Insights into diabetes remission services: perspectives from general practitioners, family physicians and multidisciplinary teams.

Abstract

Objective: Diabetes remission has emerged as an achievable treatment goal, shifting the focus of care from increasing medication use to restoring metabolic health. While clinical trials show that remission is possible in controlled settings, evidence remains limited regarding its implementation in routine care within middle-income, rice-based dietary contexts. This study aims to explore healthcare provider experiences with implementing diabetes remission services in Thailand, focusing on dietary strategies, deprescription practices and patient management in routine care settings.

Design: Qualitative study using semi-structured, in-depth interviews, supplemented by structured questionnaires and programme documents.

Setting: Thirteen healthcare facilities across six Thai regions and two national-level professional or policy organisations.

Participants: 17 key informants purposively sampled for regional, institutional and professional diversity, including physicians, nurses, dietitians and national programme leaders. Data were collected and analysed iteratively until no new insights emerged. Thematic content analysis was conducted in QDA Miner Lite v3.0 with investigator triangulation.

Result: Five major themes emerged: key strengths, success factors, nutritional approaches and lifestyle modification, implementation challenges, and development strategies. Multidisciplinary teamwork, personalised care plans and regular monitoring facilitated service delivery. Culturally adapted dietary strategies, such as low-carbohydrate Thai-style meals and intermittent fasting, were widely used. Challenges included unclear clinical guidelines, limited staffing and technological disparities. Medication deprescription varied across sites due to the absence of standardised protocols. Healthcare providers emphasised the need for community engagement and policy support to enable scale-up. Real-world implementation of diabetes remission services is feasible but challenged by systemic constraints and contextual variability. Flexible, culturally tailored approaches, empowered care teams and supportive policy frameworks are essential for sustainability.

Conclusion: These findings provide practical insights for scaling remission programmes in other middle-income settings. Flexible, culturally tailored clinical pathways, empowered teams and supportive policy and financing are required to sustain outcomes and expand coverage.