DiCE Program 2019 – Thailand (October)

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: MANAGING CVD RISK IN PEOPLE WITH DIABETES: Managing Diabetes Risk in People with CVD

Nahathai Chatrasingha, MD
Cardiologist, Theptarin Hospital

34 years ago when Theptarin opened its door, diabetes was generally known and treated as a disease of high blood glucose. Later when syndrome X was recognized, diabetes has become known as a family member of the atherosclerosis family. Today, evidence strongly shows that diabetes not only associates with atherosclerotic heart disease but other heart complications such as heart failure or atrial fibrillation as well.

Diabetes is categorized as a specialization of endocrinologists or diabetologists while heart diseases are categorized an expert area for cardiologists. In the era of specialization like today and the situation that two diseases becoming same disease, how can we best care for this two-in-one?

Multidisciplinary team for diabetes care alone is probably not comprehensive enough anymore. Diabetes team and cardiovascular team need to work together in arriving at best standard of care for prevention and treatment of both diabetes and heart diseases. Monthly cardiology team and diabetes team at Theptarin Hospital sit together and discuss how to best treat as well as optimize screening process to prevent CVD in people with diabetes as well as diabetes in people with CVD.

Nahathai Chatrasingha, MD

Cardiologist, Theptarin Hospital

Dr. Nahathai received her medical degree with first class honor and completed her internal medicine and cardiology training with master degree in Medical Sciences from Chulalongkorn University, Thailand, in 2016.

Dr. Nahathai’s special interest is in echocardiography and had attended several trainings in the field. At Theptarin, she also had hands-on experience with verified proctors in several difficult interventions such as Periprocedural Echocardiographic Assessment of Transcatheter Left Atrial Appendage Occluder Implantation and Periprocedural Echocardiographic Assessment of Transcatheter Aortic Valve Replacement (TAVR).

Dr. Nahathai joined Theptarin since the inception of our iCATH Cardio Metabolic Center in 2016. She performs as the right-hand man of Dr.Wason Udayachalerm, Thailand’s most reputable intervention cardiologist and the director of iCATH. Dr.Nahathai is the key person working with diabetes team in organizing monthly cardiometabolic meeting at Theptarin where diabetes and cardiology teams meet to discuss and drive implementation of academic knowledge to routine patient care at Theptarin. Prevention of cardiovascular diseases in diabetes patients and prevention of diabetes in cardiovascular patients are top concerns of the group.

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.