Since diabetes management is complex for health systems at every level, embedding the DSMS program into routine practice is quite difficult. This is especially the case for health facilities with a large patient volume and limited personnel resources. In Thailand, barriers to continuing a DSMS program service include low public awareness, high healthcare worker turnover and workloads in rural areas, insufficient resource, and staff shortages(Deerochanaworg&Ferrari,2013). Therefore, the evaluation of DSMS programs is important in order to assess their overall impact as well as potential application into "real word" practice. However, most randomized controlled trials (RATs) of DSMS intervention have emphasized only on efficacy of outcomes rather than overall impact (Eldridge et al.,2008).