, he had already envisioned a model of holistic therapy for diabetes that aimed to empower patients who suffer from a disease that demands effective treatment and constant monitoring. The Theptarin Diabetes and Thyroid Center was created as a specialist in diabetes and thyroid management. While it opened with all but eight beds for overnight admission, the clinic was huge in its all-encompassing commitment to excellence in service, education for both healthcare professionals and patients, and to research. It was this emphasis on developing a three-pronged expertise that gave life to the first diabetes care team of Thailand which included an endocrinologist, a nurse to educate patients on diabetes, and a dietitian to support proper nutrition.

Seven years later, it evolved into the Theptarin Hospital, acquiring new skills, equipment, and team specialists in order to meet the ever-changing needs of patients. The Hospital began to offer 24-hour services, distal bypass surgery, hyperbaric medicine, and even launched Thailand’s fi­rst foot clinic specializing in diabetic foot wound care and prevention.

Because continuous evolution had always been at the core of its quest for excellence, when scientific studies revealed in 2005 that diabetes is a preventable condition, Theptarin Hospital jumped at the opportunity to further enhance its range of therapeutic services. From simply preventing diabetes-related complications, it set up a “Lifestyle Building” to also promote the prevention of diabetes and associated chronic diseases. Subsequently, the Hospital introduced its MEDE Health Solution Club and Weight Management Clinic to advocate healthy daily living, behavior modi­fication, and optimal quality of life for both diabetes patients and the general public.

From a humble clinic with noble dreams, Theptarin Hospital has now become a standout amongst private
hospitals mainly because of its clear focus on developing high quality patient care – from expanded medical teams composed of specialists from diverse branches of healthcare to world-class facilities. Its passion to raise public awareness on diabetes also makes Theptarin Hospital a cut above the rest. The level of excellence achieved by the institution has made it a source of sought-after resource speakers and a training center for students and professionals from local and international healthcare establishments.

In addition, not only was Theptarin Hospital entrusted by the Thai government to train its staff in implementing nationwide behavior modification activities, it was also appointed in 2011 by the World Diabetes Foundation (Denmark) to serve as a center of excellence for training healthcare personnel throughout Southeast Asia. It continues to pursue increased awareness on the early detection and timely risk reduction of diabetes toward the prevention or prolonged onset of this most prevalent disease. Theptarin Hospital has also earned its stripes as the ­first thyroid center to offer complete diagnosis and treatment, acting as a transfer center for both domestic and international patients.

In 2015, a team of country’s leading cardiologists co-invested to open one of the most comprehensive
cardiology with services ranging from screening through interventions including complicated catheterization, open-heart surgeries, and 24-hour cardiac services. Cardiology team and diabetes team hold academic and service meetings monthly allowing flow of communication and making the care of the two specialties coherent and optimal.