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โรคเบาหวาน (Diabetes Mellitus) 6 โรคเบาหวาน (Diabetes Mellitus) นพ.สมเกยี รติ โพธิสตั ย นพ.สถิตย นริ มิตมหาปญ ญา นพ.ชัยชาญ ดีโรจนว งศ นพ.วรี ะศกั ด์ิ ศรินนภากร พญ.นภา ศิรวิ วิ ฒั นากุล นพ.สทิ ธชิ ัย อาชายนิ ดี พญ.ธนพร รัตนสุวรรณ การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition



โรคเบาหวาน (Diabetes Mellitus) 6-1 โรคเบาหวาน (Diabetes Mellitus) 6 นพ.สมเกยี รติ โพธิสตั ย* นพ.สถติ ย นิรมิตมหาปญญา** นพ.ชัยชาญ ดีโรจนวงศ* * นพ.วีระศักดิ์ ศรินนภากร ** พญ.นภา ศริ วิ ิวัฒนากุล** นพ.สิทธชิ ัย อาชายนิ ดี*** พญ.ธนพร รัตนสุวรรณ*** ÝćÖÖćøìĊęðøąßćÖøĔîðŦÝÝčïĆîöĊĂć÷č÷Čî÷ćü×ċĚî ÿõćóøŠćÜÖć÷ìęĊđÿČęĂöêćöüĆ÷ ÿõćüąÙüćöđðŨîĂ÷ĎŠ ĒúąüĉëĊßĊüĉêìęĊ đðúĊę÷îĕð øŠüöÖĆïÖćøöĊóùêĉÖøøöÿč×õćóìęĊĕöŠđĀöćąÿö ìĞćĔĀšēøÙđøĚČĂøĆÜÖúć÷đðŨîðŦâĀćÿč×õćóìĊęìęĆüēúÖÖĞćúĆÜĔĀšÙüćöÿĞćÙĆâ Ă÷ŠćÜöćÖ ēé÷đÞóćąĂ÷ŠćÜ÷ęĉÜēøÙđïćĀüćî àęċÜĒïŠÜĂĂÖđðŨî 4 ßîĉé1,2 ĕéšĒÖŠ 1) đïćĀüćîßîĉéìĊę 1 (type 1 diabetes) đÖĉéÝćÖ ÖćøìęĊêĆïĂŠĂîĕöŠÿćöćøëÿøšćÜăĂøŤēöîĂĉîàĎúĉîĔĀšđóĊ÷ÜóĂ đîČęĂÜÝćÖđïêćđàúúŤ (beta cells) ×ĂÜêĆïĂŠĂîëĎÖìĞćúć÷éšü÷øąïï õĎöĉÙčšöÖĆî×ĂÜøŠćÜÖć÷ 2) đïćĀüćîßîĉéìĊę 2 (type 2 diabetes) đðŨîđïćĀüćîìĊęóïđðŨîÿŠüîĔĀ⊠đÖĉéÝćÖÖćøìęĊêĆïĂŠĂî÷ĆÜ ÿćöćøëÿøšćÜĂĉîàĎúĉîĕéšĒêŠĕöŠđóĊ÷ÜóĂêŠĂÙüćöêšĂÜÖćø×ĂÜøŠćÜÖć÷ ĀøČĂđÖĉéõćüąéĚČĂêŠĂĂĉîàĎúĉî 3) ēøÙđïćĀüćîìĊęöĊÿćđĀêč ÝćĞ đóćą (other specific type) đðîŨ ēøÙđïćĀüćîìöęĊ ÿĊ ćđĀêčßéĆ đÝîìćĞ ĔĀêš ĆïĂŠĂîĕöŠÿćöćøëñúĉêăĂøŤēöîĂĉîàĎúĉî đߊî ÝćÖÖćøĔßš ÷ćïćÜßîĉé ÝćÖÖćøêĉéđßĚČĂ đðŨîêšî Ēúą 4) ēøÙđïćĀüćî×èąêĚĆÜÙøøõŤ (gestational diabetes mellitus) đðŨîēøÙđïćĀüćîìĊę êøüÝóïÙøĚĆÜĒøÖ×èąêĚĆÜÙøøõŤ ÖćøýċÖþćĔîðŦÝÝčïĆîÿŠüîĔĀâŠÝąđÖęĊ÷üךĂÜÖĆïēøÙđïćĀüćîßîĉéìĊę 2 ĒúąïćÜÿŠüîìĊęìĞćÖćøýċÖþć ĔîñšĎðśü÷đïćĀüćî×èąêĆĚÜÙøøõŤ Ĕî×èąìĊęÖćøýċÖþćĂČęîė ìęĊđÖęĊ÷üÖĆïđïćĀüćîßîĉéìęĊ 1 ĒúąđïćĀüćîÝćÖÿćđĀêčÝĞćđóćą÷ĆÜöĊĂ÷ŠĎ ÝĞćÖĆé ÖćøìĊęñĎšìęĊđðŨîēøÙđïćĀüćîÿŠüîĔĀâŠĕöŠÿćöćøëÙüïÙčöøąéĆïîĚĞćêćúĔĀšĂ÷ŠĎĔîđÖèæŤìęĊđĀöćąÿöĕéš ÝąÿŠÜñúĔĀšđÖĉé õćüąĒìøÖàšĂîêŠćÜė êćööć ðŦÝÝčïĆîĂĆêøćÖćøđךćóĆÖøĆÖþćêĆüĔîēøÜó÷ćïćú×ĂÜñšĎìęĊđðŨîēøÙđïćĀüćîöĊĒîüēîšöđóęĉööćÖ×Ěċî Ă÷ŠćÜêĂŠ đîČĂę Ü ĀćÖñĎìš đĊę ðŨîēøÙđïćĀüćîĕöŠĕéšøĆïÖćøéĎĒúøĆÖþćĂ÷ŠćÜëĎÖêšĂÜ øüöëċÜÖćøĔĀšÿč×ýċÖþćĒúąÖćøÿîĆïÿîčîÖćøéĎĒúìęĊ êŠĂđîČęĂÜ ÝąÖĂŠ ĔĀđš ÖĉéõćüąĒìøÖàšĂîĔîĀúć÷øąïï×ĂÜøŠćÜÖć÷ ìĆĚÜõćüąĒìøÖàšĂîĒïïđÞĊ÷ïóúĆîĒúąĒïïđøČĚĂøĆÜ ĂĆîîĞćĕðÿŠĎ ÙüćöóĉÖćøĒúąđÿĊ÷ßĊüĉêÖŠĂîüĆ÷ĂĆîÙüø ÿŠÜñúÖøąìïêŠĂÖćøéĞćøÜßĊüĉê õćüąđýøþåÖĉÝ ĒúąÙčèõćóßĊüĉê×ĂÜñĎšìęĊđðŨîēøÙĒúą ÙøĂïÙøüĆ øüöìĚÜĆ ðøąđìýßćê3ĉ Ă÷ŠćÜĕøÖĘêćöĒöšĀúć÷ðøąđìýìĆęüēúÖÝąöĊÖćøêøąĀîĆÖëċÜðŦâĀćēøÙđïćĀüćîìĊęđóęĉöÝĞćîüîöćÖ×Ěċî ĒúąöĊÖćøĔßš ÙŠćĔߚ݊ć÷ĔîÖćøøĆÖþćēøÙđïćĀüćîðøąöćèøšĂ÷úą 11.0 ×ĂÜÙŠćĔߚ݊ć÷ĔîÖćøøĆÖþćó÷ćïćúìĚĆÜĀöéìĆęüēúÖ4 ĒêŠđÖĉéÙĞćëćöëċÜ Triple paradox üŠćēøÙđïćĀüćîđðîŨ ēøÙìęüĊ ĉîÝĉ ÞĆ÷ĕéÜš ćŠ ÷ ĒêñŠ šĎìđĊę ðŨîÿüŠ îĔĀâŠĕöĕŠ éøš ĆïÖćøüĉîĉÝÞ÷Ć ĂĊÖìĆĚÜðŦÝÝčïĆîöĊ÷ćìĊęøĆÖþć ēøÙđïćĀüćîìĊęöĊðøąÿĉìíĉõćóøüöëċÜ÷ćÞĊéĂĉîàĎúĉî ĒêŠñĎšìĊęđðŨîÿŠüîĔĀâŠĕöŠÿćöćøëÙüïÙčöøąéĆïîĞĚćêćúĔĀšĂ÷ĎŠĔîđÖèæŤìęĊ đĀöćąÿöĕéš ĒúąõćüąĒìøÖàšĂîÝćÖēøÙđïćĀüćîÿćöćøëðŜĂÜÖĆîĕéš ĒêŠñšĎìęĊđðŨîÝĞćîüîöćÖđÖĉéõćüąĒìøÖàšĂîÝćÖ ēøÙđïćĀüćîêćööć ÖćøéĞćđîĉîÜćîÖćøéĎĒúøĆÖþćēøÙđïćĀüćî ÿĉęÜÿĞćÙĆâêšĂÜöĊÖćøéĞćđîĉîÜćîìęĊÙøĂïÙúčö ìĆĚÜéšćîÖćøðŜĂÜÖĆîĒúą ÙüïÙčöÖćøđÖĉéēøÙ ÖćøóĆçîćøąïïïøĉÖćøĒúąÖćøéĎĒúøĆÖþćñĎšìęĊđðŨîēøÙđïćĀüćîĔĀšđðŨîĕðĂ÷ŠćÜëĎÖêšĂÜĒúąêŠĂđîČęĂÜ ÿćöćøëđךćëċÜøąïïïøĉÖćøéĎĒúøĆÖþćĒúąÙĆéÖøĂÜÖćøđÖĉéõćüąĒìøÖàšĂîìęĊÝĞćđðŨîĕéšĂ÷ŠćÜìĆęüëċÜĒúąđìŠćđìĊ÷ö éĆÜîĆĚîÝċÜöĊ ÙüćöÝĞćđðŨîĂ÷ŠćÜ÷ęĉÜìęĊÝąêšĂÜđøŠÜóĆçîćøąïïåćîךĂöĎú øąïïïøĉÖćø Ēúąÿëćîó÷ćïćú êúĂéÝîóĆçîćïčÙúćÖøĔîøąïï ÖćøĒóì÷ŤĒúąÿćíćøèÿč×ĔîÿŠüîìĊęđÖęĊ÷üךĂÜÖĆïÖćøðŜĂÜÖĆîĒúąÙüïÙčöÖćøđÖĉéēøÙ ÖćøóĆçîćøąïïïøĉÖćø ÖćøéĎĒúøĆÖþć ĒúąÙéĆ ÖøĂÜÖćøđÖĉéõćüąĒìøÖàšĂîēøÙđïćĀüćî ĂĆîÝąîĞćĕðÿĎŠÖćøÝĆéìĞćךĂđÿîĂĒîąîē÷ïć÷ óĆçîćĒñîÖćøïøĉÖćø øąïï ךĂöĎú/Öćøêĉéêćö ĒúąÖćøÿîĆïÿîčîìćÜđìÙēîēú÷Ċêćöïìïćì×ĂÜÖøöÖćøĒóì÷Ť êúĂéÝîýċÖþć üĉÝĆ÷ĒúąÖĞćĀîéÿŠüîìĊę ×ćé×ĂÜÜćîĔîÖćøéĎĒúøĆÖþćēøÙđïćĀüćîéšćîêŠćÜė Ĕîðøąđìýĕì÷đóęĉöđêĉö đóęČĂîĞćĕðÿŠĎÖćøÝĆéÖćøÙüćöøĎšüĉßćÖćøĂ÷ŠćÜ đĀöćąÿöêĂŠ ĕð øąïćéüĉì÷ć (Epidemiology) ÙüćößčÖ×ĂÜēøÙđïćĀüćî ðŦÝÝčïĆîÙüćößčÖ×ĂÜēøÙđïćĀüćîìęĆüēúÖđóĉęöÿĎÜ×ĚċîĒúąöĊĒîüēîšöđóĉęö×ĚċîĂ÷ŠćÜêŠĂđîęČĂÜ ēé÷ÙüćößčÖ×ĂÜēøÙđïćĀüćîìęĆü ēúÖĔîðŘ 2011 ÝćÖךĂöĎú×ĂÜ International Diabetes Federation (IDF)4 óïÙüćößčÖ×ĂÜñšĎðśü÷ēøÙđïćĀüćîìęĆüēúÖĔîðŘ 2011 øĂš ÷úą 8.3 ÙĉéđðîŨ ÝĞćîüî 366 úšćîøć÷ ĒúąÙćéÖćøèŤĕüšüŠćĔîðŘ 2030 ÝąöĊñšĎđðŨîēøÙđïćĀüćîÝĞćîüî 552 úšćîøć÷ ĒúąóïÙüćößčÖ * ÿćĞ îÖĆ ìðĊę øÖċ þć ÖøöÖćøĒóì÷Ť ** ēøÜó÷ćïćúøćßüëĉ Ċ *** ēøÜó÷ćïćúđúĉéÿĉî การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-2 โรคเบาหวาน (Diabetes Mellitus) ×ĂÜ Impaired Glucose Tolerance (IGT) ĔîðŘ 2011 øšĂ÷úą 6.4 ÙĉéđðŨîÝĞćîüî 280 úšćîøć÷ ĒúąÙćéÖćøèŤüŠćÝąđóĉęö×ċĚîđðŨî 398 úćš îøć÷ĔîðŘ 2030 ÿĞćĀøĆïðøąđìýĕì÷ ÝćÖÖćøÿĞćøüÝÿč×õćóðøąßćßîĕì÷ēé÷ÖćøêøüÝøŠćÜÖć÷ (NHES) ÙøĚĆÜúŠćÿčé (ÙøĆĚÜìĊę 4) ĔîðŘ 2008-20095 óïüŠć ÙüćößčÖ×ĂÜēøÙđïćĀüćîĔîðøąßćÖøĕì÷Ăć÷č 15 ðŘ×Ěċîĕð öĊøšĂ÷úą 6.9 ēé÷đóýĀâĉÜöĊÙüćößčÖÿĎÜÖüŠć Ĕîđóýßć÷ (øšĂ÷úą 7.7 Ēúą 6.0 êćöúĞćéĆï) ĒúąÙüćößčÖöĊĒîüēîšöÿĎÜ×ċĚîêćöĂć÷č àęċÜÝąóïÙüćößčÖÿĎÜÿčéĔîÖúčŠöĂć÷č 60-69 ðŘ øĂš ÷úą 16.7 (đóýßć÷øšĂ÷úą 13.6 Ēúą 19.2 ĔîđóýĀâĉÜ) ĀúĆÜÝćÖîĚîĆ ÙüćößÖč ÝąúéúÜ ĒúąóïÙüćößčÖ×ĂÜēøÙđïćĀüćîĔîđ×ê đìýïćúÿĎÜÖüŠćîĂÖđ×êđìýïćúìĚĆÜĔîđóýßć÷ (øšĂ÷úą 8.3 Ēúą 5.0) ĒúąĀâĉÜ (øšĂ÷úą 9.4 Ēúą 7.0) àċęÜđöęČĂđðøĊ÷ïđìĊ÷ïÖĆïÖćø ÿĞćøüÝÙøĆĚÜìęĊ 3 (ðŘ 2003-2004)6 ìęĊøąéĆïîĚĞćêćúĔîđúČĂéĀúĆÜĂéĂćĀćø œ126 öĉúúĉÖøĆö/đéàĉúĉêø (öÖ./éú.) ĀøČĂñšĎìĊęÖĞćúĆÜøĆÖþć éüš ÷ÖćøøĆïðøąìćî÷ćúéîĞĚćêćú ĀøĂČ ÞéĊ ĂĉîàúĎ ĉî ìÿĊę ĞćøüÝĔîðøąßćÖøĂć÷č 15 ðŘ×Ěċîĕð óïüŠćÙüćößčÖ×ĂÜēøÙđïćĀüćîēé÷øüööĊ úÖĆ þèąĔÖúšđÙĊ÷ÜÖîĆ ÙČĂ øĂš ÷úą 6.7 êúĂéÝîÙüćößÖč ÝćĞ ĒîÖêćöđóý Ăć÷č Ēúąđ×êÖćøðÖÙøĂÜÖĘöúĊ ÖĆ þèąÙúšć÷ÙúċÜÖĆî (êćøćÜ ìęĊ 6.1) êćøćÜìĊę 6.1 ÙüćößčÖēøÙđïćĀüćîĔîðøąßćÖøĕì÷Ăć÷č 15 ðŘ×îĚċ ĕð ÝĞćĒîÖêćöđóý ÖúŠčöĂć÷č Ēúąđ×êÖćøðÖÙøĂÜ NHES 3*(2003-4)6 NHES 4**(2008-9)5 ךĂöĎú ßć÷ ĀâÜĉ ßć÷ ĀâÜĉ (øĂš ÷úą) (øšĂ÷úą) (øšĂ÷úą) (øšĂ÷úą) Ăć÷č (ð)Ř 15-29 2.0 1.6 0.8 0.5 30-44 5.2 5.1 3.7 3.2 45-59 11.4 12.6 8.5 11.6 60-69 13.8 18.9 13.6 19.2 70-79 12.3 15.7 14.3 17.1 80+ 10.1 9.2 12.9 10.5 øüöìÖč ÖúŠčöĂć÷č 6.4 7.3 6.0 7.7 đ×êÖćøðÖÙøĂÜ Ĕîđ×êđìýïćú 8.6 7.8 8.3 9.4 îĂÖđ×êđìýïćú 5.7 7.1 5.0 7.0 øüöìčÖđ×êÖćøðÖÙøĂÜ 6.4 7.3 6.0 7.7 Āöć÷đĀê:č * FPG œ126 mg/dl ĀøČĂñšĎìęÖĊ ĞćúĆÜøÖĆ þćéšü÷ÖćøøïĆ ðøąìćî÷ćúéîĞĚćêćú ĀøĂČ ÞéĊ Ăîĉ àúĎ ĉî ** FPG œ126 mg/dl ÙüćößÖč ×ĂÜðÝŦ ÝĆ÷đÿę÷Ċ ÜēøÙđïćĀüćî ÝćÖÖćøýċÖþć NHES ÙøÜĆĚ ìęĊ 3 ĒúąÙøĚĆÜìęĊ 4 óï×Ăš öúĎ ÙüćößčÖ×ĂÜðŦÝÝ÷Ć đÿ÷ęĊ ÜēøÙđïćĀüćîìÿęĊ ĞćÙĆâ éÜĆ êćøćÜìęĊ 6.2 êćøćÜìĊę 6.2 ÙüćößÖč ×ĂÜðÝŦ Ý÷Ć đÿęĊ÷ÜìęÿĊ ĞćÙĆâ (aged-adjusted) NHES 3 NHES 4 (2003-4)6 (2008-9)5 ךĂöúĎ ßć÷ ĀâĉÜ ßć÷ ĀâĉÜ ÿïĎ ïĀč øĊę (Ăć÷čöćÖÖüŠć 15 ð)Ř (%) 41.6 2.6 45.1 1.9 ÙüćößčÖ ÙüćöéĆîēúĀĉêÿĎÜ (%) 46.3 47.6 41.5 47.1 ÙüćößÖč ēøÙđïćĀüćî (%) (FPG œ126 mg/dl) 6.3 7.6 6.4 8.1 ÙüćößÖč ēøÙēÙđúÿđêĂøĂú (%) (cholesterol œ240 mg/dl) 57.2 60.1 57.3 74.2 Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-3 Ăïč êĆ ĉÖćøèŤēøÙđïćĀüćî 6 ĂčïĆêĉÖćøèŤ×ĂÜēøÙđïćĀüćîĔîߊüÜĂć÷č 35-60 ðŘ ĔîðŘ 20057 ÙČĂ 17.8 êŠĂ 1,000 ðøąßćÖøêŠĂðŘĔîđóýßć÷ Ēúą 9.2 êŠĂ 1,000 ðøąßćÖøêŠĂðŘĔîđóýĀâĉÜ ÿŠüîĔîÖćøýċÖþćĂęČîĔîߊüÜðŘ 2001-20058 óïĂčïĆêĉÖćøèŤ×ĂÜēøÙđïćĀüćî 13.6 êŠĂ 1,000 ðøąßćÖøêŠĂðŘĔîđóýßć÷ Ēúą 6.4 êŠĂ 1,000 ðøąßćÖøêŠĂðŘĔîđóýĀâĉÜ àęċÜðŦÝÝĆ÷ìĊęÿĞćÙĆâÙČĂ Ăšüî öĊøąéĆï alanine aminotransferase levels >18 öÖ./éú. ĒúąöĊøąéĆï FPG œ96 öÖ./éú. ĒúąÖćøýċÖþćÖŠĂîĀîšćîĚĊĔîðŘ 1985 Ēúą 1997 óïĂčïĆêĉÖćøè׍ ĂÜēøÙđïćĀüćîēé÷øüöĂ÷ìŠĎ Ċę 11.3 êĂŠ 1,000 ðøąßćÖøêĂŠ ð9Ř ÙüćößÖč ×ĂÜ Impaired Fasting Glucose (IFG) ÿĞćĀøĆïÙüćößčÖ×ĂÜñšĎìęĊđðŨî IFG Ĕî NHES ÙøĚĆÜìĊę 45 ēé÷ÝĞćĒîÖêćöÖúŠčöĂć÷čĒúąđóý (õćóìĊę 6.1) óïÙüćößčÖ ×ĂÜ IFG øšĂ÷úą 11.8 Ĕîđóýßć÷ ĒúąđóýĀâĉÜøšĂ÷úą 9.5 ĒúąÙüćößčÖēé÷øüöøšĂ÷úą 10.7 àċęÜÙüćößčÖ×ĂÜ IFG Ýąđøĉęö đóĉęö×ċĚîĂ÷ŠćÜßĆéđÝîêĆĚÜĒêŠĂć÷čöćÖÖüŠć 30 ðŘ ēé÷đóýßć÷ìęĊĂć÷čߊüÜ 30-44 ðŘ öĊ IFG øšĂ÷úą 11.4 đóýĀâĉÜøšĂ÷úą 6.0 Ēúą ÙüćößčÖēé÷øüöøšĂ÷úą 8.6 îĂÖÝćÖîĊĚ÷ĆÜóïüŠćñĎìš öęĊ ĂĊ ć÷čöćÖÖüŠć 15 ðŘ đðîŨ ēøÙđïćĀüćîĀøČĂ IFG ëċÜøšĂ÷úą 17.6 ĒúąóïüŠć öĊÖćøÖøąÝć÷êćöđ×êðÖÙøĂÜ ÙČĂÙüćößčÖĔîđ×êđìýïćúÿĎÜÖüŠćîĂÖđ×êĄ ÖćøÖøąÝć÷×ĂÜÙüćößčÖđïćĀüćîêćöõćÙ óïüŠćöĊ ÙüćöĒêÖêŠćÜøąĀüŠćÜđóý ēé÷ĔîñĎšĀâĉÜóïÙüćößčÖÿĎÜÿčéĔîÖøčÜđìóĄ (øšĂ÷úą 9.9) øĂÜúÜöćÙČĂõćÙêąüĆîĂĂÖđÞĊ÷ÜđĀîČĂ (øšĂ÷úą 9.1) êćöéšü÷ õćÙÖúćÜ õćÙĔêš ĒúąõćÙđĀîČĂ êćöúĞćéĆï ÿŠüîĔîđóýßć÷ óïÿĎÜÿčéĔîÖøčÜđìóĄ (øšĂ÷úą 8.5) øĂÜúÜöćÙČĂõćÙÖúćÜ (øšĂ÷úą 7.7) ÖćøÖøąÝć÷êćöõćÙ×ĂÜõćüą IFG óïüŠćÿĎÜìęĊÿčéĔîõćÙÖúćÜ (øšĂ÷úą 18.6) øĂÜúÜöć ÙČĂ õćÙĔêš õćÙđĀîČĂ ÖøčÜđìóĄ ĒúąõćÙêąüĆîĂĂÖđÞĊ÷ÜđĀîČĂ êćöúĞćéĆï õćÙđĀîČĂ õćÙêąüĆîĂĂÖđÞĊ÷ÜđĀîČĂ ĒúąõćÙĔêš êćöúćĞ éïĆ õćóìęĊ 6.1 ÙüćößčÖ×ĂÜ IFG ĔîðøąßćÖøĕì÷Ăć÷č 15 ðŘ×îĚċ ĕð5 ÙüćößÖč đïćĀüćîßüŠ ÜêĆÜĚ ÙøøõŤ (Gestational Diabetes Mellitus: GDM) ÙüćößčÖ×ĂÜ GDM öĊÙüćöĒêÖêŠćÜÖĆîêćöđÖèæŤìĊęĔßšüĉîĉÝÞĆ÷10 ēé÷ÝćÖđÖèæŤÖćøüĉîĉÝÞĆ÷×ĂÜ National Diabetes Data Group (NDDG) óïÙüćößčÖøšĂ÷úą 1.4 đðøĊ÷ïđìĊ÷ïđÖèæŤÖćøüĉîĉÝÞĆ÷×ĂÜ WHO criteria óïøšĂ÷úą 15.7 ĒúąÝćÖÖćøýċÖþć×ĂÜ Hyperglycemia and Adverse Pregnancy Outcome (HAPO) ĔîÖćøýċÖþćìĊęöĊđßČĚĂßćêĉĕì÷ óïüŠć öĊÙüćößčÖ×ĂÜ GDM øšĂ÷úą 23.0 àċęÜÖćøüĉîĉÝÞĆ÷éĆÜÖúŠćüĂćýĆ÷ international association of the diabetes and pregnancy study groups (IADPSG) 75 g oral glucose tolerance test (75 g OGTT) ēé÷ĔßšđÖèæŤÖćøüĉîĉÝÞĆ÷ การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-4 โรคเบาหวาน (Diabetes Mellitus) ßĆęüēöÜìęĊ 1, 2 Ēúą 3 đðŨî 92 öÖ./éú., 180 öÖ./éú., 153 öÖ./éú. ēé÷ĀćÖöĊÙŠćñĉéðÖêĉ×ĂÜÙŠćĔéÙŠćĀîęċÜëČĂüŠćđðŨîēøÙđïćĀüćî Ĕî×èąÖćøêĚĆÜÙøøõŤ11 ÿĞćĀøĆïÖćøÙĆéÖøĂÜđïćĀüćîĔî×èąêĆĚÜÙøøõŤēé÷ĂćýĆ÷ðŦÝÝĆ÷đÿĊę÷ÜÝąĕöŠÿćöćøëüĉîĉÝÞĆ÷ēøÙđïćĀüćî Ĕî×èąêÜĆĚ ÙøøõŤðøąöćèøšĂ÷úą 50.0 ĔîñšĀĎ âÜĉ ìĊĂę ć÷čöćÖÖüćŠ 30 ðŘ ÝćÖÖćøýċÖþć (hospital based) ĔîðŘ 1992 ēé÷ÖćøìĞć 75 g OGTT 4-6 ÿĆðéćĀŤĀúĆÜÙúĂé óïüŠćøšĂ÷úą 42.2 Ĕî 71 øć÷ìĊęìĞćÖćøìéÿĂï óïüŠćöĊ IGT øšĂ÷úą 7.0 đðŨîēøÙđïćĀüćî ĒúąøšĂ÷úą 35.2 đðŨî IFG12 îĂÖÝćÖîĊĚ÷ĆÜóïÖćøýċÖþć ÙüćößčÖ×ĂÜđïćĀüćîߊüÜêĚĆÜÙøøõŤ (hospital based) ĂČęîė Ĕîðøąđìýĕì÷ éÜĆ êćøćÜìęĊ 6.3 êćøćÜìęĊ 6.3 ÙüćößčÖ×ĂÜđïćĀüćîßüŠ ÜêĚĆÜÙøøõĔŤ îðøąđìýĕì÷ Hospital Year Sample Study type Screen OGTT Criteria GDM size test 100g 3h NDDG rate Rajavithi Hospital12 50g 1h 100g 3h NDDG 2.02% 1987-9 25,992 prospective 100g 3h NDDG 50g 1h 100g 3h NDDG 3.0% Siriraj Hospital13 cohort 50g 1h 7.05% 2001-2 9,861 prospective 50g 1h 1.5% cohort Maharaj Nakorn Chiang 2001-2 411 retrospective Mai Hospital14 descriptive Lumphun Hospital15 2006-7 637 retrospective descriptive đÙøĂęČ ÜßĊĚüéĆ õćøąēøÙ (Burden of Disease) ĂĆêøćÖćøđÿĊ÷ßüĊ ĉê ÝćÖÖćøýċÖþćïĆîìċÖÖćøđÿĊ÷ßĊüĉê Ēúą verbal autopsy ĔîðŘ 200516 óïüŠćēøÙđïćĀüćîđðŨîÿćđĀêčìĊęđÿĊ÷ßĊüĉê ĂĆîéĆïÿĂÜĔîđóýĀâĉÜ (øšĂ÷úą 8.0) ĒúąđðŨîÿćđĀêčìĊęđÿĊ÷ßĊüĉêĂĆîéĆïÿĉïĔîđóýßć÷ (øšĂ÷úą 3.2) àċęÜÿćđĀêčÖćøđÿĊ÷ßĊüĉêìĊęóï ïŠĂ÷ÿčéÙĂČ stroke ìÜĚĆ Ĕîđóýßć÷ĒúąĀâÜĉ (øĂš ÷úą 9.4 ĒúąøšĂ÷úą 11.3 êćöúĞćéïĆ ) õćüąĒìøÖàĂš î ÝćÖÖćøýċÖþć Thailand diabetes registry17 (multi-hospitals based) óïüŠć õćüąĒìøÖàšĂîÝćÖēøÙđïćĀüćî ìĊęóïöćÖìĊęÿčé ÙČĂ ēøÙĕê óïøšĂ÷úą 43.9 êćöéšü÷ diabetic retinopathy øšĂ÷úą 30.7 ēøÙ ischemic heart disease óïøšĂ÷úą 8.1 ĒúąēøÙĀúĂéđúČĂéÿöĂÜøšĂ÷úą 4.4 àċęÜÙúšć÷ÖĆïÖćøýċÖþćĂęČîė ìęĊóïüŠćõćüąĒìøÖàšĂîìćÜĕêöĊöćÖìęĊÿčé ÿŠüîìęĊóïĒêÖêŠćÜÖĆîöĊđóĊ÷ÜÖćøýċÖþć×ĂÜ Thai Multicenter Research Group on Diabetes Mellitus18 ìęĊóïüŠć öĊõćüąĒìøÖàšĂîìćÜêćöćÖÖüŠćìćÜĕê îĂÖÝćÖîĚĆî÷ĆÜöĊךĂöĎúõćüąĒìøÖàšĂîìćÜđìšć ìćÜÿöĂÜ ĒúąĀúĂéđúČĂéĀĆüĔÝ éÜĆ êćøćÜìĊę 6.4 Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-5 êćøćÜìĊę 6.4 øšĂ÷úąÖćøđÖéĉ õćüąĒìøÖàšĂî×ĂÜēøÙđïćĀüćî Diabetic Diabetic Diabetic foot problem ÜćîüĉÝ÷Ć retinopathy nephropathy Diabetic Pulse Amputation neuropathy deficit (%) (%) (%) (%) (%) Thai Multicenter Research 32.1 18.7 - - 1.3 Group on Diabetes Mellitus18 (Multi-hospitals based) The Diabcare-Asia19 21.0 39.0 27.0 8.0 1.0 (Multi-hospitals based) 3.9 1.6 6 Thailand diabetes registry 30.7 43.9 (TDR) Project17 (Multi-hospitals based) Clinical complication in Type 23.7 38.3 21.0 5.3 0.45 2 diabetes patients (DD Comp.)* 20 (Multi-hospitals based) Medical Research 7.4 21.5 NA NA 0.2 Network (MedResNet)** 255621 (ךĂöúĎ ðŘ 2555)21 (Population based) Āöć÷đĀê:č * ÿëćïîĆ üÝĉ ÷Ć ĒúąðøąđöĉîđìÙēîēú÷ìĊ ćÜÖćøĒóì÷Ť ÖøöÖćøĒóì÷Ť ** đÙøČĂ׊ć÷üĉÝĆ÷ÖúčöŠ ÿëćïîĆ Ēóì÷ýćÿêøŤĒĀŠÜðøąđìýĕì÷ ÙćŠ ĔßšÝćŠ ÷ĔîÖćøøĆÖþć ÝćÖÖćøýċÖþćøðĎ ĒïïÙćŠ Ĕߚ݊ć÷ēøÙđïćĀüćî×ĂÜēøÜó÷ćïćúĔîðøąđìýĕì÷ ߊüÜðŘ 2000-200122 óïüŠćÙŠćĔߚ݊ć÷ ĔîÖćøøĆÖþćēøÙđïćĀüćîßîĉéìęĊ 2 ìęĊöĊĒñúìĊęđìšćđÞúĊę÷ 7,603 ïćì ēøÙĀúĂéđúČĂéÿöĂÜ 10,418 ïćì ñĎšìęĊđðŨîēøÙđïćĀüćîìĊę öĊ gangrene 13,440 ïćì Ēúą 4,037 ïćì ĔîñĎšìđęĊ ðîŨ ēøÙđïćĀüćîìęĊĕöŠöõĊ ćüąĒìøÖàšĂî (êćøćÜìęĊ 6.5) êćøćÜìĊę 6.5 ÙŠćĔߚ݊ć÷ĔîÖćøøÖĆ þćēøÙđïćĀüćîßîéĉ ìęĊ 2 êĂŠ ðŘ (N=186) ĔîðŘ 200122 ïćì ÙćŠ ĔßšÝćŠ ÷ 4,037.- 4,686.- ĕööŠ õĊ ćüąĒìøÖàšĂî 5,775.- öõĊ ćüąÙüćöéĆîēúĀĉêÿĎÜøŠüö 7,603.- öēĊ øÙĕ×öĆîÿÜĎ øüŠ ö 8,369.- öĒĊ ñúìęđĊ ìćš 9,860.- öĊøąéĆïîĞćĚ êćúÿÜĎ öćÖ 10,418.- öøĊ ąéĆïîćĚĞ êćúêĞęć 13,417.- öĊēøÙĀúĂéđúĂČ éÿöĂÜ öĒĊ ñú gangreen ÝćÖÖćøýċÖþćÙŠćĔߚ݊ć÷ĔîñìšĎ đęĊ ðîŨ ēøÙđïćĀüćî 475 øć÷ ìęĊēøÜó÷ćïćúüćøĉßõĎöĉ (hospital based) ÝĆÜĀüĆéÿÖúîÙø ĔîðŘ 2007-200823 ēé÷üĉíĊ micro-costing ĔîÿŠüî direct medical cost ÙĞćîüèēé÷üĉíĊ multiplying the quantity of medical services consumed by their unit costs ×èąìęĊ indirect cost ÙĞćîüèēé÷üĉíĊ human capital approach ñúÝćÖÖćøýċÖþćóïüŠć ñĎšìĊęđðŨîēøÙđïćĀüćî 475 øć÷ öĊÙŠćĔߚ݊ć÷đðŨîđÜĉîđÞúęĊ÷øć÷úą 4,480 ïćì ēé÷đðŨî direct medical costs øĂš ÷úą 22.6 đðîŨ direct non-medical costs øĂš ÷úą 39.7 Ēúą indirect costs øšĂ÷úą 37.5 (êćøćÜìęĊ 6.6) การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-6 โรคเบาหวาน (Diabetes Mellitus) êćøćÜìęĊ 6.6 ÿéĆ ÿüŠ îÖćøýÖċ þćÙćŠ ĔßÝš Šć÷ĔîñĎšìęđĊ ðŨîēøÙđïćĀüćî23 ÙćŠ ĔßšÝćŠ ÷ øšĂ÷úą(%) direct medical cost 22.6 (ÿüŠ îĔĀâŠđðîŨ in-patient care) (øĂš ÷úą 11.1 ×ĂÜÙćŠ øĆÖþćó÷ćïćúìĚĆÜĀöé) direct non-medical cost 39.7 (ÿŠüîĔĀâđŠ ðŨî permanent disability) (øšĂ÷úą 27.8 ×ĂÜÙŠćøÖĆ þćó÷ćïćúìĚĆÜĀöé) indirect cost 37.5 îĂÖÝćÖîĊĚ÷ĆÜóïüŠć ÙŠćĔߚ݊ć÷ēøÙđïćĀüćîßîĉéìĊę 1 êŠĂøć÷đðŨî 23,936 ïćì ÙŠćĔߚ݊ć÷ĔîēøÙđïćĀüćîßîĉéìęĊ 2 êŠĂøć÷đðŨî 4,480 ïćì ÙŠćĔߚ݊ć÷ĔîÖćøøĆÖþćēøÙđïćĀüćîÝąÿĎÜ×ċĚîêćö Ăć÷č øą÷ąđüúćìĊęđðŨîēøÙđïćĀüćî øąéĆïîĚĞćêćú ÖŠĂîĂćĀćø ĒúąēøÙøŠüö ēé÷ÙŠćĔߚ݊ć÷ÿĞćĀøĆïñĎšìęĊđðŨîēøÙđïćĀüćîìęĊöĊõćüąĒìøÖàšĂîðøąöćèøć÷úą 15,358 ïćì àċęÜÿĎÜ ÖüŠćñĎšìęĊĕöŠöĊõćüąĒìøÖàšĂî (3,684 ïćì) Ă÷ŠćÜöĊîĆ÷ÿĞćÙĆâìćÜÿëĉêĉ øüöëċÜÙŠćĔߚ݊ć÷ÝąÿĎÜ×ĚċîêćöÝĞćîüîõćüąĒìøÖàšĂîìĊę öćÖ×Ěċîéšü÷ (êćøćÜìęĊ 6.7) êćøćÜìęĊ 6.7 ÙŠćĔßÝš Šć÷ĔîÖćøøĆÖþćēøÙđïćĀüćîìĊēę øÜó÷ćïćúüćøßĉ õöĎ ĉ ÝĆÜĀüéĆ ÿÖúîÙø ĔîðŘ 2006-2008 (USD=32 THB)23 number cost of illness (%) median inter-quartile P value* range Complications With complications 148 (31.2) 479.93 120.43-1552.22 <0.001 Without complications 327 (68.8) 115.12 73.54-286.08 Number of complications One complication 96 (20.2) 261.32 100.45-826.29 <0.001 Two complications 44 (9.3) 758.09 240.28-2749.14 Three and more complications 8 (1.7) 2131.34 1091.34-3795.43 Types of complications‡ Microvascular 59 (12.4) 641.20 206.57-2267.65 0.001 Macrovascular 11 (2.3) 366.55 110.56-2463.43 Micro and macrovascular 11 (2.3) 666.42 201.03-2706.59 Microvascular and cataract 23 (4.8) 745.44 376.41-1357.58 Cataract 44 (9.3) 151.06 93.90–586.51 Total (N=475) 475 (100.0) 139.79 82.01–522.50 Āöć÷đĀêč: Cost data covered the period from October 2007 to September 2008. *Subgroup comparisons were done by using Kruskal–Wallis or Jonckheere-Terpestra test whichever is applicable. ‡Microvascular complications include diabetic retinopathy, diabetic nephropathy and diabetic neuropathy while macrovascular complications include cardiovascular diseases (Fowler 2008). ÝćÖÖćøýċÖþćÙŠćĔߚ݊ć÷éšćîÿč×õćóÝćÖõćüąîĚĞćĀîĆÖđÖĉîĒúąēøÙĂšüîĔîðøąđìýĕì÷ ĔîēÙøÜÖćøðøąđöĉî đìÙēîēú÷ĊĒúąîē÷ïć÷éšćîÿč×õćó (HITAP)24 óïüŠćñĎšìęĊöĊõćüąîĚĞćĀîĆÖđÖĉîĒúąēøÙĂšüîöĊÙŠćĔߚ݊ć÷éšćîÿč×õćóđÖęĊ÷üÖĆïēøÙ đïćĀüćîöćÖìÿęĊ éč ìĚÜĆ ĔîñðĎš üś ÷îĂÖĒúąñĎšðśü÷Ĕî ēé÷Ùéĉ đðîŨ 671 úšćîïćìĔîñðšĎ üś ÷îĂÖ Ēúą 2,716 úšćîïćìĔîñðĎš śü÷Ĕî ÝąđĀĘîĕéšüŠćÙŠćĔߚ݊ć÷ĔîÖćøøĆÖþćēøÙđïćĀüćîÙŠĂîךćÜöĊÝĞćîüîöćÖ ēé÷đÞóćąñšĎìęĊöĊõćüąĒìøÖàšĂî ìęĊÖŠĂĔĀšđÖĉé ñúÖøąìïìĆĚÜñĎšìĊęđðŨîēøÙ ÙøĂïÙøĆü ĒúąđðŨîõćøą×ĂÜÿĆÜÙö éĆÜîĆĚîĔîÖćøéĞćđîĉîÜćîÖćøðŜĂÜÖĆîĒúąÖćøøĆÖþćēøÙđóČęĂĕöŠĔĀš đÖéĉ õćüąĒìøÖàšĂîÝÜċ öĊÙüćöÿćĞ ÙâĆ Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-7 Cost and Interventions 6 1. ÖćøìćĞ îć÷ÖćøđÖéĉ ēøÙđïćĀüćî ÝćÖÖćøýċÖþćÙüćöđÿĊę÷ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîĔîđóýßć÷ìĊęĕöŠĕéšđðŨîēøÙđïćĀüćî25 ìĊęöĊøąéĆïîĚĞćêćúÖŠĂî ĂćĀćøĔîøąéĆïêŠćÜė ĒúąöĊøąéĆïĕ×öĆîĕêøÖúĊđàĂĕøéŤ ĒúąøąéĆïéĆßîĊöüúÖć÷ìĊęĒêÖêŠćÜÖĆî óïüŠćñĎšìĊęöĊøąéĆïîĞĚćêćúÖŠĂî ĂćĀćøìðĊę ÖêĉĒêĂŠ ÷ŠĎĔîߊüÜ 91-99 öÖ./éú. øŠüöÖĆïöĊøąéĆïĕ×öĆîĕêøÖúĊđàĂĕøéŤìęĊöćÖÖüŠćĀøČĂđìŠćÖĆï 150 öÖ./éú. ÝąöĊÙüćöđÿęĊ÷Ü êŠĂÖćøđÖĉéēøÙđïćĀüćîðøąöćè 8 đìŠć đöČęĂđðøĊ÷ïđìĊ÷ïÖĆïïčÙÙúìĊęöĊøąéĆïîĞĚćêćúÖŠĂîĂćĀćøĔîߊüÜìĊęîšĂ÷ÖüŠć 86 öÖ./éú. ĒúąöĊøąéĆïĕ×öîĆ ĕêøÖúĊđàĂĕøéìŤ Ċîę Ăš ÷ÖüćŠ 150 öÖ./éú. îĂÖÝćÖîĊĚñìĎš ęöĊ ĊøąéĆïîĚĞćêćúÖŠĂîĂćĀćøìęĊðÖêĉĒêŠĂ÷ŠĎĔîߊüÜ 91-99 öÖ./éú. øŠüöÖĆïöĊøąéĆïéĆßîĊöüúÖć÷ìęĊöćÖÖüŠćĀøČĂđìŠćÖĆï 30 ÖÖ./êøö. ÝąöĊÙüćöđÿęĊ÷ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîðøąöćè 8 đìŠć đöČęĂ đðøĊ÷ïđìĊ÷ïÖïĆ ïčÙÙúìĊęöĊøąéĆïîĚĞćêćúÖŠĂîĂćĀćøĔîߊüÜìęĊîšĂ÷ÖüŠć 86 öÖ./éú. ĒúąöĊøąéĆïéĆßîĊöüúÖć÷ìĊęîšĂ÷ÖüŠć 25 ÖÖ./êøö. (õćóìęĊ 6.2) éÜĆ îĆĚîîĂÖÝćÖÖúöŠč ìđĊę ðîŨ IFG Ēúą IGT ÝąÙüøĕéšøĆïÖćøðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćîĒúšü ïčÙÙúìęĊĂšüîĀøČĂöĊøąéĆïĕ×öĆî ĕêøÖúđĊ àĂĕøéŤÿĎÜ (àċęÜđðŨîđÖèæŤĔîÖćøüĉîĉÝÞĆ÷ metabolic syndrome) ëċÜĒöšüŠćÝąöĊøąéĆïîĚĞćêćúìęĊĕöŠñĉéðÖêĉĒêŠöĊøąéĆïìęĊĔÖúš øąéĆï 100 öÖ./éú. ĂćÝÝąđðŨîÖúčŠöđÿęĊ÷ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîĒúąÙüøĔĀšÖćøðŜĂÜÖĆîēøÙđïćĀüćîđߊîÖĆî îĂÖÝćÖîĚĊñĎšìĊęöĊ ðÝŦ ÝĆ÷đÿĊ÷ę ÜĂČęîė ĕéšĒÖŠ ÖćøöðĊ øąüêĆ ĉēøÙđïćĀüćîĔîÙøĂïÙøĆü ÖćøđðŨîēøÙđïćĀüćîߊüÜÖćøêĚĆÜÙøøõŤ ñĎšðśü÷ìĊęöĊÙüćöéĆîēúĀĉêÿĎÜ ñšĎðśü÷ìęĊöĊõćüą insulin resistance đߊî Polycystic Ovarian Syndrome (PCOS) ÙüøĕéšøĆïÖćøðŜĂÜÖĆîēøÙđïćĀüćîéšü÷ đßîŠ ÖĆî õćóìęĊ 6.2 Ùüćöđÿ÷Ċę Ü×ĂÜēøÙđïćĀüćîêćöøąéĆï FPG, triglyceride Ēúą BMI25 ÿćĞ ĀøïĆ ÖćøðøąđöĉîÙüćöđÿę÷Ċ ÜēøÙđïćĀüćîĔîÙîĕì÷9 ĕéšöĊÖćøýċÖþćëċÜÙüćöđÿ÷ęĊ Üēé÷Ăćý÷Ć ×Ăš öúĎ Ăć÷č đóý éĆßîĊ öüúÖć÷ đÿšîøĂïüÜđĂü ÙüćöéĆîēúĀêĉ ĒúąðøąüĆêÙĉ øĂïÙøüĆ (êćøćÜìĊę 6.8) การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-8 โรคเบาหวาน (Diabetes Mellitus) êćøćÜìęĊ 6.8 Ùüćöđÿ÷ęĊ Üēé÷ĂćýĆ÷ךĂöúĎ Ăć÷č đóý éßĆ îöĊ üúÖć÷ đÿîš øĂïüÜđĂü ÙüćöéĆîēúĀêĉ ĒúąðøąüĆêĉÙøĂïÙøĆü9 Risk factor Coefficient Diabetes risk score Ăć÷č (ð)Ř 30-39 0 40-44 -0.07 0 45-49 0.27 1 œ50 0.60 2 đóý ĀâÜĉ 0 ßć÷ 0.44 2 éĆßîĊöüúÖć÷ (ÖÖ./êøö.) 0.69 0 <23 1.24 3 23-27.5 5 œ27.5 0.56 0 đÿšîøĂïđĂü (àö.) 0.64 2 <80 ĔîđóýĀâÜĉ <90 Ĕîđóýßć÷ 1.08 0 œ80 ĔîđóýĀâĉÜ œ90 Ĕîđóýßć÷ 2 ÙüćöéĆîēúĀêĉ ÿĎÜ 0 4 ĕöŠöĊ öĊ ðøąüĆêēĉ øÙđïćĀüćîĔîÙøĂïÙøüĆ ĕöŠöĊ öĊ Ă÷ŠćÜĕøÖĘêćöÖćøÙĞćîüèÙüćöđÿĊę÷ÜÝćÖêćøćÜìĊę 6.8 ÷ĆÜöĊךĂÝĞćÖĆéđÖęĊ÷üÖĆïÖćøĔߚךĂöĎúðøąüĆêĉÙøĂïÙøĆü ëšćïĉéć ĒúąöćøéćđðŨîēøÙđïćĀüćîìĚÜĆ ÙŠĎ ÝąÙĉéÙĞćîüèÙüćöđÿęĊ÷ÜĂ÷ŠćÜĕø đóøćąÝąöĊÙüćöđÿęĊ÷ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîÿĎÜÖüŠćïčÙÙú ìęĊöĊïĉéćĀøČĂöćøéćđðŨîēøÙđïćĀüćîđóĊ÷ÜÙîđéĊ÷ü ĒúąÖćøĔĀšÙąĒîîđóýßć÷öćÖÖüŠćđóýĀâĉÜàċęÜÙüćößčÖìęĊóïöĊÙüćöđÿęĊ÷Ü ×ĂÜÖćøđÖĉéēøÙđïćĀüćîĔîđóýĀâÜĉ öćÖÖüćŠ đóýßć÷ 2. ÖćøðŜĂÜÖĆîēøÙđïćĀüćî ÿĞćĀøïĆ ÖćøðŜĂÜÖĆîÖćøđÖéĉ ēøÙđïćĀüćîĔîðøąßćÖøÖúŠčöđÿęĊ÷Ü ĂćÝÝąĒïÜŠ đðîŨ 2 üíĉ Ċ ĕéšĒÖŠ ÖćøðøĆïđðúĊę÷îóùêĉÖøøö ĒúąÖćøĔß÷š ć (êćøćÜìęĊ 6.9) Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-9 êćøćÜìĊę 6.9 ÖćøýÖċ þćđóČĂę ðĂŜ ÜÖĆîÖćøđÖĉéēøÙđïćĀüćîßîéĉ ìęĊ 2 Studies Patients Duration Intervention Onset of DM Finnish study26 middle age 2.2 years brief 58%RRR obese diet+exercise DPP study27 with IGT 2.8 years Intensive 58%RRR Da Qing study28 obese 6 years life style 31%RRR IGT metformin 31%RRR IGT diet only 48%RRR exercise only 42%RRR TRIPOD29 hispanic 30 months diet+exercise 56%RRR 6 STOP-NIDDM30 previous GDM 3.0 years TZD XENDOS31 IGT 4 years 25%RRR D-glucosidase DREAM32,33 obese 3.0 years inhibitor 45%RRR with or 3.0 years oristat no effect without IGT IGT group 60%RRR IFG, IGT without IGT 9%RRR (NS) IFG, IGT rosiglitazone regession to ramipril normoglycemia 16% ACT NOW34 IGT+ one other 2.4 years (p=0.001) NAVIGATER35,36 risk factor 5 years pioglitazone 0.72 RRR IGT+ CVD or CVD p<0.001 risk nateglinide HR=1.07 p=0.05 valsartan 0.14 RRR p<0.001 2.1ÖćøðøïĆ đðúęĊ÷îóùêÖĉ øøö ÝćÖÖćøýċÖþć Finnish Diabetes Study37 óïüŠćÖúŠčöìĊęĕéšøĆïÖćøðøĆïđðúęĊ÷îóùêĉÖøøöĂ÷ŠćÜđךöÜüéēé÷ ÖćøøïĆ ðøąìćîĂćĀćøðøąđõìĕ×öĆîêĞęć ĂĂÖÖĞćúĆÜÖć÷ 150 îćìĊêŠĂÿĆðéćĀŤ ĒúąúéîĞĚćĀîĆÖðøąöćèøšĂ÷úą 7.0 ĔîÖúčŠöđÿĊę÷Ü ÿćöćøëðŜĂÜÖîĆ ÖćøđÖĉéēøÙđïćĀüćîĕéøš Ăš ÷úą 58.0 àÜęċ ÖćøðøĆïđðúęĊ÷îóùêÖĉ øøöðøąÖĂïéüš ÷ 5 Ă÷ćŠ Ü éÜĆ îĚĊ 1) úéîĞćĚ ĀîÖĆ öćÖÖüćŠ øĂš ÷úą 5.0 2) øĆïðøąìćîĂćĀćøĕ×öĆî îĂš ÷ÖüŠćøšĂ÷úą 30.0 ×ĂÜóúĆÜÜćî 3) øĆïðøąìćîĂćĀćøĕ×öĆîĂöĉę êüĆ îšĂ÷ÖüćŠ øĂš ÷úą 10.0 ×ĂÜóúÜĆ Üćî 4) øĆïðøąìćîĂćĀćøđÿšîĔ÷öćÖÖüŠćĀøČĂđìŠćÖĆï 15 ÖøöĆ êŠĂ 1,000 ÖĉēúĒÙúĂøĊę 5) ÖćøĂĂÖÖćĞ úÜĆ Öć÷öćÖÖüŠć 30 îćìĊêŠĂüîĆ ÝćÖÖćøýċÖþćìĆĚÜÖúŠčöìęĊĕéšĔĀšÙĞćĒîąîĞćĔîÖćøðøĆïđðúęĊ÷îóùêĉÖøøöĀøČĂÖúčŠöìęĊĕöŠĕéšøĆïÙĞćĒîąîĞć ĒêŠëšć ðäĉïĆêĉ 4-5 ךà ĔîךćÜêšîóïüŠćĕöŠđÖĉéēøÙđïćĀüćîĔîߊüÜđüúćìĊęìĞćÖćøýċÖþć ĒêŠëšćðøĆïđðúĊę÷îóùêĉÖøøöĕéšÝĞćîüîîšĂ÷ךà ÙüćöđÿęĊ÷ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîÖĘÝąÿĎÜ×ċĚî37 îĂÖÝćÖîĚĊ÷ĆÜöĊÖćøýċÖþćìęĊóïüŠćÖćøøĆïðøąìćîךćü×ĆéÿĊÝąđóęĉöÙüćöđÿĊę÷ÜêŠĂ ÖćøđÖéĉ ēøÙđïćĀüćîßîĉéìęĊ 238 ÖćøýċÖþćêŠĂÝćÖ The Diabetes Prevention Program (DPP) đöęČĂÿĉĚîÿčéÖćøýċÖþćĔîĒêŠúąÖúčŠöÝąëĎÖ ĒîąîĞćĔĀšìĞć Intensive Lifestyle Modification (ILM) ĔîìčÖÖúčŠö ĒúąêĉéêćöÖćøđÖĉéēøÙđïćĀüćîĔîđüúćêŠĂöć óïüŠć ðÝŦ ÝĆ÷ĀîęċÜìęĊđÿ÷ęĊ ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîÙČĂ ĀúÜĆ ÝćÖìĊĕę éđš ×ćš øüŠ öÖćøýċÖþćñðšĎ śü÷ÿćöćøëìĞćĔĀšøąéĆïîĚĞćêćúÖúĆïöćðÖêĉĂ÷ŠćÜ การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-10 โรคเบาหวาน (Diabetes Mellitus) îšĂ÷ 1 ÙøĚĆÜĀøČĂĕöŠ ēé÷đöęČĂđðøĊ÷ïđìĊ÷ïÖúŠčöìęĊÿćöćøëìĞćĔĀšîĚĞćêćúðÖêĉĕéšĂ÷ŠćÜîšĂ÷ 1 ÙøĚĆÜÝąöĊÙüćöđÿĊę÷ÜêŠĂÖćøđÖĉé ēøÙđïćĀüćîîšĂ÷ÖüŠćðøąöćè øšĂ÷úą 56.0 ĒúąÖúčŠöìĊęđÙ÷ĕéš ILM đöęČĂđðøĊ÷ïđìĊ÷ïÖĆïÖúŠčöìĊęĕöŠđÙ÷ĕéšìĞć ILM àęċÜĂćÝÝąĕéš ĀøČĂĕöŠĕéšøĆï÷ć Metformin ÝąöĊÖćøđÖĉéēøÙđïćĀüćîĔîøą÷ąêŠĂöćìęĊýċÖþćöćÖÖüŠć39 đîęČĂÜÝćÖ 2 ÖúčŠöĀúĆÜĕöŠđÙ÷ìĞć ILM đöĂęČ ĕéšìĞćÝÜċ đÖéĉ ðøąē÷ßîŤÝćÖÖćøðøĆïđðúĊę÷îóùêĉÖøøö Ĕî×èąìęĊÖúŠčöìęĊđÙ÷ìĞć ILM ĕöŠöĊÖćøøĆÖþćđóęĉöđêĉö éĆÜîĚĆîÖćøìĞć ILM ÝąöðĊ øąē÷ßîߍ éĆ đÝîĔîÖćøðŜĂÜÖîĆ ēøÙđïćĀüćî 2.2 ÖćøðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćîéšü÷÷ć ÝćÖÖćøýċÖþć NAVIGATER35,36 óïüŠćÖćøĔßš÷ćÖúŠčöìĊęÖøąêščîÖćøĀúĆęÜĂĉîàĎúĉî đߊî Nateglinide ĕöŠ ÿćöćøëðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćîĕéš Ĕî×èąìęĊ÷ćĔîÖúŠčöìĊęúéÖćøéĚČĂĂĉîàĎúĉî đߊî Metformin Ēúą Thiazolidinediones (TZD) ÿćöćøëðĂŜ ÜÖĆîÖćøđÖĉéēøÙđïćĀüćîÝćÖ DPP ÖúŠčöìĕĊę éšøĆï÷ć Metformin ÿćöćøëúéÖćøđÖĉéēøÙđïćĀüćîĕéš øšĂ÷úą 31.0 ĒêŠđöęČĂýċÖþćĔî subgroup óïüŠćÖćøðŜĂÜÖĆîēøÙđïćĀüćîĔîÖúŠčöìĊęĂć÷čîšĂ÷ (25-44 ðŘ) ĒúąÖúčŠöìĊęĂšüî (BMI œ35 ÖÖ./êøö.) ñúÖćøðŜĂÜÖĆîēøÙĕöŠĒêÖêŠćÜÝćÖÖúŠčöìęĊìĞć ILM ÿŠüî÷ćÖúčŠö TZD öĊĀúĆÖåćîÝćÖÖćøĔßš÷ć Rosiglitazone Ĕî DREAM study32,33 Ēúą Pioglitazone ÝćÖ ACT NOW study34 ÿŠüî÷ćÖúŠčö D-glucosidase inhibitor öĊÖćøýċÖþćĔîÖćø ìéúĂÜ STOP-NIDDM30 óïüŠć÷ćÖúčŠö D-glucosidase inhibitor ðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćîĕéšøšĂ÷úą 25.0 ĒêŠđöČęĂ êĉéêćöñšĎìĊęđðŨîēøÙđïćĀüćîĔîÖúčŠöìęĊđÙ÷ĕéšøĆï÷ćÖúĆïđðŨîđïćĀüćîöćÖ×ĚċîĀúĆÜÝćÖÖćøĀ÷čé÷ć ÝċÜîŠćÝąđðŨîñúÖćøøĆÖþć×ĂÜ ÷ćöćÖÖüŠćÖćøðŜĂÜÖĆî ÿĞćĀøĆï÷ćÖúčŠöĂČęîìĊęĕöŠĔߊ÷ćøĆÖþćēøÙđïćĀüćî ĕéšĒÖŠ ÷ćÖúŠčö Angiotensin-Converting Enzyme inhibitor (ACEI) Ēúą Angiotensin Receptor Blockers (ARB) ÝćÖךĂöĎú×ĂÜ DREAM study32,33 ÷ć Ramipril ĕöŠ ÿćöćøëðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćî ĒêŠóïüŠćöĊñúĔîÖćøìęĊìĞćĔĀšÖúŠčöìęĊöĊîĚĞćêćúñĉéðÖêĉÖúĆïÿĎŠîĚĞćêćúðÖêĉöćÖÖüŠćĂ÷ŠćÜ ßĆéđÝî ÿŠüî÷ć ARB öĊךĂöĎúÝćÖ NAVIGATER35,36 đðøĊ÷ïđìĊ÷ï÷ć Valsartan öĊñúĔîÖćøðŜĂÜÖĆîēøÙđïćĀüćîĕéšéĊÖüŠćÖúčŠö ÙüïÙčö ĒîüìćÜÖćøðŜĂÜÖĆîēøÙđïćĀüćîĔîÖúčŠöđÿĊę÷Ü×ĂÜ American Diabetes Association (ADA) ìĊęđðŨî IFG Ēúą IGT ĔîðŘ 200740 ēé÷ÝąđøęĉöĔĀšÖćøðøĆïđðúęĊ÷îóùêĉÖøøö ĒêŠëšć÷ĆÜöĊîĞĚćêćúìęĊñĉéðÖêĉĀøČĂĕöŠÿćöćøëðäĉïĆêĉĕéš ĂćÝÝą óĉÝćøèćÖćøĔßš÷ć Metformin ĔîÖúčŠöìęĊöĊÙüćöđÿęĊ÷ÜÿĎÜĀøČĂîŠćÝąĕéšðøąē÷ßîŤÝćÖ÷ć đߊî Ăć÷čîšĂ÷ÖüŠć 60 ðŘ BMI œ35 ÖÖ./êøö. ðøąüĆêÙĉ øĂïÙøĆüđðŨîēøÙđïćĀüćî øąéĆïĕêøÖúĊđàĂĕøéŤÿĎÜ HDL Cholesterol êĞęć ÙüćöéĆîēúĀĉêÿĎÜ HbA1c >6% ÿĞćĀøĆï÷ć ĂČęî đߊî ÷ćÖúčŠö TZD ĔîÖćøðŜĂÜÖĆîēøÙđïćĀüćî ĂćÝÝąêšĂÜóĉÝćøèćëċÜ øćÙć÷ć ñúךćÜđÙĊ÷Ü×ĂÜ÷ć đöęČĂđðøĊ÷ïđìĊ÷ïÖĆï ךĂéĊÝćÖÖćøðŜĂÜÖĆîēøÙđïćĀüćî ÿŠüî÷ć ACEI ĀøČĂ ARB đðŨî÷ćÖúŠčöĒøÖė ĔîÖćøøĆÖþćēøÙÙüćöéĆîēúĀĉêÿĎÜìęĊđðŨî metabolic syndrome ĀøČĂñĎšðüś ÷ìĊęöÙĊ üćöđÿę÷Ċ ÜêĂŠ ēøÙĀúĂéđúĂČ éÿĎÜĂ÷ĒĎŠ úšü ÿĞćĀøĆïĒîüìćÜÖćøðŜĂÜÖĆîēøÙđïćĀüćîĔîÖúčŠöđÿęĊ÷Ü×ĂÜĕì÷ öĊÖćøðøąđöĉîÙüćöđÿĊę÷ÜĒÿéÜéĆÜêćøćÜìĊę 6.8 đöČęĂÙćĞ îüèÙüćöđÿę÷Ċ ÜêćöÙąĒîî ÝąÿćöćøëðøąđöĉîÙüćöđÿęĊ÷ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîĔîđüúć 12 ðŘ ĒúąĔĀšÙĞćĒîąîĞć ĔîÖćøðäĉïĆêĉêîĒúąðøąđöĉîÙüćöđÿĊę÷Ü (êćøćÜìĊę 6.10)41 đóČęĂđðŨîĒîüìćÜĔîÖćøéĎĒúøĆÖþćñšĎìęĊđðŨîēøÙđïćĀüćî àęċÜóïüŠć ÙĞćĒîąîĞćĔîÖćøĂĂÖÖćĞ úĆÜÖć÷Ă÷ŠćÜÿöćĞę đÿöĂĒúąÙüïÙöč îćĚĞ ĀîÖĆ êĆüöĊĂ÷ĎŠĔîñĎšìĊęđðŨîēøÙđïćĀüćîĕöŠüŠćöĊÙüćöđÿĊę÷ÜĔéÖĘêćö ĒêŠ ëšćñìĎš Ċöę ĊÙüćöđÿĊ÷ę ÜêĆĚÜĒêŠ 6 ÙąĒîî×Ěċîĕð ÙüøĔĀšÙüćöÿĞćÙĆâÖĆïÖćøÙüïÙčöĂćĀćøøŠüöéšü÷ ĒúąÙüøöĊÖćøêĉéêćöøąéĆïîĚĞćêćú ĔîđúĂČ éêćöÙüćöđÿęĊ÷ÜêŠĂÖćøđÖéĉ ēøÙđïćĀüćî Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-11 êćøćÜìęĊ 6.10 ÙćĞ ĒîąîćĞ ĔîÖćøðäïĉ êĆ êĉ îĒúąðøąđöîĉ Ùüćöđÿ÷Ċę ÜêćöĒîüìćÜđüßðäïĉ êĆ ×ĉ ĂÜĕì÷41 ñúøüö Ùüćöđÿ÷Ċę ÜêŠĂ øąéïĆ ēĂÖćÿđÖĉé ךĂĒîąîćĞ ÙąĒîî đïćĀüćîĔî 12 ðŘ Ùüćöđÿ÷Ċę Ü đïćĀüćî Œ2 <øšĂ÷úą 5 îĂš ÷ 1/20 - ĂĂÖÖćĞ úĆÜÖć÷ÿöćĞę đÿöĂ - ÙüïÙčöîĞćĚ ĀîÖĆ êüĆ ĔĀšĂ÷ĎŠĔîđÖèæŤìĊę đĀöćąÿö - êøüÝüĆéÙüćöéîĆ ēúĀêĉ - Ùüøðøąđöîĉ ÙüćöđÿĊ÷ę ÜàĚĞćìčÖ 3 ðŘ 3-5 øĂš ÷úą 5-10 đóęĉö×îċĚ 1/12 - ĂĂÖÖĞćúĆÜÖć÷ÿöćęĞ đÿöĂ 6 - ÙüïÙöč îĞćĚ ĀîÖĆ êĆüĔĀšĂ÷ŠĎĔîđÖèæìŤ Ċę đĀöćąÿö - êøüÝÙüćöéîĆ ēúĀĉê - ÙüøðøąđöĉîÙüćöđÿę÷Ċ ÜàĚĞćìčÖ 1-3 ðŘ 6-8 øšĂ÷úą 11-20 ÿĎÜ 1/7 - ÙüïÙöč ĂćĀćø ĒúąĂĂÖÖĞćúÜĆ Öć÷ ÿöęćĞ đÿöĂ - ÙüïÙöč îćĚĞ ĀîÖĆ êüĆ ĔĀšĂ÷ŠĎĔîđÖèæìŤ Ċę đĀöćąÿö - êøüÝÙüćöéĆîēúĀêĉ - êøüÝøąéïĆ îćĞĚ êćúĔîđúĂČ é - ÙüøðøąđöĉîÙüćöđÿĊę÷ÜàĚćĞ ìÖč 1-3 ðŘ >8 >øšĂ÷úą 20 ÿĎÜöćÖ 1/3-1/4 - ÙüïÙöč ĂćĀćø ĒúąĂĂÖÖćĞ úÜĆ Öć÷ ÿöęćĞ đÿöĂ - ÙüïÙöč îćĚĞ ĀîĆÖêĆüĔĀšĂ÷ĎŠĔîđÖèæŤìĊę đĀöćąÿö - êøüÝÙüćöéĆîēúĀĉê - êøüÝøąéĆïîĞĚćêćúĔîđúČĂé - ÙüøðøąđöĉîÙüćöđÿ÷ęĊ ÜàĞćĚ ìÖč 1 ðŘ 2.3 êîš ìîč ðøąÿìĉ íĉñúöćêøÖćøðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćî ÝćÖÖćøüĉđÙøćąĀŤêšîìčîðøąÿĉìíĉñúöćêøÖćøðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćî éšü÷üĉíĊÖćøðøĆïđðúĊę÷îüĉëĊßĊüĉê (lifestyle modification) ĒúąÖćøĔĀš÷ćĔîÖúŠčöđÿĊę÷ÜêŠĂÖćøđÖĉéēøÙđïćĀüćî Ăć÷č 35 ðŘ×ċĚîĕð Ĕîðøąđìýĕì÷ìęĊñŠćîÖćø ÙĆéÖøĂÜđïćĀüćî ÝĞćîüî 10,000 Ùî ēé÷ÿĞćîĆÖÜćîðŜĂÜÖĆîÙüïÙčöēøÙìĊę 6 ÝĆÜĀüĆé×ĂîĒÖŠî ĔîðŘ 255542 éšü÷Öćø đðø÷Ċ ïđì÷Ċ ïöćêøÖćøĔîÖćøðŜĂÜÖĆîÖćøđÖéĉ ēøÙđïćĀüćî 4 öćêøÖćø ÙČĂ 1) ÖćøðøĆïđðúęĊ÷îüĉëĊßĊüĉê éšü÷ÖćøĔĀšÙüćöøšĎĒúąÙüïÙčöÖćøøĆïðøąìćîĂćĀćø (úéĀüćî öĆî đÙĘö đóęöĉ ñÖĆ /ñúĕöš) 2) ÖćøðøïĆ đðúĊ÷ę îüëĉ ßĊ üĊ ĉê éšü÷ÖćøĔĀšÙüćöøšĎĒúąÖćøĂĂÖÖĞćúÜĆ Öć÷Ă÷ćŠ ÜîĂš ÷ 150 îćìêĊ ĂŠ ÿðĆ éćĀŤ 3) ÖćøðøĆïđðúĊę÷îüĉëĊßĊüĉê éšü÷ÖćøĔĀšÙüćöøĎšĒúąÖćøÙüïÙčöÖćøøĆïðøąìćîĂćĀćø (úéĀüćî öĆî đÙĘö đóęĉöñĆÖ/ñúĕö)š ĒúąÖćøĂĂÖÖĞćúĆÜÖć÷Ă÷ŠćÜîĂš ÷ 150 îćìĊêŠĂÿðĆ éćĀŤ 4) ÖćøøïĆ ðøąìćî÷ć Metfomin üĆîúą 2 ÙøĚÜĆ ÙøĚĆÜúą 850 öĉúúĉÖøĆö ñúÖćøýċÖþćóïüŠć ÖćøĔĀšöćêøÖćøéšü÷ÖćøðøĆïđðúĊę÷îüĉëĊßĊüĉê éšü÷ÖćøĔĀšÙüćöøĎšøŠüöÖĆïÖćøÙüïÙčö ĂćĀćøĒúąĂĂÖÖĞćúĆÜÖć÷ öĊÙüćöÙščöìčîÿĎÜìĊęÿčéêŠĂÖćøðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćî ēé÷ðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćîĔî ðøąßćÖøÖúŠčöđÿęĊ÷Üĕéš 8,560 øć÷ éšü÷êšîìčî 5,872.6 éĂúúćøŤÿĀøĆå ÖćøĔĀš÷ć Metformin 7,830 øć÷ éšü÷êšîìčî 8,456.06 éĂúúćøŤÿĀøåĆ (êćøćÜìęĊ 6.11) การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-12 โรคเบาหวาน (Diabetes Mellitus) êćøćÜìęĊ 6.11 đðøĊ÷ïđìĊ÷ïÖćøüĉđÙøćąĀŤêšîìčîðøąÿĉìíĉñú×ĂÜÖćøĔĀšöćêøÖćøðŜĂÜÖĆîÖćøđÖĉéēøÙđïćĀüćî éšü÷ÖćøðøĆïđðúęĊ÷î üĉëßĊ üĊ êĉ ēé÷üíĉ ÖĊ ćøêćŠ Üė ĒúąÖćøĔĀ÷š ć Metformin42 strategy cost marg cost eff marg eff c/e marg c/e diet+exercise 5,872.50 8,560.00 0.69 Metformin 8,456.10 2,583.60 7,830.00 -730 1.08 (dominated) diet 21,351.30 15,478.80 6,900.00 -1,660.00 3.09 (dominated) exercise 25,012.50 19,140.00 5,400.00 -3,160.00 4.63 (dominated) 3. ÖćøÙéĆ ÖøĂÜēøÙđïćĀüćî ÝćÖÖćøðøąđöĉîêšîìčîðøąÿĉìíĉñú ĒúąêšîìčîĂøøëðøąē÷ßîŤ×ĂÜÖćøÙĆéÖøĂÜđïćĀüćîßîĉéìĊę 2 ēé÷Ĕßš ĒïïÝĞćúĂÜìćÜđýøþåýćÿêøŤ (ĒïïÝĞćúĂÜ Decision tree Ēúą Markov) ĔîðøąßćÖøĕì÷Ăć÷č 15 ðŘ×ċĚîĕð ēé÷Ùèą Ēóì÷ýćÿêøŤýĉøøĉ ćßó÷ćïćúøŠüöÖĆïēÙøÜÖćøðøąđöĉîđìÙēîēú÷ĊĒúąîē÷ïć÷éšćîÿč×õćó (HITAP)43 àęċÜìćÜđúČĂÖìĊęîĞćöćýċÖþć ÙČĂ 1) ĔßšĒïïÿĂïëćöđóęČĂÙĆéÖúŠčöìĊęöĊÙüćöđÿĊę÷ÜÿĎÜ êćöéšü÷đÝćąđúČĂéðúć÷îĉĚü ĒúąđÝćąøąéĆïîĚĞćêćúĔîđúČĂéĀúĆÜÜéĂćĀćø (Capillary Blood Glucose: CBG) 2) ĔßšĒïïÿĂïëćöđóČęĂÙĆéÖúŠčöìĊęöĊÙüćöđÿĊę÷ÜÿĎÜ ĒúšüêøüÝøąéĆïîĞĚćêćúĔîđúČĂéĀúĆÜÜé ĂćĀćø (Fasting Plasma Glucose: FPG) 3) ÖćøÙĆéÖøĂÜēé÷ÖćøêøüÝéšü÷ CBG êćöéšü÷ÖćøêøüÝ FPG 4) ÖćøÙĆéÖøĂÜ ēé÷ÖćøêøüÝéšü÷ FPG đðø÷Ċ ïđìĊ÷ïÖïĆ ĕöŠöĊÖćøÙĆéÖøĂÜ ñúÖćøýċÖþćóïüŠć ÖćøĔßšĒïïÿĂïëćöđóęČĂÙĆéÖúčŠöìĊęöĊÙüćöđÿĊę÷ÜÿĎÜ ĒúąÖćøÙĆéÖøĂÜĔîðøąßćÖøêćöÖúŠčöĂć÷čéšü÷ CBG ĀøČĂ FPG öĊÙüćöÙščöìčî ēé÷ìęĊêšîìčîîšĂ÷ÖüŠćÖćøĕöŠÙĆéÖøĂÜ ĒúąÖćø ÙĆéÖøĂÜéšü÷ FPG ÖĆïðøąßćÖøÖúčŠöĂć÷č 30-35 ðŘ öĊêšîìčîêęĞćÿčé ĒúąđóĉęöðŘÿč×õćüąĕéšöćÖìęĊÿčéđöęČĂđìĊ÷ïÖĆïÖćøÙĆéÖøĂÜ ßîĉéĂęîČ ė ēé÷õćøąÜïðøąöćèÖćøÙéĆ ÖøĂÜđïćĀüćîéüš ÷ FPG êŠĂðŘ ĒÿéÜéĆÜõćóìĊę 6.3 àċęÜÖćøýċÖþćéĆÜÖúŠćüĕéšđÿîĂĒîąüŠć ñĎšìęöĊ ĊĂć÷č 30 ðŘ×îĚċ ĕð Ùüøĕéøš ĆïÖćøêøüÝÙĆéÖøĂÜđïćĀüćîéüš ÷ FPG ìÖč ė 5 ðŘ õćóìĊę 6.3 õćøąÜïðøąöćè (úšćîïćì) ÖćøêøüÝÙéĆ ÖøĂÜđïćĀüćîéšü÷ FPG êŠĂðŘ43 Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-13 4. ÖćøüĉîĉÝÞ÷Ć ēøÙ ÖćøüĉîĉÝÞĆ÷ēøÙđïćĀüćîêćöĒîüìćÜ×ĂÜÿĀóĆîíŤđïćĀüćîîćîćßćêĉ (International Diabetes Federation: IDF) àęċÜđðŨîĕðêćöđÖèæŤ×ĂÜĂÜÙŤÖćøĂîćöĆ÷ēúÖ ēé÷ñšĎìĊęÝąĕéšøĆïÖćøüĉîĉÝÞĆ÷üŠćđðŨîēøÙđïćĀüćîÝąêšĂÜöĊךĂĔéךĂĀîęċÜêŠĂĕðîĚĊ44 ĒúąóïÙüćößčÖ×ĂÜēøÙđïćĀüćîēé÷ĂćýĆ÷đÖèæŤéĆÜÖúŠćüĔîßćêĉêŠćÜė ìĊęĂćýĆ÷ĔîðøąđìýÿĀøĆåĂđöøÖĉ ć éÜĆ êćøćÜìĊę 6.1245 1) FPG œ126 mg/dl 2) random plasma glucose œ200 mg/dl øŠüöÖĆïöĂĊ ćÖćø×ĂÜõćüąîĚćĞ êćúÿÜĎ 3) 75 g OGTT ìĊę 2 ßęĆüēöÜ œ200 mg/dl 4) HbA1c œ6.5% êćøćÜìĊę 6.12 ÙüćößÖč ēøÙđïćĀüćîēé÷Ăćý÷Ć đÖèæŤ FPG, HbA1c Ēúą 75 g OGTT ĔîßćêĉêŠćÜė ìĊęĂćý÷Ć ĔîðøąđìýÿĀøĆåĂđöøÖĉ ć45 6 ×Ăš öúĎ Filipino Native Filipino Japanese Hawaiian (Hawaii) (Hawaii) øüö (San Diego) ÝćĞ îüî 993 382 210 171 170 Ăć÷č (ð)Ř 54.2 57.5 46.1 53.1 57.9 BMI (kg/m2) 26.9 25.3 31.6 25.8 25.7 IFG ĀøĂČ IGT (%) 45.5 39.6 45.2 48.5 55.9 HbA1c œ6.5% 8.9 12.6 5.2 8.8 4.2 ēøÙđïćĀüćî (OGTT) (%) 15.5 22.0 10.0 11.7 11.8 FPG œ126 mg/dl 6.5 6.5 8.6 4.1 6.5 2hr PPG œ126 mg/dl 9.0 15.5 1.4 7.6 5.3 ÿĞćĀøĆïðøąđìýĕì÷ÖćøüĉîĉÝÞĆ÷ēøÙđïćĀüćîÝąĒêÖêŠćÜÝćÖĒîüìćÜÖćøüĉîĉÝÞĆ÷×ĂÜ IDF ÙČĂ ÝąĕöŠĒîąîĞćĔĀšĔßš HbA1c ĔîÖćøüîĉ Ýĉ ÞĆ÷ēøÙđïćĀüćî đîęČĂÜÝćÖ÷ĆÜĕöŠöĊ standardization Ēúą quality control ×ĂÜêøüÝ HbA1c ìĊęđĀöćąÿö đóĊ÷ÜóĂ øŠüöÖĆïðŦâĀćÙüćößčÖ×ĂÜēøÙíćúĆÿàĊđöĊ÷Ĕîðøąđìýĕì÷ ĒêŠÖćøüĉîĉÝÞĆ÷éĆÜÖúŠćüĂćýĆ÷ךĂöĎúÖćøüĉîĉÝÞĆ÷ēé÷Ĕßš FPG ÖøèĊìęĊĔßšÖćøüĉîĉÝÞĆ÷ēé÷Ĕßš HbA1c ĀøČĂ 75 g OGTT ÙüćößčÖ×ĂÜēøÙđïćĀüćîÝąđóĉęööćÖ×Ěċîēé÷ךĂöĎú×ĂÜêŠćÜðøąđìý45 (êćøćÜìĊę 6.12) ÝąóïüŠćĔîÖćøýċÖþćéĆÜÖúŠćüÖćøüĉîĉÝÞĆ÷ēøÙđïćĀüćîēé÷ĂćýĆ÷ FPG 126 öÖ./éú. óïÙüćößčÖ×ĂÜ ēøÙđïćĀüćî øšĂ÷úą 6.5 ĒêŠđöČęĂĔßš HbA1c œ6.5% óïÙüćößčÖøšĂ÷úą 8.9 ĒêŠëšćìĞć 75 g OGTT ÝąóïÙüćößčÖ×ĂÜ ēøÙđïćĀüćîđðîŨ øĂš ÷úą 15.5 àÜċę öćÖÖüćŠ 2 đìŠć×ĂÜÖćøüîĉ Ýĉ ÞĆ÷ÝćÖÖćøĔßš FPG éĆÜîĚĆîÙüćößčÖ×ĂÜēøÙđïćĀüćîĔîðøąđìýĕì÷ìęĊêøüÝēé÷üĉíĊ FPG ìĊęóïøšĂ÷úą 6.9 àęċÜëšćĀćÖĔßšÖćøêøüÝēé÷üĉíĊ HbA1c Ēúą 75 g OGTT ÝąóïüŠćÙüćößčÖ×ĂÜēøÙđïćĀüćîĔîðøąđìýĕì÷ÿĎÜÖüŠćìĊęðøąđöĉîĕüšöćÖ ÝćÖÖćøýċÖþć ×ĂÜÿčõöĆ÷ ÿčîìøóĆîíŤ ìęĊēøÜó÷ćïćúÿÜ×úćîÙøĉîìøŤ ēé÷đðøĊ÷ïđìĊ÷ïÖćøüĉîĉÝÞĆ÷ēøÙđïćĀüćîĔîÙîĕì÷ēé÷ÖćøêøüÝ FPG Ēúą 75 g OGTT ĔîêĆüĂ÷ŠćÜ 1,002 øć÷ (êćøćÜìęĊ 6.13) óïüŠćÙüćößčÖ×ĂÜēøÙđïćĀüćîēé÷ÖćøêøüÝ FPG øšĂ÷úą 2.0 (19 øć÷ ÝćÖ 1,002 øć÷) ĒúąöĊøšĂ÷úą 3.0 (30 øć÷ ÝćÖ 1,002 øć÷) ìđęĊ ðŨî IFG (ēé÷ĔßšđÖèæŤ œ110 öÖ./éú.) ĒêŠđöČęĂĔßšüĉíĊ 75 g OGTT óïñĎšìęĊđðîŨ ēøÙđïćĀüćîđóöĉę đðŨîøšĂ÷úą 7.0 (77 øć÷ ÝćÖ 1,002 øć÷) ĒúąóïüŠćñĎšìĊęđðŨîēøÙđïćĀüćî 77 øć÷îĊĚ öĊöćÖÖüŠćÙøęċÜĀîęċÜ (46 øć÷ ÝćÖ 77 øć÷) ìĊęöĊøąéĆï FPG <110 öÖ./éú. îĂÖÝćÖîĊĚïčÙÙúìęĊëĎÖüĉîĉÝÞĆ÷üŠćđðŨî IFG ÝćÖÖćø êøüÝ FPG 30 øć÷ đöęČĂĕéšìĞć 75 g OGTT óïüŠćöĊ 13 øć÷ (øšĂ÷úą 43.0) đðŨîēøÙđïćĀüćî (àċęÜëšćĕöŠĕéšìĞć 75 g OGTT Ýą ĕéøš ïĆ Öćøüîĉ Ýĉ Þ÷Ć üŠćđðŨîđóĊ÷Ü IFG) ÿĞćĀøĆïñĎšðśü÷ IGT (ñĎšìęĊöĊøąéĆïîĞĚćêćúìĊę 2 ßęĆüēöÜ øąĀüŠćÜ 140-199 öÖ./éú.) óïüŠćöĊÝĞćîüîÿĎÜëċÜ 347 øć÷ ÝćÖ 1,002 øć÷ àÜċę ñĎðš üś ÷đĀúŠćîĊöĚ ĊÙüćöđÿ÷ęĊ ÜêŠĂÖćøđÖĉéēøÙđïćĀüćîĔîĂîćÙê ÝćÖךĂöúĎ éĆÜÖúŠćüÝąóïüćŠ ĔîðŦÝÝïč ĆîÖćøüîĉ Ýĉ Þ÷Ć ēøÙđïćĀüćî ĒúąñĎšìęđĊ ÿ÷ęĊ ÜêĂŠ ēøÙđïćĀüćîÝąêĞęćÖüŠćìęĊðøąđöĉîĕüš öćÖ đóøćąðâŦ ĀćÖćøĔßš 75 g OGTT öćĔßĔš îÖćøüĉîĉÝÞĆ÷đïćĀüćîĔîøąéĆï population based îĆîĚ ÝąêšĂÜúÜìîč öćÖ การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-14 โรคเบาหวาน (Diabetes Mellitus) êćøćÜìęĊ 6.13 ÙüćößÖč ×ĂÜēøÙđïćĀüćî ēé÷üíĉ Ċ FPG Ēúą IGT 2 hrPG <140 mg/dl 140-199 mg/dl œ200 mg/dl øüö FPG 28(3%) 875(100%) <100 mg/dl 556(64%) 291(33%) 31(29%) 108(100%) 18(95%) 19(100%) 100-125 mg/dl 22(20%) 55(51%) 77 1,002 œ126 mg/dl 0 1(5%) øüö (øć÷) 578 347 ìĊęöć: ÝćÖÖćøýÖċ þć×ĂÜÿčõö÷Ć ÿîč ìøóîĆ íŤ ìęēĊ øÜó÷ćïćúÿÜ×úćîÙøĉîìøŤ Āöć÷đĀêč: ñúÜćî÷ĆÜĕöĕŠ éêš óĊ ĉöóŤ 5. ÖćøÙĆéÖøĂÜõćüąĒìøÖàšĂî ÖćøÙĆéÖøĂÜõćüąĒìøÖàšĂîìęĊÿĞćÙĆâĔîñšĎìĊęđðŨîēøÙđïćĀüćî êúĂéÝîðøąÿĉìíĉñú ĒúąÙüćöÙščöÙŠć×ĂÜÖćøÙĆé ÖøĂÜĕéøš üïøüö×Ăš öúĎ interventions êŠćÜė ìĊęđÖ÷ęĊ üךĂÜĕüĔš îõćÙñîüÖìĊę 6.1 ךĂÿøčð ÙüćößčÖ×ĂÜēøÙđïćĀüćîđóęĉööćÖ×ĚċîĒúąÝąđðŨîðŦâĀćìćÜÿćíćøèÿč× ÖćøðøąđöĉîÙüćöđÿęĊ÷Ü×ĂÜēøÙđïćĀüćî đðŨîÿęĉÜÿĞćÙĆâ ÖćøðŜĂÜÖĆîēøÙđïćĀüćîĔîÖúčŠöđÿĊę÷Üēé÷ÖćøðøĆïđðúĊę÷îóùêĉÖøøöĂ÷ŠćÜđךöÜüé đðŨîÖćøðŜĂÜÖĆîìęĊĕéšñúéĊ (ëćš ñĎšðüś ÷ìćĞ ) ÖćøðŜĂÜÖĆîēøÙݹߊü÷úéõćøąÙŠćĔßšÝćŠ ÷ĔîÖćøøÖĆ þćēøÙĒúąÖćøøÖĆ þćõćüąĒìøÖàĂš î îĂÖÝćÖîĊĚÖćøðŜĂÜÖĆî õćüąĒìøÖàšĂîÝćÖēøÙđïćĀüćîìęéĊ ìĊ ęĊÿčéÙĂČ ÖćøðĂŜ ÜÖĆîĕöŠĔĀšđÖĉéēøÙđïćĀüćî ÙčèõćóÖćøïøĉÖćø (Quality of Care) Öćøđ×ćš ëċÜÖćøïøĉÖćøđïćĀüćî ÝćÖÖćøðøąöćèÖćøÖćøđךćëċÜÖćøïøĉÖćøđïćĀüćîđìĊ÷ïÖĆïĂĆêøćÙüćößčÖ46 ðŘ 2009-2013 óïüŠćöĊĒîüēîšö đóĉęö×ċĚîÝćÖ 55 ÙîêŠĂ 100,000 ðøąßćÖø ĔîðŘ 2009 đðŨî 95.72 ÙîêŠĂ 100,000 ðøąßćÖø ĔîĕêøöćÿìęĊ 3 ðŘ 2013 (õćóìĊę 6.4) 120.0 100.0 88.5 95.72 77.68 ĆĂêøćÙüćö čßÖ 80.0 71.38 60.0 55.0 40.0 20.0 0.0 2009 2010 2011 2012 2013 (Q3) õćóìĊę 6.4 ÖćøðøąöćèÖćøÖćøđ×ćš ëÜċ ÖćøïøĉÖćøđïćĀüćîđìĊ÷ïÖĆïĂĆêøćÙüćößčÖ46 Āöć÷đĀêč: ĂêĆ øćÙüćößÖč ×ĂÜÖćøÿĞćøüÝ NHES 2, ךĂöĎúÝćÖåćî IP, OP/PP Individual, OPEA ñúÜćîëÜċ 30 öĉëîč ć÷î 2556 Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-15 ךĂöĎúÝćÖÿĞćîĆÖîē÷ïć÷Ēúą÷čìíýćÿêøŤ ÖøąìøüÜÿćíćøèÿč×47 óïüŠćêĆĚÜĒêŠðŘ 2007-2012 ĂĆêøćÖćøđךćóĆÖ øĆÖþćêĆüĔîēøÜó÷ćïćú×ĂÜñšĎìĊęđðŨîēøÙđïćĀüćîöĊĒîüēîšöđóęĉööćÖ×ĚċîĂ÷ŠćÜêŠĂđîČęĂÜ ēé÷öĊĂĆêøćđóĉęö×ċĚîÝćÖ 763.43 đðŨî 1,050.05 êŠĂ 100,000 ðøąßćÖø ĔîðŘ 2012 ĒúąöĊñšĎđÿĊ÷ßĊüĉêÝćÖēøÙđïćĀüćîĔîðŘ 2013 ðøąöćè 7,749 øć÷ ĀøČĂ ðøąöćèüĆîúą 21 øć÷ Öćøđ×ćš ëċÜÖćøüĉîÝĉ Þ÷Ć ēøÙđïćĀüćî 6 ñúÝćÖÖćøÿĞćøüÝÙüćößčÖ×ĂÜēøÙđïćĀüćîĒúąõćüąïÖóøŠĂÜ×ĂÜîĚĞćêćúĔî NHES ÙøĚĆÜìĊę 45 óïüŠćÙüćö ÙøĂïÙúčöĔîÖćøïøĉÖćøöĊÖćøđðúęĊ÷îĒðúÜĔîìćÜéĊ×ċĚî îĆęîÙČĂÿĆéÿŠüî×ĂÜñšĎìĊęđðŨîđïćĀüćîìęĊĕöŠìøćïüŠćêîđĂÜđðŨîēøÙđïćĀüćî úéúÜÝćÖøĂš ÷úą 56.6 đðŨîøĂš ÷úą 31.2 đöęČĂđì÷Ċ ïÖĆïñúÖćøÿĞćøüÝĔîðŘ ÙøĆĚÜìĊę 36 ÝćÖÖćøÿĞćøüÝ NHES ÙøĆĚÜìĊę 36 ĔîÖúčŠöìęĊđðŨîēøÙđïćĀüćî óïüŠćøšĂ÷úą 66.0 Ĕîđóýßć÷ ĒúąøšĂ÷úą 49.0 Ĕî đóýĀâĉÜ ĕöŠđÙ÷ĕéšøĆïÖćøüĉîĉÝÞĆ÷üŠćđðŨîēøÙđïćĀüćîöćÖŠĂî ÿŠüîÿĞćøüÝ NHES ÙøĆĚÜìęĊ 45 ĔîÿŠüîñĎšìĊęđÙ÷ĕéšøĆïÖćøüĉîĉÝÞĆ÷ēé÷ Ēóì÷ŤüćŠ đðŨîēøÙđïćĀüćîĒêŠĕöŠĕéšøĆïÖćøøĆÖþćóïøšĂ÷úą 3.3 ×ĂÜñĎšđðŨîđïćĀüćîìĚĆÜĀöé ÿŠüîìĊęđĀúČĂðøąöćè 2 Ĕî 3 ×ĂÜñĎšìęĊ đðŨîđïćĀüćî ĕéšøĆïÖćøøĆÖþć ĒúąÿĆéÿŠüî×ĂÜðøąßćÖøìĊęöĊĂć÷č 35 ðŘ×ĚċîĕðøšĂ÷úą 44.4 đÙ÷ĕéšøĆïÖćøêøüÝđúČĂé ÙĆéÖøĂÜ đïćĀüćîĔîøĂï 12 đéĂČ îìĊęñŠćîöć ĒúąøĂš ÷úą 15.3 đÙ÷ĕéšøĆïÖćøêøüÝĔî 1-5 ðŘìęĊñŠćîöć ÖćøÙüïÙčöēøÙđïćĀüćîĔĀĂš ÷ŠĎĔîđÖèæìŤ ĊęđĀöćąÿö ÝćÖÖćøðøąđöĉîÖćøÙüïÙčöøąéĆïîĞĚćêćúĔîđúČĂé×ĂÜñĎšìĊęđðŨîēøÙđïćĀüćîĔĀšĂ÷ŠĎĔîđÖèæŤìĊęđĀöćąÿö ēé÷ĂćýĆ÷ đÖèæŤ HbA1c Ēúą FPG ĔîðøąđìýêŠćÜė øüöìĆĚÜðøąđìýĕì÷ óïøšĂ÷úą×ĂÜñšĎìĊęđðŨîēøÙđïćĀüćîìęĊÿćöćøëÙüïÙčöøąéĆï îćĚĞ êćúĔîđúĂČ éĂ÷ŠĔĎ îđÖèæìŤ Ċđę Āöćąÿö (êćøćÜìęĊ 6.14 Ēúą 6.15) êćøćÜìĊę 6.14 øšĂ÷úą×ĂÜñĎšìęĊđðŨîēøÙđïćĀüćîìĊęÙüïÙčöøąéïĆ îĞĚćêćúĔîđúĂČ éĂ÷ŠĔĎ îđÖèæìŤ đęĊ Āöćąÿö ðøąđìý đÖèæŤ HbA1c øĂš ÷úą đÖèæŤ FPG øĂš ÷úą ĕì÷ (MedResNet 2013)21 (NHES 4; 2008-2009)5 <7% 35.8 70-130 mg/dl 37.8 ĂĂÿđêøđú÷Ċ 48 - - <126 mg/dl 28.5 îĉüàĒĊ úîéŤ49 <7% 57 - - - ÿĀøåĆ ĂđöøÖĉ ć50 <7% 73 - - <7% 49 - êćøćÜìęĊ 6.15 ñúÖćøøĆÖþćēøÙđïćĀüćî ÖćøýÖċ þć úÖĆ þèąÖćøýÖċ þć ÙüïÙöč HbA1c<7% Mayurasakorn51 41.3 2007 29.7 Worawongprapa52 13 primary care units (287 patients) 2007 30.2 Kosachunhanun53 diabetic clinic (325 patients) T1DM 17.0 2003 T2DM 21.6 Likitmaskul54 11 tertiary diabetic centers (8913 patients) 2003 11 tertiary diabetic centers children and adolescents (58 T1DM 22 T2DM) การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-16 โรคเบาหวาน (Diabetes Mellitus) Öćøđ×ćš ëċÜïøĉÖćøÖćøêøüÝÙĆéÖøĂÜõćüąĒìøÖàĂš î ðŦÝÝčïĆîÖćøêøüÝÙĆéÖøĂÜõćüąĒìøÖàšĂîìĊęÿĞćÙĆâ÷ĆÜĕöŠÿćöćøëìĞćĕéšÙøĂïÙúčöñĎšìęĊđðŨîēøÙđïćĀüćîìčÖÙî ìĚĆÜîĊĚ ×šĂöĎúÿëĉêĉÝćÖðøąđìýêŠćÜė (êćøćÜìęĊ 6.16) øüöëċÜðøąđìýĕì÷ àċęÜĕéšÝćÖñúÖćøéĞćđîĉîÜćîÖćøðøąđöĉîñúÖćøéĎĒúñšĎìęĊđðŨî ēøÙđïćĀüćîßîĉéìĊę 2 ĒúąÙüćöéĆîēúĀĉêÿĎÜ×ĂÜēøÜó÷ćïćúĔîÿĆÜÖĆéÖøąìøüÜÿćíćøèÿč×ĒúąēøÜó÷ćïćúĔîÿĆÜÖĆéÖøčÜđìóöĀćîÙø ðøąÝĞćðŘ 255621 ÝĞćîüîìĆĚÜÿĚĉî 602 ĒĀŠÜìĆęüðøąđìý ēé÷đÙøČĂ׊ć÷üĉÝĆ÷ÖúčŠöÿëćïĆîĒóì÷ýćÿêøŤĒĀŠÜðøąđìýĕì÷ (Medical Research Network: MedResNet) øŠüöÖĆïÿĞćîĆÖÜćîĀúĆÖðøąÖĆîÿč×õćóĒĀŠÜßćêĉ (ÿðÿß.) óïñúéĆÜêćøćÜìĊę 6.17 ĒúąÝĞćĒîÖ êćöđ×êĒÿéÜéÜĆ õćóìęĊ 6.5 êćøćÜìęĊ 6.16 øĂš ÷úą×ĂÜÖćøĕéšøĆïÖćøÙĆéÖøĂÜõćüąĒìøÖàšĂîĔîêŠćÜðøąđìý ðøąđìý øšĂ÷úą×ĂÜÖćøĕéøš ïĆ ÖćøÙéĆ ÖøĂÜõćüąĒìøÖàĂš îĔîøĂïðŘ ĂĂÿđêøđú÷Ċ 55,56 ĒÙîćéć57 êć ĕê đìćš îĉüàĊĒúîéŤ49 ÿĀøåĆ ĂđöøÖĉ ć50 32.0 27.0 - ÿĀøćßĂćèćÝĆÖø58 48.0 - - 72.0 (2 ðŘ) 64.0 - 61.4 - 64.3 61.0 83.0 - êćøćÜìĊę 6.17 øĂš ÷úą×ĂÜÖćøĕéšøĆïÖćøêøüÝÙéĆ ÖøĂÜõćüąĒìøÖàšĂîìÿęĊ ćĞ ÙĆâ×ĂÜñšĎìĊđę ðŨîēøÙđïćĀüćîĔîðøąđìýĕì÷21 Öćøĕéøš ïĆ ÖćøêøüÝÙéĆ ÖøĂÜõćüąĒìøÖàĂš î ðŘ 2554 ðŘ 2555 ðŘ 2556 êøüÝĀćøąéïĆ Albumin ĀøĂČ Protein Ă÷ćŠ ÜîšĂ÷ðŘúą 1 ÙøĆÜĚ 65.0 53.0 56.0 êøüÝÝĂðøąÿćìêćðøąÝĞćðĂŘ ÷ŠćÜîĂš ÷ 1 ÙøĆĚÜêĂŠ ðŘ 50.3 55.1 55.8 êøüÝđìšćĂ÷ŠćÜúąđĂĊ÷éðøąÝĞćðŘ 55.7 59.9 62.4 êøüÝÿ×č õćóßĂŠ ÜðćÖðøąÝĞćðŘĂ÷ŠćÜîĂš ÷ 1 ÙøÜĆĚ êŠĂðŘ 28.5 34.9 38.1 õćóìĊę 6.5 Öćøđ×ćš ëÜċ ÖćøêøüÝÙéĆ ÖøĂÜõćüąĒìøÖàšĂîĔîñšĎìĊđę ðŨîēøÙđïćĀüćîÝĞćĒîÖêćöđ×êïøÖĉ ćøÿč×õćóðŘ 255621 Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-17 êĆüßĊĚüĆéìÿęĊ ąìĂš îÙèč õćóÖćøïøĉÖćø đÙøČĂ×ćŠ ÷üÝĉ Ć÷ìćÜÖćøĒóì÷ĒŤ ĀÜŠ ðøąđìýĕì÷øüŠ öÖïĆ ÿĞćîÖĆ ÜćîĀúĆÖðøąÖĆîÿč×õćóĒĀŠÜßćêĉ (ÿðÿß.) öĊÖćøđÖĘïךĂöĎú ìęĊđÖęĊ÷üךĂÜÖĆïÖćøïøĉÖćøĔîñĎšìĊęđðŨîēøÙđïćĀüćî ìĊęÿąìšĂîëċÜÙčèõćóÖćøïøĉÖćøđóČęĂĔßšĔîÖćøøć÷ÜćîñúÖćøðøąđöĉî 19 êüĆ ßüĊĚ Ćé ēé÷ö×Ċ Ăš öĎú÷Ăš îĀúĆÜêĆÜĚ ĒêŠðŘ 2554-255621 (êćøćÜìęĊ 6.18) êćøćÜìĊę 6.18 ךĂöúĎ êćöêüĆ ßĊüĚ éĆ ×ĂÜđÙøĂČ ×Šć÷üĉÝĆ÷ìćÜÖćøĒóì÷ĒŤ ĀŠÜðøąđìýĕì÷ Ēúą ÿðÿß.21 ìęĊ êĆüßĚĊüĆé 2554 2555 2556 (øĂš ÷úą) (øĂš ÷úą) (øšĂ÷úą) 28,649 27,515 1 ÝćĞ îüîñðšĎ śü÷đïćĀüćîìĕĊę éøš ïĆ ÖćøÿčŠöðøąđöîĉ (øć÷) 26,230 6 39.2 37.8 2 öĊøąéïĆ FPG ĀøĂČ PBS Ă÷ĎŠĔîđÖèæŤÙüïÙöč ĕéš 70-130 mg/dl 40.4 78.9 79.0 33.4 35.8 3 êøüÝĀć HbA1c ðøąÝĞćðŘ Ă÷ŠćÜîšĂ÷ 1 ÙøĆĚÜêŠĂðŘ 74.0 3.3 2.9 75.4 77.1 4 ÖćøöĊøąéĆï HbA1c <7% 34.6 43.6 44.2 51.8 47.8 5 Admit đîĂęČ ÜÝćÖõćüąĒìøÖàĂš îđÞ÷Ċ ïóúĆîÝćÖēøÙđïćĀüćî 4.1 53.0 56.0 6 êøüÝĀć lipid profile ðøąÝćĞ ðŘ Ă÷ćŠ ÜîĂš ÷ 1 ÙøĚĆÜêĂŠ ðŘ 72.9 59.7 66.7 14.9 14.5 7 ÖćøöĊøąéĆï LDL <100 mg/dl 42.8 55.1 55.8 8.4 7.4 8 ñĎšðśü÷ DM öĊ BP Œ130/80 mmHg Ēúą ñĎšðśü÷ DM+DN öĊ BPŒ 54.6 34.9 38.1 59.9 62.4 120/80 mmHg 2.1 1.8 0.3 0.4 9 êøüÝĀćøąéĆï albumin ĀøĂČ protein Ă÷ŠćÜîšĂ÷ðŘúą 1 ÙøĚÜĆ 65.0 1.1 0.9 0.4 0.5 10 ñĎšðśü÷ microalbuminuria ĕéøš Ćï÷ć ACE Inhibitor ĀøĂČ ARB 51.7 11 ĕéøš ïĆ Öćøüîĉ Ýĉ ÞĆ÷đðŨî diabetic nephropathy 8.0 12 êøüÝÝĂðøąÿćìêćðøąÝćĞ ðĂŘ ÷ŠćÜîĂš ÷ 1 ÙøĚÜĆ êŠĂðŘ 50.3 13 ĕéøš ĆïÖćøüîĉ Ýĉ ÞĆ÷đðŨî dabetic retinopathy 7.1 14 êøüÝÿč×õćóßĂŠ ÜðćÖðøąÝćĞ ðĂŘ ÷ŠćÜîšĂ÷ 1 ÙøĚĆÜêĂŠ ðŘ 28.5 15 êøüÝđìćš Ă÷ŠćÜúąđĂ÷Ċ éðøąÝĞćðŘ 55.7 16 êøüÝóïĒñúìđĊę ìćš 2.4 17 ĂêĆ øćÖćøêéĆ îĚĉüđìšć êĆéđìšć êĆé×ć 0.3 18 óïõćüąĒìøÖàĂš îĀĆüĔÝĒúąĀúĂéđúĂČ éĔîøĂï 12 đéĂČ î 1.3 19 óïõćüąĒìøÖàĂš î×ĂÜĀúĂéđúĂČ éÿöĂÜĔîøĂï 12 đéĂČ î 0.5 îĂÖÝćÖîĊĚ÷ĆÜóïüŠćñĎšìĊęđðŨîēøÙđïćĀüćîöĊĂĆêøćÖćøÖúĆïöćøĆÖþćàĚĞćéšü÷ēøÙđïćĀüćîĀøČĂõćüąĒìøÖàšĂî 5.41 êŠĂðøąßćÖøÿĉìíĉ UC Ăć÷č 15 ðŘ×ċĚîĕð 100,000 Ùî ĒúąĂĆêøćðśü÷êć÷ÝćÖēøÙđïćĀüćîĒúąõćüąĒìøÖàšĂî đìŠćÖĆï 1.09 êŠĂðøąßćÖøÿĉìíĉ UC Ăć÷č 15 ð×Ř Ěîċ ĕð 100,000 Ùî21 ÖćøóçĆ îćïÙč úćÖø ÿĞćĀøĆïךĂöĎúÖćøóĆçîćïčÙúćÖø×ĂÜēøÙđïćĀüćîöĊÖćøđÖĘïךĂöĎúøŠüöÖĆïõćüąÙüćöéĆîēúĀĉêÿĎÜĔîøĎðĒïïÖćø óçĆ îćïÙč úćÖøéćš îēøÙđøĚĂČ øĆÜ óïÖøąÝć÷ïčÙúćÖøéĆÜÖúćŠ üĂ÷ĎŠìüęĆ ðøąđìý (õćóìĊę 6.6)46 àęċÜðøąÖĂïéüš ÷ 1) nurse case manager (CM) ÝćĞ îüî 1,064 Ùî ÝćÖ 77 ÝĆÜĀüĆé 2) system management team (SM) ÝćĞ îüî 310 Ùî ÝćÖ 69 ÝĆÜĀüĆé การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-18 โรคเบาหวาน (Diabetes Mellitus) õćóìĊę 6.6 ÖćøÖøąÝć÷ïÙč úćÖøéšćîēøÙđøĂĚČ øÜĆ (nurse case manager Ēúą system management team) ìęüĆ ðøąđìýĕì÷46 øąïï×Ăš öúĎ ĒúąÖćøêĉéêćö ðŦÝÝčïĆîÖøąìøüÜÿćíćøèÿč×ĕéšöĊĒîüÙĉéĔîÖćøĂĂÖĒïïøąïïÿćøÿîđìýÜćîēøÙĕöŠêĉéêŠĂđøČĚĂøĆÜ ēé÷öĊĒîüÙĉéÝą đðúęĊ÷îøĎðĒïïÖćøìĞćÜćîĒïïđéĉö ìęĊĂćýĆ÷ÖćøðŜĂîךĂöĎúéšü÷öČĂēé÷öĊđÝšćĀîšćìęĊøĆïñĉéßĂïàęċÜÝąöĊÖćøðŜĂîךĂöĎúĕð÷ĆÜ ēðøĒÖøöÿĞćîĆÖîē÷ïć÷Ēúą÷čìíýćÿêøŤ øć÷Üćîÿćíćøèÿč×ÝĆÜĀüĆé øć÷ÜćîÿĞćîĆÖÜćîĀúĆÖðøąÖĆîÿč×õćóĒĀŠÜßćêĉ (ÿðÿß.) ìąđïĊ÷îÖúčŠöđðŜćĀöć÷ ìąđïĊ÷îÖúŠčöđÿĊę÷ÜĒúąìąđïĊ÷îÖúŠčöðśü÷ àċęÜđðúĊę÷îĒðúÜĕðđðŨîøąïïÜćîĔĀöŠēé÷Ĕßšøąïï Information Technology (IT) öćðøą÷čÖêŤĔßš ēé÷ðÖêĉÿëćîïøĉÖćøÝąïĆîìċÖךĂöĎúðøąÝĞćüĆîúÜēðøĒÖøöøąïïïøĉÖćøìęĊ ÿëćîïøĉÖćøĔßšĂ÷ŠĎ đߊî ēðøĒÖøö JHCIS/HOS-XP (PCU) ìęĊÿĞćîĆÖĂîćöĆ÷ ēðøĒÖøö HOS-XP Ēúą MIT-NET ìęĊøąéĆï ēøÜó÷ćïćúßčößî ēðøĒÖøö HOME-C ìęĊøąéĆïēøÜó÷ćïćúìĆęüĕð øüöĕðëċÜßčéךĂöĎú 21/43 ĒôŜöךĂöĎúēé÷Ĕßšøąïï Chronic Database Import and Export System (chronic DBIES system) ēé÷ÿŠÜĂĂÖךĂöĎúĂĂÖöćĔîøĎðĒïï text file ĒúąÿŠÜ Thailand Medical Services Profile 2011 - 2014

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6-20 โรคเบาหวาน (Diabetes Mellitus) ×Ăš đÿîĂđóęĂČ ÖćøýÖċ þć üĉÝ÷Ć ĒúąÝéĆ ÖćøÙüćöøšĎ ÝćÖÖćøúąđú÷ðŦâĀćēøÙĕöŠêéĉ êŠĂđøČĚĂøĆÜ (non-communicable disease: NCD) ìĞćĔĀšðŦâĀćéĆÜÖúŠćüđøęĉöúÖč úćö öćÖ×ċĚî ÝîðÝŦ Ýïč îĆ NCD ìĞćúć÷ßĊüĉêðøąßćÖøēúÖĕðĒúšüĕöŠêĞęćÖüćŠ 36 úćš îÙîêŠĂðŘ ēé÷ēøÙìęĊđðŨîðâŦ ĀćÙČĂ ēøÙĀúĂéđúČĂé ēøÙđïćĀüćî ēøÙöąđøÜĘ ĒúąēøÙðĂéđøĚĂČ øÜĆ ÝćÖðŦâĀćéÜĆ ÖúŠćüÝćĞ đðŨîêĂš ÜöĒĊ îüìćÜÖćøĒÖšĕ×Ă÷ŠćÜđøŠÜéüŠ îĒúąÙüøöčÜŠ đîšîĕð ìĊęÖćøðĂŜ ÜÖîĆ ēøÙ Ă÷ŠćÜĕøÖĘêćöÝćÖïìđøĊ÷îĀîęÜċ ìĊĕę éøš ĆïÝćÖÖćøĒÖšðâŦ ĀćēøÙđĂéÿŤ (HIV) ìęéĊ ĞćđîĉîÖćøöćêĚĆÜĒêðŠ Ř 2006 àċęÜ ÝćÖìĊęðøąßöč ÿĀðøąßćßćêĉ đĀîĘ üŠćÙüćöÿćĞ ÙĆâĔîÖćøĒÖšðâŦ Āć HIV ÙüøĂ÷ĎŠìÖęĊ ćøðŜĂÜÖĆîĒúąÖćøéĎĒúøÖĆ þć ĒêŠÖćøöŠčÜđîšîĕð ìęĊÖćøðŜĂÜÖĆîēøÙÝąìćĞ ĔĀñš Ďðš śü÷ĔîðŦÝÝčïîĆ ĒúąĂîćÙêëÖĎ đóÖĉ đÞ÷ éÜĆ îĆĚîĔîÖćøĒÖðš ŦâĀćēøÙĕöêŠ éĉ êŠĂđøČĚĂøĆÜ ÝąêšĂÜöÝĊ čéÿöéúč ×ĂÜÖćøðŜĂÜÖîĆ ÖćøđÖĉéēøÙĔîĂîćÙêÖĆïðøąÿìĉ íõĉ ćó×ĂÜÖćøéĎĒúñšĎðśü÷ NCD ĔĀšöĊÙčèõćó×ĂÜÖćøéĒĎ úÙüïÙÖĎŠ îĆ ĕð ĔîðøąđìýìĊęÖĞćúĆÜóĆçîć øąïïÖćøéĎĒúÿč×õćóÝąöŠčÜđîšîĕðìĊęēøÙêĉéêŠĂ ×èąìĊę NCD îĆĚîÖúĆïĕöŠöĊìĚĆÜēÙøÜÿøšćÜ ĀøĂČ øąïïĔîÖćøêéĉ êćö ìĞćĔĀš×Ăš öúĎ đÖęĊ÷üÖĆï morbidity Ēúą mortality öĊĕöŠđóĊ÷ÜóĂ àęċÜךĂöĎúéĆÜÖúŠćüđðŨîðŦÝÝĆ÷ÿĞćÙĆâìęĊĔßš ĔîÖćøüćÜĒñîÖćøéĎĒúÿč×õćóĒÖŠðøąßćÖøĔîðøąđìý àęċÜöćÖćđøĘê àćî Director-General ×ĂÜ WHO ĕéšÖúŠćüĔîÖćøðŗé ðøąßčö World Health Assembly đöČęĂóùþõćÙö ðŘ 2012 üŠć “đøćêšĂÜÖćøðŜĂÜÖĆîÖćøđÖĉé NCD ĔĀšĒÖŠðøąßćÖøìĆęüĕð Ēúą÷ĆÜêšĂÜóĆçîćÜćîĂĊÖĀúć÷Üćî×ċĚîöćߊü÷ĒêŠđøćÖĘêšĂÜÖćøéĎĒúñšĎðśü÷ĔîøĎðĒïïđÞóćąøć÷éšü÷đߊîÖĆî đøć÷ĆÜêšĂÜÖćøđĀĘî üĉîĉÝÞĆ÷øüéđøĘü øĆÖþćĒúąéĎĒúõćüąĒìøÖàšĂî ĒúąêšĂÜÖćøÖćøéĎĒúĔîøą÷ą÷ćü àċęÜĂćÝÝą÷ćüĕðÝîêúĂéßĊóÖĘĕéš ÖćøéĎĒú ñĎðš üś ÷đïĚĂČ Üêîš îĆĚîđðŨîÿĉęÜÿćĞ ÙĆâöćÖĔîÖćøéĒĎ úÿč×õćó ĒêêŠ Ăš ÜöÙĊ üćöÙščöÙćŠ ĒúąÙšöč ìîč ìĊÝę ąìĞćéüš ÷” ĔîÖćøýċÖþćüĉÝĆ÷îĚĆî ÝąêšĂÜîĞćöćĔßšĔîÖćøüĉîĉÝÞĆ÷ ĂčðÖøèŤĔîÖćøéĎĒúøĆÖþćÖĘêšĂÜöĊÙčèõćó ĒúąÿćöćøëîĞć øĎðĒïï (model) ĕðĔßšĔĀšđĀöćąÿöÖĆïïøĉïìĒúąøąïćéüĉì÷ćêćöĒêŠúąÿëćîÖćøèŤ ëċÜĒöšÝąĂ÷ĎŠĔîÿõćüąìćÜđýøþåÖĉÝìĊę òŚéđÙČĂÜ ÖćøÝĆéÿøøìøĆó÷ćÖø ÖćøúÜìčîđøęČĂÜÖćøðŜĂÜÖĆî ÖćøéĎĒúøĆÖþćÖĘ÷ĆÜêšĂÜìĞćêćöĀúĆÖ×ĂÜÿĉìíĉöîčþ÷ßî êšĂÜĂćýĆ÷ìĆĚÜ õćÙøĆåìĊęöĊĀúć÷ĀîŠü÷Üćîđךćöćߊü÷ĀîŠü÷ÜćîìęĊéĎĒúÿč×õćó×ĂÜðøąßćßîĔîđïČĚĂÜêšî ÖĘÝąéċÜÝčéđðúĊę÷î×ĂÜÖćøéĎĒúñšĎðśü÷ NCD 1. ÖćøóçĆ îćøąïï×Ăš öĎú ÖćøìĊęÝąóĆçîćøąïïÖćøøĆÖþćēøÙđïćĀüćîÝąêšĂÜìøćïðŦâĀćüŠćöĊðŦâĀćéšćîĔéïšćÜ àċęÜÝąÿćöćøëìøćïĕéšēé÷ ÖćøúÜìąđïĊ÷îñðĎš śü÷ēøÙđïćĀüćî (registry) ĒêëŠ šćÖćøúÜìąđïĊ÷îĕöŠĕéšîĞćöćĔßšĔîÖćøøĆÖþćĀøČĂĒÖšĕ×ÙÜĕöŠđÖĉéðøąē÷ßîŤĀøČĂ ÖćøóĆçîć ÝċÜêšĂÜîĞćךĂöĎúîĚĆîöćđóČęĂĔßšĔîÖćøøĆÖþćüŠćïčÙÙúîĚĆîĕéšøĆïÖćøêøüÝõćüąĒìøÖàšĂîĔéïšćÜĀøČĂ÷ĆÜ×ćéÖćøêøüÝ õćüąĒìøÖàšĂîĂąĕøïšćÜ ĀøČĂĕéšøĆïÖćøÿĂîĔĀšÙüćöøšĎđÖęĊ÷üÖĆïēøÙđïćĀüćîĂąĕøïšćÜĒúą÷ĆÜĕöŠĕéšÿĂîđøęČĂÜĔé (reminder) Ēúąìćš ÷ìęÿĊ čéĔĀîš ćРךĂöĎúîĆĚîöćóçĆ îćøąïïÖćøøĆÖþćēøÙđïćĀüćî (reevaluation) ëċÜĒöšüŠćÝąöĊÖćøóĆçîćÖćøøĆÖþćēøÙđïćĀüćî ĒêŠÝćÖÖćøýċÖþć Thailand diabetes registry59,53 ÷ĆÜóïüŠć ñúÖćøøĆÖþćēøÙđïćĀüćî÷ĆÜĕöŠÿćöćøëÙüïÙčöøąéĆïîĚĞćêćú ĒúąðŦÝÝĆ÷đÿĊę÷ÜĂęČîė đߊî ÙüćöéĆîēúĀĉêÿĎÜ ĕ×öĆîÿĎÜ ĒúąÖćø Ā÷čéÖćøÿĎïïčĀøĊę øüöëċÜÖćøđÖĉéõćüąĒìøÖàšĂîÝćÖēøÙđïćĀüćî óïüŠćöĊÖćøđÖĉéõćüąĒìøÖàšĂîĔîÙüćößčÖìęĊÿĎÜ ĒêŠÖćø úÜìąđïĊ÷îñšĎðśü÷ðŦâĀćĀîċęÜÙČĂøąïïĕöŠÿćöćøëĔßšøŠüöÖĆîĔîĒêŠúąēøÜó÷ćïćúđîęČĂÜÝćÖĒêŠúąēøÜó÷ćïćúĂćÝÝąöĊøąïï×ĂÜ êîđĂÜ éĆÜîĆĚîÖøąìøüÜÿćíćøèÿč×ÙüøÝĆéøąïïÙĂöóĉüđêĂøŤìęĊÿćöćøëúÜìąđïĊ÷îĒúąđßęČĂöē÷ÜĒêŠúąēøÜó÷ćïćúđóČęĂ ðøąē÷ßîŤĔîÖćøÿŠÜêŠĂñĎšðśü÷ĒúąđðŨîåćîךĂöĎúìĊęĕöŠàĚĞćàšĂî øąïïúÜìąđïĊ÷îÝąöĊךĂöĎúñĎšðśü÷ ךĂöĎúÖćøøĆÖþć øüöëċÜÖćø êøüÝõćüąĒìøÖàĂš î ĒúąÖćøĔĀšÙüćöøšĒĎ ÖŠñšðĎ üś ÷ ךĂöĎúìĊęêšĂÜÖćøđóęČĂÖćøóĆçîćøąïïÖćøéĎĒúøĆÖþćñĎšðśü÷ēøÙđïćĀüćîøüöëċÜÖćøđÿîĂĒîąđßĉÜîē÷ïć÷ ðøąÖĂïéüš ÷ 1) ×Ăš öúĎ éćš îõćøąēøÙ ÙüøöĊÖćøóçĆ îćåćîךĂöúĎ õćøąēøÙĔîñĎìš ęĊđðîŨ ēøÙđïćĀüćî ēé÷đÞóćąõćøąēøÙìęĊ đÖĉéÝćÖõćüąĒìøÖàšĂîêŠćÜė ×ĂÜđïćĀüćî đóęČĂĔĀšÿćöćøëîĞćĕðüćÜĒñîìĞćךĂđÿîĂĒîąĕéšÿĂéÙúšĂÜÖĆïúĆÖþèąðŦâĀć îĂÖÝćÖîĚĆîÙüøÿîĆïÿîčîĔĀšöĊÖćøýċÖþćךĂöĎúÙüćöÿĎâđÿĊ÷ìćÜđýøþåýćÿêøŤ×ĂÜñšĎìęĊđðŨîēøÙđïćĀüćîêćößîĉé×ĂÜ ēøÙđïćĀüćîĒúąõćüąĒìøÖàĂš î ÙøĂïÙúčöëÜċ ÙüćöóĉÖćøìęĊđÖĉéÝćÖēøÙđïćĀüćîéšü÷ đîęČĂÜÝćÖךĂöĎúìęĊöĊĂ÷ŠĎĕöŠÿćöćøëîĞćĕð ßĊĚßĆéĔîÖćøÖĞćĀîéîē÷ïć÷ìęđĊ Āöćąÿöĕéš 2) ךĂöĎú cost effectiveness of intervention ÙüøýċÖþćÙüćöÙčšöÙŠć×ĂÜ intervention êŠćÜė ìĊę÷ĆÜĕöŠ öĊךĂöĎú đߊî ÙüćöÙčšöÙŠć×ĂÜÖćøêøüÝ microalbuminuria ÖćøÙĆéÖøĂÜđïćĀüćî×ĚċîÝĂðøąÿćìêć ÖćøêøüÝÙĆéÖøĂÜ õćüąĒìøÖàšĂîìćÜđìšć đðŨîêšî đóęĂČ îĞćĕðÖĞćĀîéđðŨî intervention ìęđĊ Āöćąÿö Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-21 3) ךĂöĎúÙčèõćóÖćøïøĉÖćø ÙüøóĆçîćךĂöĎúđÖĊę÷üÖĆïÙčèõćóïøĉÖćøēé÷đÞóćąõćüąĒìøÖàšĂî×ĂÜ 6 đïćĀüćî øüöëċÜÙüćöÙøĂïÙúčö×ĂÜÖćøĔĀšïøĉÖćø ÖćøÙĆéÖøĂÜ ÖćøđךćëċÜïøĉÖćøÖćøøĆÖþćõćüąĒìøÖàšĂî ĒúąÙüćö đßČęĂöē÷ÜךĂöĎúìęĊđÖęĊ÷üךĂÜÖĆïìøĆó÷ćÖøĒúąÙŠćĔߚ݊ć÷ìĊęđÖĊę÷üךĂÜ ìĆĚÜïčÙúćÖøìćÜÖćøĒóì÷Ť đÙøęČĂÜöČĂ/đìÙēîēú÷ĊĔîÖćøêøüÝ ÙĆéÖøĂÜ/øĆÖþć 2. ÖćøóĆçîćøąïïïøĉÖćø ÙüøöÖĊ ćøóçĆ îćøąïïïøÖĉ ćøēøÙđïćĀüćîéÜĆ ĒÿéÜĔîõćÙñîüÖìęĊ 6.3 3. ÖćøóĆçîćÿëćîó÷ćïćúñéĎš ĒĎ úñĎìš ęđĊ ðŨîēøÙđïćĀüćî ÖćøóĆçîćÿëćîó÷ćïćúđóęČĂÖćøéĎĒúñšĎìĊęđðŨîēøÙđïćĀüćî ĂćÝöĊĀúć÷ðøąđéĘî đߊî ĀîŠü÷ĔĀšÙüćöøšĎéšćîĂćĀćø ÖćøĂĂÖÖĞćúĆÜÖć÷ ìĊöéĎĒúđìšć êĆéøĂÜđìšć ÖćøêøüÝêć ÖćøÝĆéÙúĉîĉÖēøÙĕê ÙúĉîĉÖĂéïčĀøĊę øüöëċÜÙúĉîĉÖĂČęîė àęċÜēøÜó÷ćïćú ĒêŠúąēøÜó÷ćïćúĕöŠÝĞćđðŨîêšĂÜóĆçîćĔĀšĕéšìčÖđøęČĂÜĔîìĆîìĊ ĒêŠ×ċĚîÖĆïÿëćîó÷ćïćúîĆĚîöĊÙüćöóøšĂöéšćîĔéĒúąñšĎïøĉĀćøđĀĘî ÙüćöÿĞćÙĆâ×ĂÜÿŠüîĔé ēøÜó÷ćïćúÝĆÜĀüĆéđúĘÖė ĂćÝÝąÿîĔÝđøęČĂÜÖćøéĎĒúđìšć ÝċÜÿîĆïÿîčîÖćøêøüÝĒúąðŜĂÜÖĆîĒñúìęĊđìšć óøšĂöÿŠÜïčÙúćÖøĕðýċÖþćĒúąÿćöćøëìĞćøĂÜđìšćđïćĀüćîĕéš ēøÜó÷ćïćúĔÖúšđÙĊ÷ÜÖĘÿćöćøëÿŠÜñĎšðśü÷ìĊęöĊðŦâĀćéšćîđìšćöć øĆÖþćêŠĂĒúąđðŨîĒïïĂ÷ŠćÜ×ĂÜēøÜó÷ćïćúĂČęî ĒêŠ×ïüîÖćøóĆçîćÝąêšĂÜöĊĂ÷ŠćÜêŠĂđîČęĂÜđóęČĂÙøĂïÙúčöëċÜÖćøéĎĒúøĆÖþć ēøÙđïćĀüćîéćš îêŠćÜė Ă÷ćŠ ÜÙøïëüš î 4. ÖćøýÖċ þćüÝĉ Ć÷ìęĊîŠćÿîĔÝ 1) ÖćøýċÖþćüĉÝĆ÷ óĆçîćéšćîÖćøĒóì÷ŤĒñîĕì÷ Ēóì÷ŤìćÜđúČĂÖìĊęöĊÙüćöđĀöćąÿöĒúąĕéšøĆïÖćøøĆïøĂÜ ÝćÖĀîŠü÷ÜćîøĆå đߊî ÖøöÖćøóĆçîćĒóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖ øüöëċÜÖćøÿîĆïÿîčîĔĀšöĊÖćøðøą÷čÖêŤĔßšîüĆêÖøøö ĀøČĂĀĆêëÖćøìĊęÿćöćøëøĆÖþć ïøøđìć ôŚŪîôĎ ĂćÖćø×ĂÜñĎšìęĊđðŨîēøÙđïćĀüćî ēé÷ÿîĆïÿîčîìčîüĉÝĆ÷ ÖćøĔĀšÙĞćĒîąîĞć ×Ăš đÿîĂĒîąìćÜüĉßćÖćø ĒúąñúÖĆ éîĆ ĔĀđš Öéĉ ÖćøîĞćĕðĔßšÜćîêćöïøïĉ ììđęĊ Āöćąÿö 2) ÖćøýċÖþćüĉÝĆ÷đÖĊę÷üÖĆïÖćøøĆÖþćôŪŚîôĎñšĎìĊęđðŨîēøÙđïćĀüćîēé÷ÖćøöĊÿŠüîøŠüö×ĂÜßčößî đîČęĂÜÝćÖ ēøÙđïćĀüćîđðŨîēøÙìęĊđÖęĊ÷üÖĆïüĉëĊßĊüĉêðøąÝĞćüĆî ĒúąñĎšìĊęđðŨî÷ĆÜêšĂÜĔßšßĊüĉêĂ÷ĎŠÖĆïÙøĂïÙøĆü ÿĆÜÙö öĊÖćøðøąÖĂïĂćßĊóđðŨî ÖĉÝüĆêø ÖćøĔĀïš čÙÙú ÖúöčŠ ïčÙÙú ĂÜÙŤÖøĔîßčößîĀøĂČ ìĂš Üëîĉę đ×ćš öćöĊÿŠüîøŠüöĔîÖćøüćÜĒñîðäĉïĆêĉÜćîđóęČĂĒÖšĕ×ðŦâĀćĔîñĎšìĊę đðŨîēøÙđïćĀüćîĒúąÿîĆïÿîčîéšćîêćŠ Üė êćöÙüćöđĀöćąÿö 3) ÖćøýċÖþćüĉÝĆ÷đÖęĊ÷üÖĆïÖćøðøĆïóùêĉÖøøöĔîñšĎìĊęđðŨîēøÙđïćĀüćîđóČęĂúéõćüąđÿęĊ÷ÜĔîÖćøđÖĉéēøÙĒìøÖ àšĂî ÙüïÙŠĎÖĆïÖćøøĆÖþćìćÜÙúĉîĉÖēé÷ïčÙúćÖøìćÜÖćøĒóì÷Ť đߊî ÖćøĂĂÖÖĞćúĆÜÖć÷ ÖćøïøĉēõÙĂćĀćø ÖćøÝĆéÖćøÙüćöđÙøĊ÷é ÖćøêøąĀîĆÖđòŜćøąüÜĆ ĂćÖćøĒìøÖàĂš îêćŠ Üė ìĊęĂćÝđÖéĉ ÖïĆ êć ĕê đìćš đĂÖÿćøðøąÖĂïđóĉęöđêĉö 1. ĒîüìćÜÖćøøÖĆ þćēøÙđïćĀüćî60 2. Öćøðøąđöîĉ êîđĂÜëċÜÙúĉîÖĉ ēøÙđïćĀüćîÙčèõćó61 การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-22 โรคเบาหวาน (Diabetes Mellitus) đĂÖÿćøĂšćÜĂĉÜ (References) 1. American Diabetes Association. Standards of medical care in diabetes 2013. Diabetes Care 2013;36(Suppl 1):S11-66. 2. WHO. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia report of a WHO/IDF consultation. Geneva: World Health Organization; 2006. 3. ÿëćïĆîüÝĉ ÷Ć Ēúąðøąđöîĉ đìÙēîēú÷ĊìćÜÖćøĒóì÷Ť ÖøöÖćøĒóì÷Ť ÖøąìøüÜÿćíćøèÿ×č . đĂÖÿćø: ÿëćîÖćøèŤ ēøÙđïćĀüćî/ÙüćöéĆîēúĀêĉ ÿÜĎ ĒúąõćüąĒìøÖàšĂîĔîðøąđìýĕì÷ [Ăîĉ đìĂøđŤ îĘê]. 2556 [đ×ćš ëÜċ đöęČĂ 24 Ö.Ù. 2557]. đ×ćš ëÜċ ĕéšÝćÖ: http://www.dms.moph.go.th/imrta/images/data/doc_dm_ht.pdf. 4. IDF Diabetes Atlas. Fifth edition. 2011. 5. üßĉ Ć÷ đĂÖóúćÖø, đ÷ćüøŤ ĆêîŤ ðøðŦÖþ׍ ćö, ÿčøýÖĆ éĝĉ åćîóĊ ćîĉßÿÖúč , ĀìĆ÷ßîÖ óøøÙđÝøĉâ, üøćõøèđŤ ÿëĊ÷øîóđÖšć, Öîĉþåć ĕì÷Öúćš . øć÷ÜćîÖćøÿćĞ øüÝÿ×č õćóðøąßćßîĕì÷ēé÷ÖćøêøüÝøŠćÜÖć÷ ÙøĆÜĚ ìęĊ 4 ó.ý. 2551-2552. îîìïøč Ċ: đéĂą Öøćôēŗ Ö àÿĉ đêĘöÿ;Ť 2553. Āîćš 135-141. 6. đ÷ćüøŤ êĆ îŤ ðøðŦÖþ׍ ćö, óøóîĆ íčŤ ïčâ÷øĆêóîĆ íŤč. ÖćøÿĞćøüÝõćüąÿč×õćóĂîćö÷Ć ×ĂÜðøąßćßîĕì÷ēé÷ÖćøêøüÝøćŠ ÜÖć÷ ÙøĆÜĚ ìęĊ 3 ó.ý. 2546-2547. ÖøčÜđìóĄ: ÿćĞ îÖĆ ÜćîÖÝĉ ÖćøēøÜóĉöóĂŤ ÜÙŤÖćøÿÜđÙøćąĀìŤ ĀćøñŠćîýÖċ ĔîóøąïøöøćßðĎ ëĆöõŤ; 2549. 7. Jiamjarasrangsi W, Aekplakorn W. Incidence and predictors of type 2 diabetes among professional and office workers in Bangkok, Thailand. J Med Assoc Thai 2005;88:1896-904. 8. Jiamjarasrangsi W, Lohsoonthorn V, Lertmaharit S, Sangwatanaroj S. Incidence and predictors of abnormal fasting plasma glucose among the university hospital employees in Thailand. Diabetes Res Clin Pract 2008;79:343-9. 9. 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;29:1872-7. 10. Deerochanawong C, Putiyanun C, Wongsuryrat M, Serirat S, Jinayon P.Comparison of National Diabetes Data Group and World Health Organization criteria for detecting gestational diabetes mellitus. Diabetologia 1996;39:1070-3. 11. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel- recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 2012;3:526-8. 12. Serirat S, Deerochanawong C, Sunthornthepvarakul T, Jinayon P. Gestational diabetes mellitus. J Med Assoc Thai 1992;75:315-9. 13. Sunsaneevithayakul P, Ruangvutilert P, Sutanthavibul A, Kanokpongsakdi S, Boriboohirunsarn D, Raengpetch Y, et al. Effect of 3-day intensive dietary therapy during admission in women after diagnosis of gestational diabetes mellitus. J Med Assoc Thai 2004;87:1022-8. 14. Chanprapaph P, Sutjarit C. Prevalence of gestational diabetes mellitus (GDM) in women screened by glucose challenge test (GCT) at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai 2004; 87:1141- 6. 15. Lueprasitsakul K, Teeyapun K, Kittivarakul E, Srisupundit K, Patumanond J. Gestational diabetes in Lumphun Hospital: Prevalence clinical risk factors and pregnancy outcomes. Chiang Mai Med J 2008;47:65-73 16. Rao C, Porapakkham Y, Pattaraarchachai J, Polprasert W, Swampunyalert N, Lopez AD. Verifying causes of death in Thailand: rationale and methods for empirical investigation. Popul Health Metr 2010;8:148-54. Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-23 17. Chetthakul T, Deerochanawong C, Suwanwalaikorn S, Kosachunhanun N, Ngarmukos C, Rawdaree P, et al. 6 Thailand diabetes registry project: prevalence of diabetic retinopathy and associated factors in type 2 diabetes mellitus. J Med Assoc Thai 2006;89(1 Suppl):S27-36. 18. Vascular complications in non-insulin dependent diabetics in Thailand. Thai Multicenter Research Group on Diabetes Mellitus. Diabetes Res Clin Pract 1994;25:61-9. 19. Nitiyanant W, Tandhanand S, Mahtab H, Zhu XX, Pan CY, Raheja BS, et al. The Diabcare-Asia 1998 study-outcomes on control and complications in type 1 and type 2 diabetic patients. Curr Med Res Opin 2002;18:317-27. 20. ÿöđÖ÷Ċ øêĉ ēóíĉÿĆê÷Ť, Ăčéö ĕÖøùìíĉß÷Ć , ßćâđüß ýøìĆ íćóìč í, ĂöĆ óø ÝÜđÿøÝĊ ĉêê.Ť øć÷ÜćîüĉÝ÷Ć ÞïïĆ ÿöïøĎ èŤ ßéč ēÙøÜÖćøüÝĉ Ć÷õćüąĒìøÖàšĂîìćÜÙúĉîÖĉ ĔîñðĎš śü÷đïćĀüćîßîĉéìęĊ 2 (Clinical complication in Type 2 diabetes patients). ÿëćïîĆ üÝĉ ÷Ć Ēúąðøąđöîĉ đìÙēîēú÷ĊìćÜÖćøĒóì÷Ť ÖøöÖćøĒóì÷Ť; 2554. Āîćš 1-296. 21. ÿĞćîÖĆ ÜćîĀúĆÖðøąÖîĆ ÿ×č õćóĒĀŠÜßćê,ĉ đÙøČĂ×ćŠ ÷üĉÝĆ÷ÖúčŠöÿëćïîĆ Ēóì÷ýćÿêøĒŤ ĀŠÜðøąđìýĕì÷. øć÷ÜćîñúÖćø éćĞ đîîĉ ÜćîÖćøðøąđöĉîñúÖćøéĎĒúñĎšðśü÷ēøÙđïćĀüćîßîĉéìĊę 2 ĒúąÙüćöéĆîēúĀĉêÿĎÜ ×ĂÜ ēøÜó÷ćïćúĔîÿĆÜÖĆé ÖøąìøüÜÿćíćøèÿ×č ĒúąēøÜó÷ćïćúĔîÿĆÜÖĆéÖøÜč đìóöĀćîÙøðøąÝĞćðŘ 2556 [Ăîĉ đìĂøŤđîĘê]. 2556 [đ×ćš ëÜċ đöęĂČ 24 Ö.Ù. 2557]. đ×ćš ëċÜĕéšÝćÖ: http://www.slideshare.net/channa7/2-2556-31017940. 22. Riewpaiboon A, Pornlertwadee P, Pongsawat K. Diabetes cost model of a hospital in Thailand. Value Health 2007;10:223-30. 23. Chatterjee S, Riewpaiboon A, Piyauthakit P, Riewpaiboon W, Boupaijit K, Panpuwong N, et al. Cost of diabetes and its complications in Thailand: a complete picture of economic burden. Health Soc Care Community 2011;19:289-98. 24. ĕóïĎú÷Ť óĉì÷ćđíĊ÷øĂîîĆ êŤ, øÖĆ öèĊ ïêč øßî, ÝĂö×üĆâ ē÷íćÿöčìø, üĉßĆ÷ đĂÖóúćÖø, ÷ý êĊøąüĆçîćîîìŤ, đîêĉ ÿ×č ÿöïĎøèŤ, ĒúąÙèą. ñúÖøąìïêŠĂÙćŠ Ĕߚ݊ć÷éšćîÿ×č õćóÝćÖõćüąîćĞĚ ĀîĆÖđÖĉîĒúąēøÙĂüš îĔîðøąđìýĕì÷.üćøÿćøüÝĉ Ć÷ øąïïÿćíćøèÿ×č 2554;(3). 25. Tirosh A, Shai I, Tekes-Manova D, Israeli E, Pereg D, Shochat T, et al. Normal fasting plasma glucose levels and type 2 diabetes in young men. N Engl J Med 2005;353:1454-62. 26. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343-50. 27. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393- 403. 28. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care1997;20:537-44. 29. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, et al. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. Diabetes 2002;51:2796-803. 30. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 2002;359:2072-7. 31. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004;27:155-61. การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-24 โรคเบาหวาน (Diabetes Mellitus) 32. The DREAM Trial investigators. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose : a randomized control trial. Lancet 2006;368:1096-105. 33. The DREAM Trial investigators.Effect of ramipril on the incidence of diabetes. N Engl J Med 2006;355:1551-62. 34. DeFronzo RA, Tripathy D, Schwenke DC, Banerji M, Bray GA, Buchanan TA, et al. Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med 2011;364:1104-15. 35. Holman RR, Haffner SM, McMurray JJ, Bethel MA, Holzhauer B, Hua TA, et al. Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med 2010;362:1463-76. 36. McMurray JJ, Holman RR, Haffner SM, Bethel MA, Holzhauer B, Hua TA, et al. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 2010;362(16):1477-90. 37. Lindström 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;26:3230-6. 38. Hu EA, Pan A, Malik V, Sun Q. White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 2012;344:e1454. 39. Perreault L, Pan Q, Mather KJ, Watson KE, Hamman RF, Kahn SE. Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study. Lancet 2012; 379:2243-51. 40. Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, et al. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007;30:753-9. 41. ÿöćÙöēøÙđïćĀüćîĒĀÜŠ ðøąđìýĕì÷, ÿöćÙöēøÙêŠĂöĕøìš ŠĂĒĀŠÜðøąđìýĕì÷, ÿĞćîĆÖÜćîĀúĆÖðøąÖîĆ ÿč×õćóĒĀŠÜßćêĉ. ÖćøðøąđöĉîÙüćöđÿę÷Ċ ÜÖćøđÖĉéēøÙđïćĀüćî Ĕî: ĒîüìćÜđüßðäïĉ Ćêÿĉ ćĞ ĀøïĆ ēøÙđïćĀüćî ó.ý. 2551. óöĉ óŤÙøĆÜĚ ìęĊ 2. ÖøčÜđìóĄ: øčŠÜýĉúðşÖćøóöĉ óŤ 2551; Āîćš 1-4. 42. Ēóøóøøè õøĎ ïĉ Ćâßć, ïâč ìîćÖø óøöõÖĆ éĊ Ēúą óĉÿö÷Ć ÿčøąÖćâÝîŤ. Öćøüđĉ ÙøćąĀêŤ îš ìčîðøąÿĉìíĉñúöćêøÖćøðĂŜ ÜÖĆî ÖćøđÖĉéēøÙđïćĀüćî éüš ÷üíĉ ĊÖćøðøĆïđðú÷ęĊ îüĉëĊßĊüĉêĒúąÖćøĔĀ÷š ćĔîÖúŠčöđÿĊ÷ę ÜêŠĂÖćøđÖĉéēøÙđïćĀüćî. üćøÿćø ÿĞćîĆÖÜćîðĂŜ ÜÖîĆ ÙüïÙöč ēøÙìĊę 6 ÝĆÜĀüéĆ ×ĂîĒÖŠî 2555;19(2):1-16. 43. üøćúĆÖþèŤ ýøîĊ îìðŤ øąđÿøåĉ , ðùþåóø ÖÜĉę ĒÖüš . Öćøðøąđöîĉ êîš ìîč ðøąÿìĉ íĉñú ĒúąêšîìčîĂøøëðøąē÷ßîŤ×ĂÜÖćøÙĆé ÖøĂÜđïćĀüćîßîéĉ ìĊę 2 ĔîðøąßćÖøĕì÷ [ĂĉîđìĂøđŤ îêĘ ]. 2556 [đ×ćš ëċÜđöęĂČ 12 ÿ.Ù. 2557]. đ×ćš ëÜċ ĕéÝš ćÖ: http://www.hiso.or.th/hiso5/report/report2.php. 44. International Diabetes Federation. Global Guideline for Type 2 Diabetes. 2012 [cited 2014 Aug 11]. Available from: http://www.idf.org/sites/default/files/IDF %20T2DM%20Guideline.pdf. 45. Araneta MRG, Grandinetti A, Chang HK. A1C and diabetes diagnosis among Filipino Americans, Japanese Americans, and Native Hawaiians. Diabetes Care 2010;33(12):2626-8. 46. ðøąìĊð íîÖÝĉ đÝøâĉ ; ÿĞćîĆÖÜćîĀúĆÖðøąÖîĆ ÿč×õćóĒĀÜŠ ßćê.ĉ Öćøðøąđöĉîñú DM/HT ðøąÝĞćðŘ 2557 ĒúąÜćîìšćìć÷ ×ćš ÜĀîšć [ĂĉîđìĂøđŤ îêĘ ]. 2557 [đ×ćš ëÜċ đöĂęČ 24 Ö.Ù. 2557]. đ×ćš ëÜċ ĕéÝš ćÖ: http://dmht.thaimedresnet.org/files_2557/slide_dmht_ph4_01.pdf. 47. ÿćĞ îÖĆ îē÷ïć÷Ēúą÷ìč íýćÿêøŤ ÿĞćîĆÖÜćîðúĆéÖøąìøüÜÿćíćøèčÿ×. ×Ăš öúĎ ÿëêĉ ĉ [ĂĉîđìĂøŤđîĘê]. [đךćëÜċ đöĂČę 18 Ö.Ù. 2557]. đ×ćš ëÜċ ĕéšÝćÖ: http://bps.ops.moph.go.th/index.php?mod=bps&doc=5. 48. Primary Health Care Research and Information Service. General Practice Divisions online Information System; 2009 [cited 2012 Nov 10]. Available from: http://www.phcris.org.au/dios/displayReport0607.php. 49. New Zealand Ministry of Health. Health Targets: Moving towards healthier futures 2007/08. Wellington: New Zealand Ministry of Health; 2007. Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-25 50. US Department of Health and Human Services, Agency for Healthcare Research and Quality. National 6 Healthcare Quality Report 2007. Rockville: US Department of Health and Human Services. Washington: National Committee for Quality Assurance; 20. 51. Mayurasakorn K, Somthip N, Caengow S, Chulkarat N, Wanichsuwan M. Glycemic control and microvascular complications among type 2 diabetes at primary care units. J Med Assoc Thai 2009;92:1094-101. 52. Worawongprapa O. Glycemic control in diabetes with metabolic syndrome in community hospital. J Med Assoc Thai 2008;91:641-7. 53. Kosachunhanun N, Benjasuratwong Y, Mongkolsomlit S, Rawdaree P, Plengvidhya N, Leelawatana R, et al. Thailand diabetes registry project: glycemic control in Thai type 2 diabetes and its relation to hypoglycemic agent usage. J Med Assoc Thai 2006;89(Suppl 1):S66-71. 54. Likitmaskul S, Wacharasindhu S, Rawdaree P, Ngarmukos C, Deerochanawong C, Suwanwalaikorn S, et al.Thailand diabetes registry project: type of diabetes, glycemic control and prevalence of microvascular complications in children and adolescents with diabetes. J Med Assoc Thai 2006;89(Suppl 1):S10-6. 55. Georgiou A, Burns J, Wan Q, Flack J, Penn D, Powell DG, et al. Analysis of Division-based diabetes register data (2000-2002). Sydney: Centre for General Practice Integration Studies, University of New South Wales; 2004. 56. Australian Council for Safety and Quality in Health Care and the National Institute of Clinical Studies. Charting the Safety and Quality of Health Care in Australia; 2004 [cited 2014 Aug 11]. Available from: http://www.health.gov.au/internet/safety/publishing.nsf/Content/F1AB7CD29C037EFBCA25716F00033 691/$File/chartbk.pdf. 57. Statistics Canada. Smoking and Diabetes Care: Results from the Canadian Community Health Survey Cycle 3.1, 2005. Ottawa: Statistics Canada; 2006. 58. The UK National Health Services. National Diabetes Audit: Key findings about the quality of care for people with diabetes in England and Wales (2005-2006). London (UK): National Health Services; 2007. 59. Rawdaree P, Ngarmukos C, Deerochanawong C, Suwanwalaikorn S, Chetthakul T, Krittiyawong S, et al. Thailand diabetes registry (TDR) project: clinical status and long term vascular complications in diabetic patients. J Med Assoc Thai 2006;89(Suppl 1):S1-9. 60. Thai Diabetes Treatment Guideline [Internet]. 2011. [cite 2013 Apr 8].Available from: http://www.diabassocthai.org/index.php?option=com_content&view=article&id=12%3A-2551- &catid=2% 3A2011-01-25-09-11-02&Itemid=6&lang=th. 61. ÿćĞ îĆÖÜćîēøÙĕöêŠ éĉ êĂŠ ÖøöÙüïÙčöēøÙ. ÙúĉîÖĉ NCD Ùèč õćó [ĂĉîđìĂøđŤ îĘê]. [đךćëċÜđöČĂę 3 Ö.÷. 2557]. đךćëÜċ ĕéšÝćÖ: http://thaincd.com/document/hot news/ Ēïïðøąđöĉî NCD Ùčèõćó.pdf. 62. Li R, Zhang P, Zhang X. Cost-effectiveness of interventions to patient and control diabetes mellitus: a systematic review. Diabetes Care 2010;33(8):1872-94. 63. ÖćøðøąđöĉîÙüćöđÿĊę÷ÜêĂŠ ēøÙĀĆüĔÝĒúąĀúĂéđúĂČ éĔîÖúöŠč đÿęĊ÷ÜÿĎÜêĂŠ ÖćøđÖéĉ ēøÙđïćĀüćîĒúąēøÙÙüćöéĆîēúĀĉêÿĎÜ (Pre-DM, Pre-HT) ĒúąñìĎš ęöĊ ĊõćüąĂšüî [Ăîĉ đìĂøŤđîêĘ ]. [đ×ćš ëċÜđöČĂę 24 Ö.Ù. 2557]. đךćëÜċ ĕéšÝćÖ: http://dpc2.ddc.moph.go.th/infopublic/data/5/pic/90-5.pdf. 64. Bhuripanyo K, Ruangratanaamporn O, Mahanonda N, Leowattana W, Sriratanasathaavorn C, Chotinaiwattarakul C, et al. Impaired fasting glucose, diabetes mellitus and coronary risk factors. J Med Assoc Thai 2000;83(Suppl 2):S146-52. การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-26 โรคเบาหวาน (Diabetes Mellitus) 65. Aekplakorn W, Stolk R, Neal B, Suriyawongpaisal P, Chongsuvivatwong V, Cheepudomwit S, Woodward M, InterASIA Collaborative Group: The Prevalence and Management of Diabetes in Thai Adults. The International Collaborative Study of Cardiovascular Disease in Asia. Diabetes Care 2003;25(10):2758-2763. 66. ÙèąÖøøöÖćøÖćøóçĆ îćøąïïïøÖĉ ćøìęêĊ ĂïÿîĂÜêŠĂðŦâĀćÿč×õćóìÿęĊ ćĞ ÙâĆ ÿć×ćēøÙĕöŠêĉéêĂŠ . ĒñîóçĆ îćøąïïïøÖĉ ćø ÿč×õćóÖøąìøüÜÿćíćøèÿč×: ĒîüìćÜóçĆ îćøąïïïøÖĉ ćøÿč×õćóÿć×ćēøÙĕöêŠ ĉéêĂŠ đøĂĚČ øÜĆ (NCD) (DM, HT, COPD, STROKE). ÖøčÜđìóĄ: ēøÜóĉöóŤßčöîčîÿĀÖøèŤÖćøđÖþêøĒĀŠÜðøąđìýĕì÷; 2556. Āîćš 6. Thailand Medical Services Profile 2011 - 2014

õćÙñîüÖìĊę 6.1 โรคเบาหวาน (Diabetes Mellitus) ÙüćöÙčöš ÙŠć×ĂÜ Interventions êŠćÜė đÖĊę÷üÖĆïēøÙđïćĀüćî êćøćÜìęĊ 6.19 ÙüćöÙčöš ÙćŠ ×ĂÜ interventions êćŠ Üė đÖĊę÷üÖĆïēøÙđïćĀüćî62 intervention comparison ßîéĉ đïćĀüćî øąéĆï×ĂÜÖćøĒîąîćĞ ñúÖćøðäïĉ Ćêĉ ĂêĆ øć×ĂÜÙüćö ÖćøðäĉïêĆ ĉ Öćøđðø÷Ċ ïđìĊ÷ï ÖúöčŠ ðøąßćÖø (ךĂöúĎ ĀîĆÖĒîŠî) (ÙüćöÙöšč ÙŠć) Ùöšč ÙćŠ ììĊę ćĞ ÖćøýċÖþć cost-saving (cost- การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition cost-saving ÖćøĔßš insulin đïćĀüćîßîĉéìęĊ 1 A: ACEI cost-saving effectiveness 1) Āúć÷×ïüîÖćø×ĂÜÖćøðäïĉ êĆ Öĉ ćø đߊî B: ÖćøÙéĆ ÖøĂÜĒúąøÖĆ þć ratios) ÖćøĔßš insulin ÖćøøÖĆ þćéšü÷ ACEI ÖćøÙéĆ đïćĀüćî×îċĚ êć cost-saving ÖøĂÜđïćĀüćî×ĚċîêćĒúąÖćøøĆÖþćđïćĀüćî cost-saving ×ċĚîêć 2) Āúć÷×ïüîÖćø×ĂÜÖćøðäĉïĆêĉ đßîŠ ÖćøĔßš ÖćøĔß÷š ćúéîĞĚćêćúêćö đïćĀüćîßîĉéìęĊ 2 B: ÖćøĔĀšÙüćöøšĎ öćêøåćî E: ÖćøÙĆéÖøĂÜđïćĀüćî×Ěċîêć ÷ćúéîćĞĚ êćúêćööćêøåćî B: ÖćøøÖĆ þćéšü÷ ACEI - ÖćøĔĀšÙüćöøĎš B: ÖćøÙĆéÖøĂÜđïćĀüćî×îĚċ êć - ÖćøÙéĆ ÖøĂÜđïćĀüćî×ċĚîĕê - ÖćøøÖĆ þćéüš ÷ ACEI - ÖćøÙĆéÖøĂÜđïćĀüćî×îĚċ êć 6-27 6

6-28 โรคเบาหวาน (Diabetes Mellitus)êćøćÜìĊę 6.19 ÙüćöÙšöč ÙćŠ ×ĂÜ interventions êćŠ Üė đÖ÷ęĊ üÖïĆ ēøÙđïćĀüćî62 (êŠĂ) Thailand Medical Services Profile 2011 - 2014interventioncomparison ßîĉéđïćĀüćî øąéïĆ ×ĂÜÖćøĒîąîĞć ñúÖćøðäĉïêĆ ĉ ĂĆêøć×ĂÜÙüćö Öćøðäïĉ êĆ ĉ Öćøđðø÷Ċ ïđìĊ÷ï ÖúčŠöðøąßćÖø (ךĂöĎúĀîÖĆ ĒîŠî) (ÙüćöÙčšöÙŠć) ììęĊ ćĞ ÖćøýċÖþć ÙščöÙćŠ (cost- effectiveness ratios) very-cost-effective ĕöŠöĊÖćøðøïĆ đðúĊ÷ę îĀøČĂĔßš IGT B: ÖćøĔĀÖš ćøøÖĆ þćìćÜĂćĀćø 4,500 USD/QALY 84,700 USD/QALY óùêÖĉ øøöìüęĆ ė ĕð medical nutrition 1) ÖćøðøïĆ đðúĊę÷îóùêĉÖøøö intensive life style A: physical activity 2) ÖćøÙüïÙčöîĞćĚ êćúĂ÷ćŠ Üđ×öš ÜüéĒïïĔî ÙüïÙöč êćöðÖêĉìĆüę ė ĕð đïćĀüćîßîĉéìĊę 2 đøęĉö A, B no data no data ÖćøýÖċ þć UKPDS üĉîÝĉ ÞĆ÷ 3) ÖćøĔßš÷ćúéĕ×öĆî Statin ĕöŠĕéš÷ćúéĕ×öĆî đïćĀüćîßîĉéìęĊ 2 ìęĊöĊ A 2,800 USD/LYG 12,300 USD/LYG ĕ×öĆîÿĎÜøüŠ öÖĆï ðøąüêĆ ēĉ øÙĀúĂéđúĂČ é 4) ÖćøĀ÷čéÿïĎ ïčĀøĊę ĕöĀŠ ÷čéÿïĎ ïčĀøĊę đïćĀüćîßîĉéìęĊ 2 A, B < 25,000 <25,000-89,800 USD/QALY /QALY

êćøćÜìęĊ 6.19 ÙüćöÙöčš ÙŠć×ĂÜ interventions êŠćÜė đÖ÷Ċę üÖĆïēøÙđïćĀüćî62 (êŠĂ) โรคเบาหวาน (Diabetes Mellitus)  intervention comparison ßîéĉ đïćĀüćî øąéïĆ ×ĂÜÖćøĒîąîĞć ñúÖćøðäïĉ êĆ ĉ ĂĆêøć×ĂÜÙüćö ÖćøðäĉïĆêĉ Öćøđðø÷Ċ ïđìĊ÷ï ÖúöŠč ðøąßćÖø (ךĂöĎúĀîĆÖĒîŠî) (ÙüćöÙöčš ÙŠć) Ùčöš ÙŠć ìęĊìĞćÖćøýÖċ þć (cost- 2,150 USD/QALY 5) ÖćøêøüÝÙéĆ ÖøĂÜêćìÖč ðŘ ĕööŠ ĊÖćøÙĆéÖøĂÜ đïćĀüćîßîĉéìĊę 1 A 6,900 USD/QALY effectiveness ratios) 6) ÖćøêøüÝÙéĆ ÖøĂÜđïćĀüćî×ċĚîĕêìÖč ðŘ ĕöŠÙĆéÖøĂÜ đïćĀüćîßîéĉ ìęĊ 2 B 49,200 ĕöÙŠ éĆ ÖøĂÜ B USD/QALY 4,300 USD/QALY 7) ÙéĆ ÖøĂÜĀćñðĎš śü÷ìĊ÷ę ÜĆ ĕöŠĕéøš ïĆ Öćøüîĉ ĉÝÞĆ÷ ðøąßćÖøìöęĊ Ċõćüą การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition đðîŨ đïćĀüćîĔîÖúčöŠ ìęđĊ ðîŨ đðćŜ Āöć÷ 2,900 USD/QALY ÙüćöéîĆ ēúĀĉêÿĎÜ 16,800-70,500 öćÖÖüćŠ 45 ðŘ ×ċĚîĕð USD/QALY (×ĚċîÖĆï Ăć÷č) 8) ÖćøøÖĆ þćéüš ÷ insulin Ă÷ćŠ ÜđךöÜüé ÙüïÙöč êćöðÖêĉ đïćĀüćîßîéĉ ìęĊ 1 A, B 27,700 10,200–50,800 (intensive insulin treatment) USD/QALY USD/QALY 9) ÖćøÙüïÙöč îĞćĚ êćúĂ÷ćŠ ÜđךöÜüéĂ÷ćŠ ÜñŠćî ÙüïÙöč êćöðÖêĉ đïćĀüćîßîéĉ ìęĊ 2 đóÜęĉ A, B 33,100 33,100 USD/QALY ÖćøðøĆïđðúĊę÷îóùêÖĉ øøö ĕéøš ĆïÖćøüîĉ Ýĉ ÞĆ÷ USD/QALY  6-29 6

6-30 โรคเบาหวาน (Diabetes Mellitus)êćøćÜìęĊ 6.19 ÙüćöÙščöÙćŠ ×ĂÜ interventions êŠćÜė đÖĊ÷ę üÖïĆ ēøÙđïćĀüćî62 (êĂŠ ) Thailand Medical Services Profile 2011 - 2014interventioncomparison ßîĉéđïćĀüćî øąéïĆ ×ĂÜÖćøĒîąîĞć ñúÖćøðäïĉ Ćêĉ ĂĆêøć×ĂÜÙüćö Öćøðäïĉ Ćêĉ Öćøđðø÷Ċ ïđì÷Ċ ï ÖúöŠč ðøąßćÖø (ךĂöúĎ ĀîÖĆ ĒîŠî) (ÙüćöÙčšöÙŠć) Ùčöš ÙćŠ ììęĊ ĞćÖćøýċÖþć (cost- 38,200 10) ÖćøĕéšøïĆ ÖćøøÖĆ þćéüš ÷÷ćúéĕ×öĆî ÙüïÙöč êćöðÖêĉ đïćĀüćîßîéĉ ìęĊ 2 ìęĊöĊ A USD/QALY effectiveness Statin ĕ×öĆîÿÜĎ ĒêĕŠ öŠöēĊ øÙ ratios) ÖúöŠč ĕéøš Ćï insulin ĀúĂéđúČĂé 49,800 11) ÖćøĔßĀš úć÷ךĂöĎúðäĉïêĆ ĉ ÙüïÙöč đïćĀüćîßîéĉ ìĊę 2 A, B USD/QALY 6,100-61,300 - ÖćøĔßš insulin Ă÷ŠćÜđךöÜüé USD/LYG - ÖćøøĆÖþćéšü÷ ACEI ÙĆéÖøĂÜđÞóćąÙîìęĊöĊ ðøąßćÖøĂć÷č œ 45 ðŘ B - ÖćøÙéĆ ÖøĂÜêć ÙüćöéîĆ ēúĀêĉ ÿÜĎ 46,500-50,600 USD/LYG 12) ÖćøÙĆéÖøĂÜđïćĀüćîĒïïìüęĆ ìčÖÙîìęĊ ĕöĕŠ éøš ĆïÖćøüîĉ Ýĉ ÞĆ÷üćŠ đðîŨ đïćĀüćî >10,000 12,300 USD/QALY USD/QALY 13) ÖćøÙüïÙčöđïćĀüćîĂ÷ŠćÜđךöÜüé ÙüïÙöč éüš ÷ðÖêĉ đïćĀüćîßîĉéìęĊ 2 A, B >10,000 >10,000-3 úšćî USD/QALY USD/QALY üĉîÝĉ Þ÷Ć đöęĂČ Ăć÷č 55- 94 ðŘ ÝćÖêćøćÜđðŨî intervention ìĊęöĊĀúĆÖåćîĂ÷ŠćÜéĒĊ êŠĂćÝÝąöïĊ ćÜ intervention ìĊęöĊךĂöĎúìĊęĔßšöćÿîĆïÿîčî (supportive evidence) Ă÷ŠĎïćš Ü àęÜċ ÝąÖúŠćüóĂÿĆÜđ×ð đßîŠ ÖćøÙéĆ ÖøĂÜñšĎ ìĊęđðŨîđïćĀüćîߊüÜêĆÜĚ ÙøøõìŤ ÜĚĆ üĉíĊ 50 g OGTT Ēúą/ĀøČĂ 100 g OGTT đìĊ÷ïÖïĆ ÖćøĕöÙŠ ĆéÖøĂÜĀøČĂ 75 g OGTT ĔîĀâÜĉ êĆĚÜÙøøõĂŤ ć÷č 30 ðŘ ×ċîĚ ĕð Ăć÷čÙøïìĊę 24-28 ÿĆðéćĀŤ óïüćŠ ÿćöćøëúé ÙćŠ ĔßšÝćŠ ÷ (cost-saving) ĕéš ĀøĂČ ÖćøéĒĎ úêüĆ đĂÜĔîñĎšìęđĊ ðîŨ đïćĀüćîìęĊ 1 ÖĘÿćöćøëúéÙćŠ ĔßÝš ćŠ ÷ĕéđš ßîŠ ÖîĆ

โรคเบาหวาน (Diabetes Mellitus) 6-31 õćÙñîüÖìęĊ 6.2 ÖćøðøąđöĉîÙüćöđÿĊę÷Ü Ēúą×îĚĆ êĂîÖćøïøÖĉ ćøĀúĆÜÖćøðøąđöîĉ ÙüćöđÿęĊ÷Ü  6 ÖúöčŠ đðćŜ Āöć÷  1. ÖúöčŠ đÿĊ÷ę ÜÿĎÜêĂŠ ÖćøđÖéĉ õćüąÙüćöéĆîēúĀĉêÿĎÜ (Pre-HT) (öøĊ ąéïĆ ÙüćöéĆîēúĀĉê êĆĚÜĒêŠ 120/80-139/89 öö.ðøĂì)  2. ÖúŠöč đÿ÷ęĊ ÜÿÜĎ êŠĂÖćøđÖĉéēøÙđïćĀüćî (Pre-DM) (öĊøąéïĆ îćĞĚ êćúĔîđúČĂéđöęĂČ ĂéĂćĀćø 8 ßĆüę ēöÜ×îċĚ ĕð êĚÜĆ ĒêŠ 100-125 öÖ./éú.)  3. ÖúŠčöìęĊöĊéĆßîöĊ üúÖć÷ œ25 ÖÖ./êøö.  ÿĂïëćö/ðøąđöîĉ ðŦÝÝĆ÷đÿ÷ęĊ Ü 7 ðøąđéĘî 1. ÿĎïïĀč øęĊ 2. øąéĆïÙüćöéĆîēúĀêĉ êĚÜĆ ĒêŠ 130/85 öö.ðøĂì (đðîŨ ÙćŠ ÙüćöéĆîēúĀĉêìđĊę ÿ÷Ċę ÜêŠĂÖćøđÖĉéēøÙĀĆüĔÝĒúąĀúĂéđúČĂé) Ēúą/ĀøĂČ đÙ÷ĕéšøĆïÖćøüîĉ Ýĉ ÞĆ÷ÝćÖĒóì÷üŤ ćŠ đðŨîõćüąÙüćöéĆîēúĀĉêÿĎÜ 3. øąéïĆ îćĞĚ êćúĔîđúĂČ é (FPG) êĚĆÜĒêŠ 100 öÖ./éú. Ēúą/ĀøČĂ đÙ÷ĕéšøïĆ Öćøüîĉ ĉÝÞ÷Ć ÝćÖĒóì÷üŤ ćŠ đðŨîēøÙđïćĀüćî 4. ĕéšøĆïÖćøüîĉ Ýĉ Þ÷Ć ÝćÖĒóì÷ŤĀøČĂó÷ćïćúüŠćöĊĕ×öĆîĔîđúĂČ éñéĉ ðÖêĉ 5. ×îćéøĂïđĂü öćÖÖüŠć ÿŠüîÿÜĎ (àö.) Āćø 2 6. đÙ÷ĕéøš ĆïÖćøüîĉ Ýĉ ÞĆ÷ÝćÖĒóì÷ŤüŠćđðŨîēøÙĀĆüĔÝ×ćéđúĂČ é ĀøČĂēøÙĂöĆ óùÖþŤĂĆöóćê 7. öðĊ øąüĆêĉâćêĉĔîÙøĂïÙøüĆ đðŨîēøÙĀĆüĔÝ×ćéđúČĂé ĀøČĂēøÙĂöĆ óùÖþŤĂöĆ óćê (ñšĎßć÷đðŨîÖŠĂîĂć÷č 55 ðŘĀøČĂñšĀĎ âĉÜ đðŨîÖĂŠ îĂć÷č 65 ðŘ) Āöć÷đĀêč: đÙ÷ĕéøš ĆïÖćøüĉîÝĉ Þ÷Ć üćŠ đðŨîđïćĀüćî ÙüćöéîĆ ēúĀĉêÿÜĎ ēøÙĀüĆ ĔÝ×ćéđúĂČ é ĀøĂČ ēøÙĂĆöóùÖĂĆöóćê ĒêŠ÷ĆÜĕöŠĕéøš ĆïÖćøøÖĆ þć ëĂČ đðŨîÖúŠčöđÿęĊ÷Ü)  ÿëćîąÙüćöđÿ÷ęĊ ÜêĂŠ ðÝŦ Ý÷Ć đÿ÷ęĊ Ü Œ2 ךà ðŦÝÝĆ÷đÿ÷Ċę Ü 3-4 ךà ðÝŦ Ý÷Ć đÿĊę÷Ü œ5 ×Ăš ÖćøđðîŨ ēøÙĀĆüĔÝĒúą đÿę÷Ċ Ü ĀúĂéđúČĂé đÿ÷Ċę ÜÿĎÜ đÿĊę÷ÜÿĎÜöćÖ õćóìĊę 6.7 ÖćøðøąđöĉîÙüćöđÿęĊ÷ÜêŠĂēøÙĀĆüĔÝĒúąĀúĂéđúČĂéĔîÖúŠčöđÿęĊ÷ÜÿĎÜêŠĂÖćøđÖĉéēøÙđïćĀüćîĒúąõćüą ÙüćöéîĆ ēúĀĉêÿĎÜ (Pre-DM, Pre-HT) ĒúąñšĎìöĊę ĊõćüąĂšüî63 การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-32 โรคเบาหวาน (Diabetes Mellitus) êćøćÜìĊę 6.20 ×ĚĆîêĂîÖćøïøĉÖćøĀúĆÜÖćøðøąđöĉîÙüćöđÿĊę÷ÜêŠĂēøÙĀĆüĔÝĒúąĀúĂéđúČĂéĔîÖúŠčöđÿĊę÷ÜÿĎÜêŠĂÖćøđÖĉé ēøÙđïćĀüćîĒúąõćüąÙüćöéîĆ ēúĀĉêÿĎÜ (Pre-DM, Pre-HT) ĒúąñìšĎ Ċöę õĊ ćüąĂšüî63 ÿëćîąÙüćöđÿęĊ÷Ü ðÝŦ Ý÷Ć đÿ÷Ċę Ü Œ2 ךà ðŦÝÝ÷Ć đÿĊ÷ę Ü 3-4 ךà ðÝŦ ÝĆ÷đÿĊ÷ę Ü œ5 ×Ăš đÿę÷Ċ Ü đÿę÷Ċ ÜÿĎÜ đÿ÷ęĊ ÜÿÜĎ öćÖ đðćŜ Āöć÷ÖćøïøĉÖćø 1. ÙüćöéĆîēúĀĉê êęĞćÖüŠć 130/85 öö.ðøĂì 2. øąéïĆ îĞćĚ êćúĔîđúĂČ é êćęĞ ÖüŠć 100 öÖ./éú. 3. Ā÷čéÿĎïïčĀøĊęĒúąĀúĊÖđúęĊ÷ÜÙüîĆ ïčĀøĊę 4. îćĞĚ ĀîÖĆ ĒúąøĂïđĂü - éßĆ îöĊ üúÖć÷ 18.5–24.9 ÖÖ./êøö. - øĂïđĂü îšĂ÷ÖüŠćÿüŠ îÿĎÜ (àö.) Āćø 2 5. ĂĂÖÖĞćúĆÜÖć÷ĀîÖĆ øąéĆïðćîÖúćÜĂ÷ŠćÜîĂš ÷ 30 îćìêĊ ĂŠ üĆî 5 üîĆ êŠĂÿĆðéćĀŤ 6. ÖćøïøĉēõÙĂćĀćøìĊęđĀöćąÿö đßîŠ ĕöøŠ ïĆ ðøąìćîĂćĀćøìöĊę ĊøÿĀüćî öĆî đÙĘö đóęöĉ ÖćøøïĆ ðøąìćîñÖĆ ĒúąñúĕöšøÿĕöĀŠ üćî úéÖćøïøĉēõÙéęČöđÙøČĂę ÜéęöČ ìĊöę Ċ ĒĂúÖĂăĂúŤ 7. øąéĆïĕ×öîĆ Ă÷ŠĎĔîđÖèæŤðÖêĔĉ îøć÷ìöęĊ ĕĊ ×öîĆ ñĉéðÖêĉ ÖćøïøĉÖćø ĔĀš×ćŠ üÿćø ÿč×ýċÖþć đÿøöĉ ìĆÖþą ō ō ō ×Ăš ĒîąîćĞ ÿöéč ïîĆ ìÖċ ðøĆïóùêĉÖøøöđÿ÷Ċę Ü/ÝéĆ Öćø ðøïĆ óùêĉÖøøöđÿĊę÷Ü úéðŦÝÝĆ÷đÿę÷Ċ Ü úéðÝŦ Ý÷Ć đÿ÷Ċę Ü êîđĂÜ êĂŠ ÿ×č õćó Ă÷ćŠ ÜîĂš ÷ 2 ðŦÝÝĆ÷ Ă÷ŠćÜîĂš ÷ 3 ðÝŦ ÝĆ÷ ìøćïĂćÖćøđêČĂî×ĂÜēøÙĀüĆ ĔÝ +/- ō ō ĒúąĀúĂéđúČĂé êéĉ êćöÖćøðøĆïóùêĉÖøøöÿč×õćó ìÖč 1 ðŘ ìÖč 6 đéČĂî ìčÖ 2-3 đéČĂî ×îĚċ ìąđïĊ÷îêĉéêćöēĂÖćÿđÿęĊ÷Ü - +/Ͳ ō ēøÙĀĆüĔÝĒúąĀúĂéđúĂČ é îĆéêøüÝðøąđöîĉ ēĂÖćÿđÿĊ÷ę Ü 2 ðÙŘ øĆĚÜ ðúŘ ąÙøĚÜĆ 6 đéČĂîÙøĚĆÜ ēøÙĀüĆ ĔÝĒúąĀúĂéđúČĂé Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-33 õćÙñîüÖìęĊ 6.3 ĒîüìćÜÖćøéĞćđîĉîÜćî ĔîÖćøéćĞ đîĉîÜćîêćööćêøÖćøÖćøÿøšćÜÿč×õćóđóęČĂúéñúÖøąìïÝćÖēøÙđïćĀüćîĒúąõćüąÙüćöéĆîēúĀĉêÿĎÜ 6 îĚĆî ÿęĉÜÿĞćÙĆâêšĂÜöĊÖćøéĞćđîĉîÜćîìĊęÙøĂïÙúčö ìĚĆÜéšćîÖćøðŜĂÜÖĆîĒúąÙüïÙčöÖćøđÖĉéēøÙ ÖćøóĆçîćøąïïïøĉÖćøĒúąÖćøéĎĒú øĆÖþćñĎšìĊęđðŨîēøÙđïćĀüćîĔĀšđðŨîĕðĂ÷ŠćÜëĎÖêšĂÜĒúąêŠĂđîęČĂÜ ñšĎìĊęđðŨîēøÙÿćöćøëđךćëċÜøąïïïøĉÖćøéĎĒúøĆÖþćĒúąÙĆéÖøĂÜ ÖćøđÖĉéõćüąĒìøÖàšĂîìęĊÝĞćđðŨîĕéšĂ÷ŠćÜìęĆüëċÜĒúąđìŠćđìĊ÷ö øüöìĚĆÜÙüøÿîĆïÿîčîĔĀšöĊÖćøóĆçîćøąïïÖćøéĎĒúñšĎðśü÷ēøÙ đøĂĚČ øÜĆ àęċÜđðŨîÖćøêøąĀîĆÖ øïĆ øĎðš ŦâĀćĒúąđÖéĉ ÙüćöøüŠ ööČĂĔîÖćøĒÖšĕ×ðâŦ Āćēé÷ßčößîĒúąìčÖõćÙÿŠüîìĊđę Öę÷Ċ ü×Ăš Ü éÜĆ îĚĊ 1. ÖćøêøüÝüĉîĉÝÞĆ÷ēøÙĒúąîĞćñĎšðśü÷đךćÿĎŠøąïïÖćøéĎĒúøĆÖþćēé÷đøĘü ðøąßćÖøÖúŠčöđÿęĊ÷ÜìĊęóïõćüą ñĉéðÖêĕĉ éøš ĆïÖćøÿŠÜêĂŠ đóĂČę øĆïÖćøêøüÝüîĉ ĉÝÞĆ÷ÝćÖĒóì÷đŤ óČĂę øïĆ ÖćøøĆÖþćìĊęëÖĎ êšĂÜđĀöćąÿö êĚĆÜĒêøŠ ą÷ąđøęĉöĒøÖ 2. ÖćøéĎĒúøĆÖþćñšĎìęĊđðŨîēøÙđïćĀüćîĒúą/ĀøČĂõćüąÙüćöéĆîēúĀĉêÿĎÜ õć÷ĀúĆÜĕéšøĆïÖćøüĉîĉÝÞĆ÷ÝćÖ Ēóì÷ŤñšĎìĊęđðŨîēøÙđïćĀüćîÝąêšĂÜĕéšøĆïÖćøéĎĒúøĆÖþćìęĊđĀöćąÿö đóČęĂøĆÖþćĂćÖćøìęĊđÖĉé×ċĚîÝćÖõćüąîĞĚćêćúĔîđúČĂéÿĎÜ ĀøČĂõćüąÙüćöéĆîēúĀĉêÿĎÜ ðŜĂÜÖĆîĒúąøĆÖþćÖćøđÖĉéēøÙĒìøÖàšĂîøą÷ąđÞĊ÷ïóúĆî ðŜĂÜÖĆîĀøČĂßąúĂÖćøđÖĉéēøÙĒìøÖ àšĂîđøČĚĂøĆÜ øüöìĆĚÜöĊđðŜćĀöć÷đóęČĂĔĀšñĎšðśü÷öĊÙčèõćóßĊüĉêìęĊéĊĔÖúšđÙĊ÷ÜÙîðÖêĉĒêŠēøÙđïćĀüćîĒúąõćüąÙüćöéĆîēúĀĉêÿĎÜ đðŨîēøÙđøČĚĂøĆÜìĊęñĎšìęĊđðŨîêšĂÜđñßĉâđðŨîđüúć÷ćüîćîÖćøéĎĒúøĆÖþćìĊęÝąđÖĉéñúéĊÝĞćđðŨîêšĂÜĔßšÙüćöøŠüööČĂøąĀüŠćÜĒóì÷Ť êüĆ ñìšĎ ĊęđðŨîēøÙĒúąâćêĉ ìĊöïÙč úćÖøÿć×ćĂČęîė ìęđĊ Ö÷ęĊ ü×Ăš Ü 3. ÖćøêøüÝÙĆéÖøĂÜÙšîĀćõćüąĒìøÖàšĂîĔîøąïïĂüĆ÷üąìęĊÿĞćÙĆâ îĂÖÝćÖÖćøÙüïÙčöĔĀšøąéĆïîĞĚćêćú ĒúąÙüćöéĆîēúĀĉêđðŨîĕðêćöđðŜćĀöć÷ĔîÖćøéĎĒúøĆÖþćĒúšüÖćøêøüÝÙĆéÖøĂÜđóČęĂÙšîĀćõćüąĒìøÖàšĂîĔîñšĎðśü÷đðŨîÿęĉÜ ÿĞćÙĆâìęĊêšĂÜéĞćđîĉîÖćøĂ÷ŠćÜêŠĂđîęČĂÜ øüöìĆĚÜĀćÖêøüÝóïõćüąñĉéðÖêĉêšĂÜÿŠÜêŠĂ đóČęĂĔĀšñĎšðśü÷óïñšĎđßĊę÷üßćâđÞóćąìćÜ ĒúąøïĆ ÖćøøÖĆ þćìęĊëĎÖêšĂÜđĀöćąÿö24,64 éĆÜîĊĚ 1) ÖćøêøüÝÙĆéÖøĂÜõćüąĒìøÖàšĂîìćÜêć (êøüÝÝĂðøąÿćìêć) ēé÷ÝĆÖþčĒóì÷Ť ĀøČĂÖćøêøüÝéšü÷ ÖúšĂÜëćŠ ÷õćóÝĂðøąÿćìêć (fundus camera) ēé÷ïčÙúćÖøìęĊñŠćîÖćøòřÖĂïøö ÙĞćĒîąîĞćĔîÖćøêøüÝÙĆéÖøĂÜĒúąêĉéêćö (êćøćÜìęĊ 6.21) êćøćÜìĊę 6.21 õćüąñĉéðÖêìĉ ÝĊę ĂðøąÿćìêćĒúąøą÷ąđüúćĔîÖćøêøüÝêĉéêćö õćüąñéĉ ðÖêĉìÝęĊ Ăðøąÿćìêć øą÷ąđüúćĔîÖćøêøüÝêĉéêćö ÷ĆÜĕöŠöĊõćüąĒìøÖàšĂîìćÜêć îéĆ êøüÝêćĂ÷ćŠ ÜîĂš ÷ðúŘ ą 1 ÙøĆÜĚ óïõćüąñĉéðÖêĉìÝęĊ Ăðøąÿćìêćøą÷ąđúĘÖîšĂ÷ (mild NPDR) îĆéóïÝĆÖþčĒóì÷đŤ óĂČę êøüÝêéĉ êćöìčÖ 6 đéČĂî óïõćüąñéĉ ðÖêĉìęĊÝĂðøąÿćìêćøą÷ąðćîÖúćÜ (moderate îĆéóïÝÖĆ þčĒóì÷ŤđóĂęČ êøüÝêĉéêćöìčÖ 3 đéĂČ î NPDR) óïõćüąñĉéðÖêĉìĊęÝĂðøąÿćìêćøą÷ąøčîĒøÜ severe NPDR ÿÜŠ êŠĂÝĆÖþčĒóì÷ŤđóĂęČ ĔĀÖš ćøøÖĆ þćìĆîìĊ ĀøČĂ Preproliferative Diabetes Retinopathy (PPDR) Ēúą/ĀøĂČ öĊÖćøïüöìĊęÝéč õćóßĆé×ĂÜÝĂðøąÿćìêć (Macular Edema) Proliferative Diabetic Retinopathy (PDR) đðŨîøą÷ąìĊęöĊ ÿŠÜêĂŠ ÝÖĆ þĒč óì÷ŤđóęĂČ ĔĀÖš ćøøÖĆ þćìîĆ ìĊ ÖćøđðúĊę÷îĒðúÜöćÖìęĊöĊÝĂðøąÿćìêć đÖĉéđÿšîđúČĂéÜĂÖĔĀöŠ öĊđúČĂéĂĂÖĔîüščîêć ĂćÝđÖĉéÝĂðøąÿćìêćúĂÖĀúčé đðŨî ÿćđĀê×č ĂÜêćïĂé 2) ÖćøêøüÝÙĆéÖøĂÜõćüąĒìøÖàšĂîìćÜĕê Āöć÷ëċÜ ÖćøðøąđöĉîÙŠćĂĆêøćÖćøÖøĂÜ×ĂÜĕê (estimated Glomerular Filtration rate; eGFR) Ēúą/ĀøČĂ ÖćøêøüÝĀćēðøêîĊ ßîĉéĂĆúïĎöĉîĔîðÿŦ ÿćüą (microalbuminuria) ìĆĚÜîĊĚ ÙŠć eGFR ÙĞćîüèéšü÷ÿĎêø CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) ĒÿéÜéĆÜêćøćÜìęĊ 6.22 การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-34 โรคเบาหวาน (Diabetes Mellitus) êćøćÜìęĊ 6.22 øąéĆï serum creatinine (mg/dl) ĒúąÿĎêøìĊęĔßš đóý øąéïĆ serum creatinine ÿêĎ øìĊĔę ßš (mg/dl) eGFR = 144 (SCr/0.7)-0.329 (0.993)Age eGFR = 144 (SCr/0.7)-1.209 (0.993)Age ĀâÜĉ <0.7 eGFR = 141 (SCr/0.7)-0.411 (0.993)Age >0.7 eGFR = 141 (SCr/0.7)-1.209 (0.993)Age ßć÷ <0.9 >0.9 ēðøêĊîßîĉéĂĆúïĎöĉîĔîðŦÿÿćüą ĂćÝêøüÝēé÷ĔßšĒëïÿĊÝŠčö microalbuminuria ĀøČĂÖćøĀćÙŠć Urinary Albumin/Creatinine Ratio (UACR) ÝćÖÖćøđÖĘïðŦÿÿćüą ÙüøöĊÖćøàĆÖðøąüĆêĉñĎšìęĊđðŨîđóĉęöđêĉöđóČęĂĔĀšĒîŠĔÝüŠć ĕöŠöĊõćüąĂęČîìęĊđðŨîÿćđĀêč×ĂÜĂĆúïĎöĉîøęĆüìćÜðŦÿÿćüą đߊî öĊĕך ĂĂÖÖĞćúĆÜÖć÷ĀĆÖēĀö øĆïðøąìćîĂćĀćøìĊęöĊēðøêĊîÿĎÜ Öćøêéĉ đßĂČĚ ìćÜđéĉîðŦÿÿćüą đðŨîêšî 3) ÖćøêøüÝÙĆéÖøĂÜõćüąĒìøÖàšĂîìćÜđìšć Āöć÷ëċÜ ÖćøêøüÝđìšćĂ÷ŠćÜúąđĂĊ÷éēé÷ïčÙúćÖøìćÜ ÖćøĒóì÷ŤìęĊĕéšøĆïÖćøòřÖĂïøö ìĆĚÜēé÷ÖćøÿĆÜđÖêÿõćóñĉüĀîĆÜõć÷îĂÖ (visual inspection) đߊî úĆÖþèąñĉüĀîĆÜ ×î đúĘï Ēñú đìšćñĉéøĎð đðŨîêšî ÖćøêøüÝðúć÷ðøąÿćìđìšć (neurological assessment) ĕéšĒÖŠ ÖćøÿĂïëćöĂćÖćøßć øŠüöÖĆïÖćøêøüÝðøąÿćìøĆïÙüćöøšĎÿċÖéšü÷ semmes-weinstein monofilament ×îćé 5.07 (10 gram) Ă÷ŠćÜîšĂ÷ 4 Ýčé ĒúąÖćøÙúĞćßóĊ Ýøđìćš (vascular assessment) ĕéšĒÖŠ dorsalis pedis Ēúą posterior tibial pulse ÖćøóĆçîćøąïïïøĉÖćøēøÙđïćĀüćî 1. đîîš ÝćÖÖćøøÖĆ þćđðîŨ ÖćøðĂŜ ÜÖĆîēøÙ đîęČĂÜÝćÖÙüćößčÖ×ĂÜēøÙđïćĀüćîìęĊđóęĉö×Ěċî ×èąìĊęïčÙúćÖøĒúąìøĆó÷ćÖøĔîÖćøøĆÖþćēøÙöĊÝĞćÖĆé Öćø ÿŠÜđÿøĉöñĎšìęĊöĊÙüćöđÿęĊ÷ÜìęĊÝąđÖĉéēøÙđïćĀüćîðŜĂÜÖĆîĕöŠĔĀšđÖĉéēøÙđïćĀüćîݹߊü÷úéõćøąÜćîĔîÖćøøĆÖþćēøÙđïćĀüćî ëšćĕöŠđÖĉéēøÙÖĘĕöŠêĂš Üđÿ÷Ċ ÙćŠ ĔßšÝćŠ ÷ĔîÖćøøĆÖþćēøÙĒúąøĆÖþćõćüąĒìøÖàšĂîÝćÖēøÙđïćĀüćîÿŠüîñĎšìęĊđðŨîēøÙÖĘĕöŠêšĂÜìî ìčÖ׍ìøöćîÝćÖēøÙĒìøÖàšĂî ĔîÙüćöÝøĉÜÙøĂïÙøĆüñšĎìęĊđðŨîēøÙđïćĀüćîÖĘĕöŠĂ÷ćÖĔĀšúĎÖĀúćî×ĂÜêîđðŨîēøÙđïćĀüćî ĒêŠĕöŠìøćïüĉíĊÖćøðŜĂÜÖĆîēøÙ éĆÜîĚĆîîĂÖÝćÖÖćøøĆÖþć ÝąêšĂÜĒîąîĞćüĉíĊÖćøðäĉïĆêĉêîĔîÙøĂïÙøĆüđóČęĂĔĀšĀŠćÜĕÖúÝćÖ ēøÙđïćĀüćî đóČęĂìđęĊ øćÝąĕéšĕöŠêĂš ÜøÖĆ þćúÖĎ ĀúćîñĎšìđĊę ðŨîĔîĂîćÙê 2. ÖćøĔĀÖš ćøüîĉ ĉÝÞ÷Ć ìĊęđøĘü×Ěċî ðŦÝÝčïĆîóïüŠćñšĎìęĊđðŨîēøÙđïćĀüćîìĊęüĉîĉÝÞĆ÷ĒêŠĒøÖöĊõćüąĒìøÖàšĂîÝćÖēøÙđïćĀüćîÿĎÜ ÖćøìĊęøĂĔĀšñĎšìęĊđðŨî ēøÙöćóïĒóì÷ŤđîęČĂÜÝćÖöĊĂćÖćø×ĂÜēøÙđïćĀüćîĀøČĂõćüąĒìøÖàšĂîÝćÖēøÙÙüøđðúęĊ÷îđðŨîÖćøÙĆéÖøĂÜēøÙĔîÖúčŠö đÿ÷ęĊ ÜÝąìĞćĔĀšÖćøüîĉ ĉÝÞĆ÷ēøÙĕéšøüéđøüĘ ×ċĚîĒúąêšĂÜĔĀÙš üćöøĎĔš îÖúöčŠ đÿĊę÷ÜđóĂČę ðĂŜ ÜÖîĆ ēøÙđïćĀüćî 3. ÖćøđךöÜüéĔîÖćøÙüïÙöč îćĞĚ êćúĒúąðŦÝÝ÷Ć đÿęĊ÷ÜêćŠ Üė ðŦÝÝčïĆî÷ĆÜÙüïÙčöøąéĆïîĞĚćêćúĒúąðŦÝÝĆ÷đÿęĊ÷ÜĕöŠéĊîĆÖ ÝćÖÖćøýċÖþć A1Chieve trial óïüŠćÖćøìĊęĒóì÷Ťđøĉęö ĔĀšñĎšðśü÷ÞĊé÷ćĂĉîàĎúĉîöĆÖđøęĉöđöęČĂöĊõćüąĒìøÖàšĂîÝćÖēøÙđïćĀüćîđÖĉé×ĚċîêĆĚÜĒêŠ øšĂ÷úą 79.9-96.165 àċęÜĒÿéÜĔĀšđĀĘîüŠć ñšĎìęĊđðŨîēøÙÝĞćîüîĕöŠîšĂ÷ĕéšøĆïÖćøÙüïÙčöîĚĞćêćúĕöŠéĊđðŨîđüúćîćîÝîđÖĉéõćüąĒìøÖàšĂîÙŠĂ÷đøĉęöìęĊÝąÞĊéĂĉîàĎúĉî îĂÖÝćÖîĚ÷Ċ ĆÜêšĂÜÙüïÙöč ðŦÝÝĆ÷đÿ÷ęĊ ÜĂîęČ ĔĀĕš éšĂ÷ŠćÜđ×öš Üüé øüöëċÜÙüøìęÝĊ ąöĊÙúîĉ Öĉ ĂéïčĀøđĊę óČęĂúéðŦÝÝĆ÷đÿĊ÷ę ÜìÿęĊ ĞćÙĆâ 4. ÖćøêøüÝõćüąĒìøÖàĂš îĒêđŠ øöĉę ĒøÖđóČĂę ðŜĂÜÖĆîĕöĔŠ Āđš ÖĉéõćüąĒìøÖàšĂîìĊøę îč ĒøÜ ÖćøđÿĊ÷ÙŠćĔߚ݊ć÷ĔîÖćøêøüÝ urine microalbuminuria ݹߊü÷úéÙŠćĔߚ݊ć÷ĔîÖćøøĆÖþćõćüąĒìøÖàšĂî đߊî ÖćøúšćÜĕê àęċÜöĊÙŠćĔßÝš Šć÷ìĊÿę ĎÜöćÖ Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-35 5. Öćøêéĉ êćöñĎìš đęĊ ðŨîēøÙđïćĀüćî 6 ĔîÖøèĊìĊñę ìšĎ đęĊ ðŨîēøÙđïćĀüćîĕöŠÿćöćøëöćêøüÝêćöîĆéÙüøöĊøąïïÖćøêĉéêćöđóČęĂĕöŠĔĀšñšĎðśü÷×ćéÖćøøĆÖþć øüöëċÜöĊøąïïÿĂïëćöìćÜÿęČĂÿćøĂČęî đߊî ēìøýĆóìŤ ÖćøÿŠÜ SMS đêČĂîÖćøéĎĒúêîđĂÜ đêČĂîÖćøêĉéêćöîĆéñšĎìęĊđðŨîēøÙ ÿćöćøëêéĉ êĂŠ ēøÜó÷ćïćúĔîÖøèĊìęĊöðĊ ŦâĀćÖćøéĒĎ ú đßîŠ ÖćøÿĂïëćöìćÜēìøýóĆ ìŤ internet 6. ÖćøđðúĊę÷îĒðúÜÝćÖĒóì÷ŤđðŨîñĎšéĎĒúñĎšìĊęđðŨîēøÙđðŨîìĊöÿĀüĉßćßĊóøüöëċÜêĆüñšĎìęĊđðŨîđĂÜõćÙøĆå Ēúą đĂÖßî ÖćøðøĆïìĊöĔîÖćøéĎĒúøĆÖþćēøÙđïćĀüćîàęċÜðøąÖĂïìĊöĔîēøÜó÷ćïćúĒúąìĊöÝćÖñĎšìĊęđðŨîēøÙ ßčößî đïćĀüćî ĂÜÙÖŤ øõćÙøĆåĒúąđĂÖßîĂČęîė 7. ÖćøöĊìĊöÖćøéĎĒúĔîēøÜó÷ćïćú ðøąÖĂïéüš ÷ĀúĆÖÖćø 3 ðøąÖćø ÙČĂ 7.1 team based approach Ēóì÷ŤĕöŠĔߊñĎšéĎĒúñĎšìęĊđðŨîēøÙđóĊ÷ÜÙîđéĊ÷ü ÝąöĊìĊöìęĊðøąÖĂïéšü÷ ó÷ćïćúñĔšĎ ĀÙš üćöøēšĎ øÙđïćĀüćî îÖĆ ēõßîćÖø ÙúĉîÖĉ ĂéïĀč øĊę ñšìĎ ęĊĔĀÙš üćöøšĎđøęČĂÜđìšćĒúąêĆéøĂÜđìšć Ēóì÷ŤđÞóćąìćÜéšćî êŠćÜė ÝĆÖþčĒóì÷Ť ýĆú÷Ēóì÷Ť ìĆîêĒóì÷Ť ĄúĄ ëċÜĒöšüŠćēøÜó÷ćïćúĂćÝÝąđðŨîēøÜó÷ćïćú×îćéđúĘÖĒêŠÖĘÙüøÝąöĊ ĒîüìćÜüŠćÿćöćøëÿŠÜêĂŠ ĕðìĊęĔé ĔîÖøèìĊ ęïĊ Ùč úćÖøöĊÝĞćÖĆé đߊî ÝĆÖþčĒóì÷ŤĕöŠđóĊ÷ÜóĂ ĂćÝÝąìĞćÖćøëŠć÷õćóÝĂðøąÿćì êćđóęĂČ êøüÝÙéĆ ÖøĂÜđïČĚĂÜêšî ĒúąÿŠÜêĂŠ Ĕîøć÷ìĊöę ĊÙüćöñéĉ ðÖêĉ 7.2 planned care visit êĂš ÜöÖĊ ćøüćÜĒñîĕüšÖŠĂîóïĒóì÷ŤÙøĚĆÜêŠĂĕðüŠćñšĎìęĊđðŨîēøÙÙüøÿŠÜĕðĔĀšÙüćöøšĎ éćš îĔé êšĂÜđêø÷Ċ öêüĆ Ă÷ćŠ ÜĕøÖĂŠ îóïĒóì÷Ť êĂš ÜóïĒóì÷ŤđÞóćąéšćîĔé üćÜĒñîđóęČĂĔĀšÿćöćøëìĞćÿęĉÜìĊęđĀöćąÿöĕéšĔîüĆî đé÷Ċ üÖîĆ 7.3 case management ðøąđöĉîñĎšìĊęđðŨîēøÙĒêŠúąøć÷üŠćêšĂÜĔĀšÙüćöøĎšéšćîĔé êšĂÜĔßš÷ćĂ÷ŠćÜĕø ðŜĂÜÖîĆ õćüąĒìøÖàĂš îĂąĕøïćš Ü 8. ñĎšìęđĊ ðŨîēøÙ ßöč ßîđïćĀüćî ĂÜÙŤÖøïøĉĀćøÿŠüîêćĞ ïúĀøČĂÝĆÜĀüéĆ õćÙđĂÖßî đîęČĂÜÝćÖìøĆó÷ćÖø×ĂÜøĆåöĊÝĞćÖĆéìĚĆÜéšćîÜïðøąöćè ïčÙúćÖø ĒêŠñšĎìĊęđðŨîēøÙđïćĀüćîÝĞćîüîöćÖìęĊ ñŠćîÖćøđøĊ÷îøšĎĒúąÿćöćøëéĎĒúêîđĂÜĕéšĂ÷ŠćÜëĎÖêšĂÜ (good role model) ïćÜøć÷öĊÙüćöóøšĂöìęĊݹߊü÷đĀúČĂñšĎìĊęđðŨî ēøÙđïćĀüćîøć÷ĂČęî ÿćöćøëđðŨîÝĉêĂćÿćìęĊĂćÝÝąöćߊü÷ĒîąîĞćĂćĀćø ÖćøĂĂÖÖĞćúĆÜÖć÷ ðŦâĀćĒúąÖćøĒÖšĕ×ĔîÖćø ðäĉïĆêĉêî ĒöšĒêŠÖćøÿĂîÖćøÞĊé÷ćĂĉîàĎúĉî àċęÜĔîÙüćöÝøĉÜĒúšüñšĎìęĊđðŨîēøÙÝą÷ĂöøĆïÖćøÞĊé÷ćÝćÖñšĎìĊęđðŨîēøÙéšü÷ÖĆîđĂÜ öćÖÖüŠćđîęČĂÜÝćÖêšĂÜÞĊé÷ćĂĉîàĎúĉîđĂÜìčÖüĆîĒêŠó÷ćïćúñĎšÿĂîđðŨîđóĊ÷ÜñšĎÿćíĉêÖćøÞĊéđìŠćîĚĆî ĒúąñĎšìęĊđðŨîēøÙøć÷ĂęČî ĂćÝÝąöĂÜüŠć×îćéñĎšìĊęđðŨîēøÙìĊęÿĎÜĂć÷č÷ĆÜÿćöćøëÞĊé÷ćĕéšÝċÜ÷ĉîéĊìĊęÝąÞĊé÷ćöćÖ×ċĚî ñĎšìęĊđðŨîĂćÝÝąöĊÖćøøüöêĆüÖĆîđðŨî ßöøöñšĎìęĊđðŨîēøÙđïćĀüćîđóČęĂÿîĆïÿîčîÖćøĔĀšÙüćöøšĎ ÖćøéĎĒúêîđĂÜ ÿŠüîõćÙøĆåĂČęîĔîßčößî đߊî Ăïê. ĂïÝ. ĂćÝÝą ߊü÷ÿîĆïÿîčîÜïïćÜÿŠüîđóęČĂßčößî ĒúąöĊÖćøĔßšìøĆó÷ćÖøøŠüöÖĆîđóČęĂĔĀšđÖĉéðøąē÷ßîŤÿĎÜÿčé đߊî ÖćøÝĆéàČĚĂđÙøČęĂÜ ëŠć÷õćóÝĂðøąÿćìêć 1 đÙøęČĂÜ ĒêöŠ ÖĊ ćøđü÷Ċ îĔßšĔîēøÜó÷ćïćúêŠćÜė ĔîÝĆÜĀüĆé×ĂÜêîđĂÜ ÿŠüîõćÙđĂÖßîìćÜñĎšñúĉê÷ć ĒúąĂčðÖøèŤìćÜÖćøĒóì÷Ť ĂćÝÿîĆïÿîčîÿČęĂĔĀšÙüćöøšĎēøÙđïćĀüćî ðćÖÖćĂĉîàĎúĉî đ×ĘöÞĊé÷ć ĂčðÖøèŤêøüÝđúČĂéðúć÷ îĚĉü ĒñŠîêøüÝîĞĚćêćúðúć÷îĚĉü îĂÖÝćÖîĚĊ÷ĆÜöĊÿöćÙöēøÙđïćĀüćî ÿöćÙöêŠĂöĕøšìŠĂĒĀŠÜðøąđìýĕì÷ ßöøöñĎšĔĀšÙüćöøĎš ēøÙđïćĀüćî ĒúąßöøöêŠćÜė ìĊęÙĂ÷ÿîïĆ ÿîîč 9. đðúęĊ÷îÝćÖĒóì÷ŤđðîŨ ñĎšéĎĒúđðîŨ ñìšĎ đęĊ ðîŨ ēøÙÿćöćøëéĎĒúêîđĂÜĕéš ÖćøøĆÖþćđéĉöĒóì÷ŤÝąđðŨîñšĎïĂÖüŠć ñšĎìęĊđðŨîēøÙêšĂÜÙüïÙčöĂćĀćø ĂĂÖÖĞćúĆÜÖć÷ øĆïðøąìćî÷ćÿöęĞćđÿöĂ ĒêÖŠ ćøìñĊę ĎšìđęĊ ðŨîÝąéĒĎ úêîđĂÜĕéš ÝąĒïŠÜñšĎìđęĊ ðŨîēøÙđïćĀüćîđðîŨ 3 øąéĆï - ĕööŠ ÙĊ üćöøšĎ - öĊÙüćöøĒĎš êŠ÷ÜĆ ĕöŠðäĉïêĆ ĉ - ñšĎìęĊđðŨîēøÙðäĉïêĆ Ăĉ ÷ćŠ ÜëÖĎ êšĂÜđðîŨ ßüĊ êĉ ðøąÝćĞ üĆîēé÷ĕööŠ ÖĊ ćøïĆÜÙĆïÝćÖĒóì÷Ť ÿĉęÜìĊęðäĉïĆêĉđðŨîÿĉęÜìęĊ ñĎðš śü÷đúĂČ ÖìĊęÝąìćĞ àÜęċ ëćš ÿćöćøëðøĆïđðúĊ÷ę îñĎìš ęĊđðŨîēøÙđïćĀüćîøąéĆïìęĊ 3 ÖćøđðúęĊ÷îĒðúÜĒóì÷ŤñĎšøĆÖþćĕöŠĔߊÿĉęÜÿĞćÙĆâđîęČĂÜÝćÖñšĎ ìĊęđðŨîđ×ćš ĔÝēøÙĒúąìøćïüíĉ ĊìĊÝę ąéĎĒúêîđĂÜ àÜċę üíĉ ìĊ ęÝĊ ąìćĞ ĔĀñš ĎšìĊđę ðîŨ ÿĎŠøąéĆïìęĊ 3 ĕéš öĊ 5 ×ĚĆîêĂî éĆÜîĚĊ การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-36 โรคเบาหวาน (Diabetes Mellitus) 9.1 ñšĎìđęĊ ðŨîöĊĒøÜÝĎÜĔÝìęĊÝąéĎĒúêîđĂÜ (motivation) ÖćøÿøšćÜĒøÜÝĎÜĔÝĔĀšñšĎìĊęđðŨîēøÙéĎĒúđðŨîÿĉęÜ ìęÿĊ ćĞ ÙĆâìÿęĊ éč đïČĚĂÜêšîìęĊÝąìĞćĔĀšñšĎìđęĊ ðîŨ ēøÙđïćĀüćîÿćöćøëéĎĒúêîđĂÜĕéš îĂÖÝćÖîĚĊÖćøĕéšĒøÜÿîĆïÿîčîÝćÖÙøĂïÙøĆüÖĘ đðŨîÿęÜĉ ÿćĞ ÙâĆ 9.2 ÖćøöĊÙüćöøĎšÙüćöđךćĔÝĔîēøÙ×ĂÜêîđĂÜ (knowledge) ÖćøýċÖþćóïüŠćñĎšìęĊđðŨî ēøÙđïćĀüćîóøšĂöìĊęÝąĀćÙüćöøšĎđÖĊę÷üÖĆïēøÙ×èąìęĊĒóì÷ŤÝąĕöŠöĊđüúćĔîÖćøĔĀšÙüćöøĎšĒÖŠñĎšìęĊđðŨî ëšćöĊøąïïÿîĆïÿîčîĔî ÖćøĔĀšÙüćöøĎšđðŨî knowledge management ÿČęĂìęĊñĎšìęĊđðŨîēøÙÿćöćøëđךćëċÜĕéšÜŠć÷ ĒñŠîóĆï ĀîĆÜÿČĂ ĂĉîđìĂøŤđîĘê ñšĎìĊę đðîŨ ēøÙÝąÿćöćøëéĎĒúêîđĂÜĕéšöćÖ×Ěîċ 9.3 öĊìĆÖþąĔîÖćøéĞćđîĉîßĊüĉêĂ÷ĎŠÖĆïēøÙđøČĚĂøĆÜ (problem solving skill) ÖćøìĊęöĊÙüćöøĎš ñšĎìęĊđðŨî ēøÙĂćÝÝąöĊìĆÖþąĔîÖćøéĎĒúēøÙđïćĀüćîìęĊĕöŠéĊ đߊî ÖćøêøüÝđúČĂéðúć÷îĉĚü ÖćøðøĆï×îćé÷ćĂĉîàĎúĉî Ēóì÷ŤÝąÙĂ÷ ĒîąîćĞ ĔĀšÖĞćúĆÜĔÝ ĒúąĒÖšĕ×ðŦâĀćìęĊđÞóćąđÝćąÝÜĒïï problem solving đߊî ÖćøìĊęĕöŠÿćöćøëÞĊé÷ćđîęČĂÜÝćÖÿć÷êć ñéĉ ðÖêĉ ĂćÝĔĀšâćêéĉ Ďé÷ćĂîĉ àĎúĉîĔĀš ĀøĂČ ÖćøĔßšðćÖÖćĂîĉ àĎúĉî 9.4 öĊÙüćööęĆîĔÝìĊęÝąéĎĒúêîđĂÜ (self-efficacy) ĒîŠîĂîüŠćđøćĕöŠÿćöćøëìĞćĔĀšñšĎìęĊđðŨî ēøÙđïćĀüćîöĊÙüćööęĆîĔÝìĊęÝąéĎĒúêîđĂÜ ĒêŠÖćøìęĊÙŠĂ÷ė ĔĀšÙüćöøšĎĒêŠúąđøČęĂÜĒúąĒÖšĕ×ðŦâĀćÝąìĞćĔĀšöĊñĎšìĊęđðŨîöĊÙüćö öęĆîĔÝìĊęÝąéĎĒúêîđĂÜ đߊîđéĊ÷üÖĆïÖćøóĆçîćÝćÖßĚĆîðøąëöýċÖþćÝîëċÜßĚĆîöĀćüĉì÷ćúĆ÷ ĒêŠëšćĕöŠöĊÖćøÿĂîđðøĊ÷ï đßîŠ đéĊ÷üÖïĆ ñìšĎ ĊęĕöĕŠ éđš ø÷Ċ îĀîĆÜÿĂČ ÿéč ìšć÷ÝąĕöŠÿćöćøëéĒĎ úêîđĂÜĕéš 9.5 ÿŠüîìęĊđðŨîĂčðÿøøÙ ĀøČĂÙüćö×ćéĒÙúîìøĆó÷ćÖø ĕéšøĆïÖćøߊü÷đĀúČĂÿîĆïÿîčî (identified barrier) ñĎšìęĊđðŨîēøÙđïćĀüćîĂćÝÝąóøšĂöìĊęÝąéĎĒúêîđĂÜ đߊî ÖćøêøüÝîĞĚćêćú ÖćøÞĊé÷ć ĒêŠöĊøć÷ĕéšĕöŠđóĊ÷ÜóĂ ēøÜó÷ćïćúÙüøÝĆéđÙøęČĂÜêøüÝîĞĚćêćúĔĀšñĎšìĊęđðŨî÷ČöĒúąïøĉÝćÙĒëïêøüÝîĞĚćêćúđóęČĂđðŨîÿęĉÜđïČĚĂÜêšîĔĀšñĎšìęĊđðŨî ēøÙđïćĀüćîÿćöćøëìøćïøąéĆïîĞćĚ êćúĒúąÖćøĒÖšĕ× Thailand Medical Services Profile 2011 - 2014

โรคเบาหวาน (Diabetes Mellitus) 6-37 õćÙñîüÖìęĊ 6.4 ÖćøóçĆ îćøąïïïøÖĉ ćøēøÙĕöŠêéĉ êĂŠ đøĂĚČ øĆÜĔîðøąđìýĕì÷ êćøćÜìęĊ 6.23 ÖćøóĆçîćøąïïïøÖĉ ćøēøÙĕöêŠ éĉ êŠĂđøĂĚČ øÜĆ Ĕîðøąđìýĕì÷ (service plan)66 êüĆ ßĊĚüĆé đðŜćĀöć÷ øąéïĆ đ×ê øąéïĆ øąéĆï øó. (øĂš ÷úą) ïøĉÖćø ÝĆÜĀüĆé øó. ÿê. êĆüßĊĚüĆéñúñúĉêéćš îÖøąïüîÖćøðĂŜ ÜÖîĆ 1. øĂš ÷úą×ĂÜðøąßćßîĂć÷č 15 ðŘ×Ěċîĕð ĕéøš ĆïÖćøÙĆé œ90 / / // ÖøĂÜđïćĀüćî ÙüćöéĆîēúĀĉêÿĎÜ 6 2. ÖúčŠöđÿĊę÷ÜÿĎÜ (pre-DM, pre-HT) ĕéøš ïĆ ÖćøðøĆïđðú÷Ċę î >50 / / / / óùêĉÖøøö 3 Ă. 2 ÿ. 3. ÖúöčŠ ðüś ÷ (DM, HT) ĕéøš ïĆ ÖćøðøïĆ đðúę÷Ċ îóùêĉÖøøö >70 / / / / 3 Ă. 2 ÿ. 4. ñĎðš śü÷đïćĀüćîĕéøš ĆïÖćøÙéĆ ÖøĂÜõćüąĒìøÖàšĂî >60 / / / +/- (êć ĕê đìšć) 5. ñĎšðüś ÷ÙüćöéîĆ ēúĀĉêÿĎÜĕéšøĆïÖćøÙéĆ ÖøĂÜ >60 / / / - õćüąĒìøÖàšĂî (ĕê) 6. ñĎðš üś ÷đïćĀüćî ÙüćöéîĆ ēúĀêĉ ÿÜĎ ìöĊę ĊõćüąĒìøÖàšĂî 100 / / / - ĕéšøïĆ ÖćøéĎĒúøĆÖþć/ÿÜŠ êŠĂ êüĆ ßüĊĚ ĆéñúúĆóíŤéćš îÖøąïüîÖćøðŜĂÜÖîĆ 1. øĂš ÷úąñšĎðüś ÷đïćĀüćîøć÷ĔĀöŠ <4 / / / / 2. øĂš ÷úąñšðĎ üś ÷ÙüćöéîĆ ēúĀĉêÿĎÜøć÷ĔĀöŠ <8 / / / / êĆüßĊĚüĆéñúúĆóíŤéćš îÖøąïüîÖćøøÖĆ þć 1. øĂš ÷úą×ĂÜñĎšðüś ÷đïćĀüćîìÙęĊ üïÙčöøąéĆïîćĞĚ êćúĕéš >50 / / / - 2. øšĂ÷úą×ĂÜñšðĎ üś ÷ÙüćöéîĆ ēúĀĉêìĊÙę üïÙčöĕéš >40 / / / - êĆüßĊĚüĆééšćîÖćøóçĆ îćøąïïïøĉÖćø 1. ÖćøÝĆéïøĉÖćø NCD ÙúĉîÖĉ ĔîÿëćîïøÖĉ ćøÿ×č õćó >70 / / /- øąéïĆ F1/M/S/A การแพทยไทย ๒๕๕๔-๒๕๕๗ First Edition

6-38 โรคเบาหวาน (Diabetes Mellitus) êćøćÜìęĊ 6.24 ĒîüìćÜ (öćêøåćî) éšćîïčÙúćÖø (service plan)66 ïÙč úćÖø A S M1 M2 F1 F2 F3 P1 P2 Ăć÷čøĒóì÷ēŤ øÙĕê // ÝÖĆ þčĒóì÷Ť // Ăć÷øč Ēóì÷ēŤ øÙĀĆüĔÝ // Ăć÷øč Ēóì÷êŤ ŠĂöĕøšìĂŠ // Ăć÷øč Ēóì÷ŤìüęĆ ĕð // / // ìöĊ ðøąÿćîÜćîēøÙĕöêŠ éĉ êŠĂøąéĆïÝÜĆ ĀüéĆ (system management team)* ñÝšĎ éĆ ÖćøðøąÿćîÜćîđïćĀüćî ÙüćöéĆîēúĀêĉ ÿĎÜ // / / (DH-HT case manager/coordinator) ó÷ćïćúñĎšÝĆéÖćøøć÷ÖøèĊ (advance diabetes foot & / / / / wound care and lifestyle modification) ó÷ćïćúìñĊę ćŠ îÖćøĂïøöđÞóćąìćÜĂć÷øč Öøøö // / / ó÷ćïćúđüßðäïĉ êĆ ĉ / / / / //// / ó÷ćïćúìüęĆ ĕð / / / / //// / DM educator / / / / /// health coaching / / / / /// îĆÖÖćĞ ĀîéĂćĀćø / / / / +/- îÖĆ ÿč×õćóÙøĂïÙøĆü // Āöć÷đĀêč: *đðŨîïÙč úćÖøøąéĆïÝÜĆ ĀüéĆ ÝĆéĔĀöš ĊĂ÷ćŠ ÜîšĂ÷ 1 ìĊö/ÝĆÜĀüéĆ Thailand Medical Services Profile 2011 - 2014