Effectiveness of Community-based Lifestyle Intervention for Diabetes (Co-LID study) Management in Rural Nepal: A Clustered Randomised Controlled Trial
1
School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
2
Appleton Institute, Physical Activity Research Group, Central Queensland University, Rochampton, Australia
3
Translational Health Research Institute, Western Sydney University, Sydney, Australia
4
Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
5
Department of Community Medicine,, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
6
Section of Global Health, Department of Hygiene and Public Health, Tokyo Women’s Medical University, Tokyo, Japan
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Type 2 diabetes mellitus (T2DM) has become a global concern, posing a significant health and economic burden in low-income countries including in Nepal. This underscores the urgent need for designing and implementing a cost-effective T2DM intervention. In this study, we assessed the effectiveness of community-based culturally appropriate health behaviour intervention to improve the management and care of people with T2DM.
METHODS:
We conducted a cluster randomised control trial among 481 patients with T2DM in Kavrepalanchowk and Nuwakot districts, Nepal, consisting of 30 healthcare facilities, randomly assigned into 15 interventions and 15 usual care groups. Intervention participants received community health workers and peer supporters-led fortnightly education sessions and phone calls to adopt and maintain healthy self-care behaviours over 6-month. The primary outcome was changes in HbA1c level and the secondary outcomes were quality of life, health care utilisation, self-care behaviour, oral health profile and economic assessment, assessed at baseline and 6-month. Generalised Estimating Equations models were applied to assess the impact.
RESULTS:
The mean HbA1c among the intervention participants decreased by 0.26%, however, it increased by 0.32% in the control participants (adjusted OR: -0.518 CIs: -0.993 to -0.042, p=0.033). Positive effects were observed in secondary outcomes including quality of life (0.035, p=0.124), health literacy (0.03, p=0.738), tobacco use (-6.58%, p=0.266), systolic and diastolic blood pressure (-0.60, p=0.810 and -0.61, p=0.641), health facility visits (7.20%, p=0.206), specialist visits (13.52%, p=0.011), physical activity (3.81%, p=0.426), and blood glucose monitoring (7.19%, p=0.258). Further, the effects of intervention sessions on health facility visits (1.16, 95% CI: 1.05-1.28, p-0.004) and tobacco use (0.86, 95% CI: 0.78-0.96, p-0.005).
CONCLUSIONS:
The community-based health behaviour intervention in Nepal showed a moderate level of effectiveness in the management of T2DM. A large-scale intervention with longer-term follow-up across diverse setting is warranted to examine the full impact of the intervention.
Type 2 diabetes mellitus (T2DM) has become a global concern, posing a significant health and economic burden in low-income countries including in Nepal. This underscores the urgent need for designing and implementing a cost-effective T2DM intervention. In this study, we assessed the effectiveness of community-based culturally appropriate health behaviour intervention to improve the management and care of people with T2DM.
METHODS:
We conducted a cluster randomised control trial among 481 patients with T2DM in Kavrepalanchowk and Nuwakot districts, Nepal, consisting of 30 healthcare facilities, randomly assigned into 15 interventions and 15 usual care groups. Intervention participants received community health workers and peer supporters-led fortnightly education sessions and phone calls to adopt and maintain healthy self-care behaviours over 6-month. The primary outcome was changes in HbA1c level and the secondary outcomes were quality of life, health care utilisation, self-care behaviour, oral health profile and economic assessment, assessed at baseline and 6-month. Generalised Estimating Equations models were applied to assess the impact.
RESULTS:
The mean HbA1c among the intervention participants decreased by 0.26%, however, it increased by 0.32% in the control participants (adjusted OR: -0.518 CIs: -0.993 to -0.042, p=0.033). Positive effects were observed in secondary outcomes including quality of life (0.035, p=0.124), health literacy (0.03, p=0.738), tobacco use (-6.58%, p=0.266), systolic and diastolic blood pressure (-0.60, p=0.810 and -0.61, p=0.641), health facility visits (7.20%, p=0.206), specialist visits (13.52%, p=0.011), physical activity (3.81%, p=0.426), and blood glucose monitoring (7.19%, p=0.258). Further, the effects of intervention sessions on health facility visits (1.16, 95% CI: 1.05-1.28, p-0.004) and tobacco use (0.86, 95% CI: 0.78-0.96, p-0.005).
CONCLUSIONS:
The community-based health behaviour intervention in Nepal showed a moderate level of effectiveness in the management of T2DM. A large-scale intervention with longer-term follow-up across diverse setting is warranted to examine the full impact of the intervention.
| eISSN: | 2654-1459 |
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