Background: Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM). The efficacy of intervention components across different sociocultural settings is relevant for real world implementation. Thus, this study aimed to evaluate the effectiveness of a culturally tailored diabetes prevention program (CTDPP) for at-risk Muslim people in Thailand.

Method: The CTDPP was developed and culturally adapted based on formative research. Participants at risk for diabetes were recruited and randomly assigned to either the intervention group (n=60) or the control group (n=59). Study group subjects participated in the CTDPP for 3 months. Control group subjects received only routine self-care recommendations for preventing diabetes. All participants were assessed for diabetes prevention knowledge and health outcomes at baseline and follow-up.

Results: At the 12th week, the intervention group and control group showed that diabetes prevention knowledge improved from baseline (p < 0.05). The score for knowledge was significantly higher in the intervention group than in control group. Other health outcomes demonstrated significant within-group improvements only in the intervention group, but not in the control group. Changes in participants’ HbA1c levels were not significant for within-group and between-group comparisons at baseline and 12 weeks. Adjusting for covariates at baseline, our ANCOVA analysis showed that differences in weight, body mass index, and waist circumference between the intervention and control groups were significant (p < 0.01).

Conclusion: This diabetes prevention program integrating Thai-Muslim culture and driven by community health leaders was successful. Our program empowered at-risk people with diabetes prevention knowledge.

Keywords: Muslims people, Community health leaders, Diabetes prevention program, Thailand


[1] Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: insights from yesterday, today, and future trends. Popul Health Manag 2017;20(1):6-12. https://doi.org/10.1089/pop.2015.0181.

[2] Papier K, Jordan S, Catherine DE, Bain C, Peungson J, Banwell C, et al. Incidence and risk factors for type 2 diabetes mellitus in transitional Thailand: results from the Thai cohort study. BMJ Open 2016;6(12):e014102. https://doi.org/10.1136/bmjopen-2016-014102.

[3] Group DPPR. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009;374(9702):1677-86. https://doi.org/10.1016/S0140-6736(09)61457-4.

[4] Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, et al. The Finnish Diabetes Prevention Study (DPS) Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003;26(12):3230-6. https://doi.org/10.2337/diacare.26.12.3230.

[5] Hoskin MA, Bray GA, Hattaway K, Khare-Ranade PA, Pomeroy J, Semler LN, et al. Prevention of diabetes through lifestyle intervention: lessons learned from the diabetes prevention program and outcomes study and its translation to practice. Curr Nutr Rep 2014;3(4):364-78. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221569/.

[6] American Association of Diabetes E. AADE position statement. Cultural sensitivity and diabetes education: recommendations for diabetes educators. Diabetes Educat 2007;33(1):41-4. https://doi.org/10.1177/0145721706298202.

[7] Tabak RG, Sinclair KA, Baumann AA, Racette SB, Sebert Kuhlmann A, Johnson-JenningsMD, et al.Areviewof diabetes prevention program translations: use of cultural adaptation and implementation research. Translat Behav Med 2015;5(4):401-14. https://doi.org/10.1007/s13142-015-0341-0.

[8] Ranee Sarinah AK. Eating pattern in Muslim patients with coronary heart disease. J Nutr Assoc Thailand 2019;54(1):95-106. ISSN: 2630-0060.

[9] Lundberg PC, Thrakul S. Diabetes type 2 self-management among Thai Muslim women. J Nurs Healthc Chron Illness 2011;3(1):52-60. https://doi.org/10.1111/j.1752-9824.2011.01079.x.

[10] Benaji B, Mounib N, Roky R, Aadil N, Houti I, Moussamih S, et al. Diabetes and Ramadan: review of the literature. Diabetes Res Clin Pract 2006;73(2):117-25. https://doi.org/10.1016/j.diabres.2005.10.028.

[11] Kalter-Leibovici O, Younis-Zeidan N, Atamna A, Lubin F, Alpert G, Chetrit A, et al. Lifestyle intervention in obese Arab women: a randomized controlled trial. Arch Intern Med 2010;170(11):970-6. https://doi.org/10.1001/archinternmed.2010.103.

[12] Aekplakorn W, Tantayotai V, Numsangkul S, Tatsato N, Luckanajantachote P, Himathongkam T. Evaluation of a community-based diabetes prevention program in Thailand: a cluster randomized controlled trial. J Prim Care Commun Health 2019;10:1-8. https://doi.org/10.1177/2150132719847374.

[13] Yuwarat Moungngern R. Effects of a health promotion program conducted by nurses on stabilization of HBA1c in subjects at risk for diabetes: a phase III randomized controlled trial. J Med Assoc Thail 2018;101(10):1343-8.

[14] Nongluck Tesana JJ, Prompukdee Boontanakorn, Pinijluek Kanokporn. Development model of the type 2 diabetes mellitus prevention in high risk group. J Health Syst Res 2016;10(1):92-100.

[15] Aekplakorn W, Bunnag P, Woodward M, Sritara P, Cheepudomwit S, Yamwong S, et al. A risk score for predicting incident diabetes in the Thai population. Diabetes Care 2006;29(8):1872-7. https://doi.org/10.2337/dc05-2141.

[16] Becker MH. The health belief model and personal health behavior. Health Educ Monogr 1974;2:324-473. https://doi.org/10.1177/109019817400200405.

[17] Eldredge LKB, Markham CM, Ruiter RA, Fern_andez ME, Kok G, Parcel GS. Planning health promotion programs: an intervention mapping approach. John Wiley & Sons; 2016.

[18] Kahn R, Davidson MB. The reality of type 2 diabetes prevention. Diabetes Care 2014;37(4):943-9. https://doi.org/10.2337/dc13-1954.

[19] Dunkley AJ, Bodicoat DH, Greaves CJ, Russell C, Yates T, Davies MJ, et al. Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabetes Care 2014;37(4):922-33. https://doi.org/10.2337/dc13-2195.

[20] Cardona-Morrell M, Rychetnik L, Morrell SL, Espinel PT, Bauman A. Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Publ Health 2010;10(1):1-17. https://doi.org/10.1186/1471-2458-10-653.

[21] Steinsbekk A, Rygg L, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res 2012;12(1):1-19. https://doi.org/10.1186/1472-6963-12-213.

[22] Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the diabetes prevention program into the community: the DEPLOY pilot study. Am J Prev Med 2008;35(4): 357-63. https://doi.org/10.1016/j.amepre.2008.06.035.

[23] Palmas W, March D, Darakjy S, Findley SE, Teresi J, Carrasquillo O, et al. Community health worker interventions to improve glycemic control in people with diabetes: a systematic review and meta-analysis. J Gen Intern Med 2015;30(7):1004-12. https://doi.org/10.1007/s11606-015-3247-0.

[24] Ravindranath R, Oldenburg B, Balachandran S, Mini GK, Mahat K, Sathish T, et al. Scale-up of the Kerala diabetes prevention program (K-DPP) in Kerala, India: implementation evaluation findings. Transl Behav Med 2020;10(1):5-12. https://doi.org/10.1093/tbm/ibz197.

[25] Sranacharoenpong K, Hanning RM. Diabetes prevention education program for community health care workers in Thailand. J Community Health 2012;37(3):610-8. https://doi.org/10.1007/s10900-011-9491-2.

[26] Sranacharoenpong K, Praditsorn P, Churak P. Developing a diabetes prevention education program for community health care workers in Thailand: translation of the knowledge to at-risk people. J Publ Health 2018;26(5):515-22. https://doi.org/10.1007/s10389-018-0897-5.

[27] Aziz Z, Absetz P, Oldroyd J, Pronk NP, Oldenburg B. A systematic review of real-world diabetes prevention programs: learnings from the last 15 years. Implement Sci 2015;10(1):1-17. https://doi.org/10.1186/s13012-015-0354-6.

[28] Galaviz KI, Weber MB, Straus A, Haw JS, Narayan KV, Ali MK. Global diabetes prevention interventions: a systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose. Diabetes Care 2018;41(7):1526-34. https://doi.org/10.2337/dc17-2222.