Abstract
BackgroundType 2 diabetes is one of the fastest emerging chronic diseases in low- and middle-income countries. Population-based approaches, such as involvement of lay health workers offering culturally appropriate diabetes health promotion, may be the blueprint for the management of type 2 diabetes. This study aims to examine the effectiveness of a family-based home health education intervention on type 2 diabetes provided by female community health volunteers (FCHVs) in a semi-urban area of Lekhnath Municipality of Nepal.MethodsThe COmmunity-Based INtervention for management of Diabetes in Nepal (COBIN-D) trial is a community-based, open-label, two-armed, cluster-randomized trial with seven randomly selected intervention and seven wait-list control clusters. A total of 112 subjects with type 2 diabetes will be recruited from the intervention clusters and 112 subjects from the wait-list control clusters. Based on the Health Belief Model and Social Support Theory, a 12-month family-based lifestyle intervention will be administered through FCHVs. Wait-list control clusters will continue to manage their glycemic condition as usual and their intervention will be delayed for 12 months. Participants will be measured at the beginning of the study and 12 months later. The primary outcome measure of the study will be difference in mean change (from baseline to 1 year) in fasting blood glucose between the two study arms. Impacts will be estimated using intention-to-treat analysis.DiscussionThe COBIN-D is the first study investigating the effect of family-based home health education and screening on blood sugar levels in adults by FCHVs at community level in Nepal. The perspective of this study is to develop and implement, in collaboration with the community, a community-based, culturally sensitive diabetes prevention and control program. It is anticipated that the study can act as a feasible and affordable tool for evidence-based integrated care for improvement of diabetes management and outcomes in Nepal as well as in other low- and middle-income countries.Trial registrationClinicalTrials.gov, Identifier: NCT03304158. Registered retrospectively on 03 October 2017.
Highlights
Introduction of Community-Based Management of Hypertension in Nepal (COBIN)D studyType 2 diabetes and its situation in NepalTheoretical aspects of diabetesDiabetes classification and its major risk factorsMeasurement of blood glucose, blood pressure, height, and weightCounseling and health promotion messages on major risk factors and medication compliancePractical session for counseling female community health volunteers (FCHVs) visitsRecording and reportingSelection of households
In our previous systematic review and meta-analysis [7], we reported that type 2 diabetes is emerging as a major healthcare problem in Nepal, with a prevalence rate of 8.4%; as the review suggests, there is minimal data regarding diabetes prevalence and risk factors in Nepal [7]
The COBIN-D is the first study investigating the effect of family-based health education and screening on blood sugar levels in adults by FCHVs at the community level in Nepal
Summary
Introduction of COBIND studyType 2 diabetes and its situation in NepalTheoretical aspects of diabetesDiabetes classification and its major risk factorsMeasurement of blood glucose, blood pressure, height, and weightCounseling and health promotion messages on major risk factors and medication compliancePractical session for counseling FCHV visitsRecording and reportingSelection of households. Counseling and health promotion messages on major risk factors and medication compliance. Type 2 diabetes is one of the fastest emerging chronic diseases in low- and middle-income countries. This study aims to examine the effectiveness of a family-based home health education intervention on type 2 diabetes provided by female community health volunteers (FCHVs) in a semi-urban area of Lekhnath Municipality of Nepal. While communicable diseases remain an important public health issue in low- and middle-income countries (LMICs), the rising burden of non-communicable diseases (NCDs) and their risk factors poses a double burden on health systems [1]. LMICs have higher predicted increases in prevalence rates, but people diagnosed with diabetes living in LMICs have worse blood glucose control compared to those living in high-income countries [5]
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