Feasibility of prevention of type 2 diabetes in low- and middle-income countries

Diabetologia, Journal Year: 2024, Volume and Issue: 67(5), P. 763 - 772

Published: Feb. 15, 2024

Abstract Type 2 diabetes is a leading cause of global mortality and morbidity. Nearly 80% individuals with live in low- middle-income countries (LMICs), where nearly half those the condition remain undiagnosed. The majority known cases have sub-optimal clinical outcomes. Moreover, large populations impaired glucose tolerance and/or fasting contribute to rapid increase type diabetes. Globally, priority should be given limit population diabetes, especially LMICs, alongside actions optimise care people diagnosed Primary prevention studies LMICs generated evidence show efficacy scalability strategies fully prevent or delay development high-risk groups. However, these are mainly limited certain Asia, particularly China India. indicated that policies effective high risk they also long-term benefits, not only for but associated metabolic disorders, such as CVDs. For conduct national programmes, innovative mechanisms must implemented, use information technology, joint efforts multiple teams implementing similar involvement governmental non-governmental partnerships. Continuous monitoring required assess utility programmes. effectiveness programmes has been proven over longer term, except China. Despite available evidence, feasibility at level remains an enigma. There challenges form cultural, societal economic constraints; insufficient infrastructure healthcare capacity; non-fully elucidated natural history determinants LMICs. Graphical

Language: Английский

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Type 2 Diabetes Prevention Programs—From Proof-of-Concept Trials to National Intervention and Beyond

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(5), P. 1876 - 1876

Published: Feb. 27, 2023

The prevention of type 2 diabetes (T2D) in high-risk people with lifestyle interventions has been demonstrated by several randomized controlled trials. intervention effect sustained up to 20 years post-trial monitoring T2D incidence. In 2000, Finland launched the national plan. For screening for high risk, non-laboratory Finnish Diabetes Risk Score was developed and widely used, also other countries. incidence drug-treated decreased steadily since 2010. US congress authorized public funding a program (NDPP) It built around 16-visit that relies on referral from primary care self-referral persons either prediabetes or risk test. uses train-the-trainer program. 2015 started inclusion online programs. There limited implementation nationwide programs Despite convincing results RCTs China India, no translation level introduced there. efforts low-and middle-income countries are still limited, but have promising. Barriers efficient greater these than high-income countries, where many barriers exist. Health disparities socioeconomic status exist its factors form challenge preventive interventions. seems stronger commitment is needed, such as successful WHO Framework Convention Tobacco Control, which legally binds act.

Language: Английский

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Evaluation of a Smartphone-Based Weight Loss Intervention with Telephone Support for Merchant Women With Obesity in Côte d'Ivoire: Protocol for a Randomized Controlled Trial

JMIR Research Protocols, Journal Year: 2025, Volume and Issue: 14, P. e69264 - e69264

Published: March 18, 2025

Background The obesity rate among women in Côte d'Ivoire is rising, particularly urban areas. Merchantry the leading occupation for country, and merchant face a high risk of owing to their sedentary lifestyle. A previous survey indicated that was 30%, double national average. Furthermore, 82.2% with were unaware condition, 40.1% expressed no interest losing weight. While most weight loss programs target individuals ready lose weight, community interventions should also address those minimal readiness. Additionally, low-cost weight-loss do not require health professionals are needed countries limited medical resources. Smartphones could offer cost-effective solution as they enable self-monitoring remote communication. Objective This study will evaluate smartphone-based intervention targets who without involvement professionals. Methods run 6 months, its efficacy be assessed an unblinded, parallel-group, randomized controlled trial 108 participants per group. All direct this carried out by staff qualifications. group receive weighing scales encouraged record smartphone app. Health education provided via weekly messages monthly phone calls. evaluation conducted face-to-face. primary outcome change, secondary differences body fat percentage, abdominal circumference, stage behavioral change behaviors from baseline 3, 6, 12 months. Results In accordance protocol, recruitment started on August 26, 2024. total 216 allocated, control began November 15, 2024, currently ongoing end Conclusions first sub-Saharan African implement app-based program Africa does care but specifically communities. if effectiveness confirmed, it has potential serve sustainable model at policy level. International Registered Report Identifier (IRRID) DERR1-10.2196/69264

Language: Английский

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1. Detection of diabetes and intermediate hyperglycaemia, and prevention of type 2 diabetes

Diabetes Research and Clinical Practice, Journal Year: 2025, Volume and Issue: unknown, P. 112145 - 112145

Published: April 1, 2025

Language: Английский

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Task-sharing for non-communicable disease prevention and control in low- and middle-income countries in the context of health worker shortages: A systematic review

PLOS Global Public Health, Journal Year: 2025, Volume and Issue: 5(4), P. e0004289 - e0004289

Published: April 16, 2025

Health workers are pivotal for non-communicable disease (NCD) service delivery, yet often unavailable in low- and middle-income countries (LMICs). There is limited evidence on what NCD-related tasks non-physician health (NPHWs) can perform their effectiveness. This study aims to understand how task-sharing used improve NCD prevention control LMICs. We also explored barriers, facilitators, unexpected consequences of task-sharing. Databases searched two phases included MEDLINE, EMBASE, CENTRAL, CINAHL, Cochrane, clinical trial registries, references studies from inception until 31 st July 2024. randomised trials (RCTs), cluster RCTs, associated process evaluation cost effectiveness studies. The risk bias was assessed using the Cochrane Risk Bias Tool v2. PROSPERO: CRD42022315701. found 5527 citations, 427 full texts were screened 149 (total population sample>432567) included. Most shared with nurses (n=83) community (n=65). focussed cardiovascular (n=47), mental (n=48), diabetes (n=27), cancer (n=20), respiratory diseases (n=10). Seventeen or more conditions. Eighty-one percent (n=120) reported at least one positive primary outcome, while 19 neutral results, a negative result, eight (5.4%) mixed findings. Economic analyses indicated that reduced total healthcare costs. Task-sharing an effective intervention NCDs It essential enhance competencies training NPHWs, provide resources augment capabilities, formalise role system community. Optimising requires holistic approach strengthens systems supporting NPHWs effectively addressing diverse needs communities. Registration: PROSPERO

Language: Английский

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Implementing text-messaging to support and enhance delivery of health behavior change interventions in low- to middle-income countries: case study of the Lifestyle Africa intervention

BMC Public Health, Journal Year: 2023, Volume and Issue: 23(1)

Published: Aug. 10, 2023

Abstract The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- middle-income countries (LMICs). Health behavior change (HBC) interventions the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology text messaging (SMS) to enhance reach participant engagement with these has great promise, yet we lack evidence-informed approaches guide integration SMS specifically support HBC LMIC contexts. To address this gap, integrated guidance from mHealth literature expertise first-hand experience establish specific development steps building implementing systems programming Specifically, provide real-world examples each step by describing our designing delivering an system a culturally-adapted DPP designed delivery South Africa. We outline eight key steps, including: 1) determining if appropriate; 2) developing architecture programming; 3) theory-based messages; 4) technology; 5) addressing international delivery; 6) testing; 7) training technical support; 8) cost considerations. discuss lessons learned extractable principles that may be use other researchers working similar Trial registration Clinicaltrials.gov, NCT03342274 . Registered 10 November 2017.

Language: Английский

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Cost-effectiveness of Lifestyle Africa: an adaptation of the diabetes prevention programme for delivery by community health workers in urban South Africa

Global Health Action, Journal Year: 2023, Volume and Issue: 16(1)

Published: May 23, 2023

Background Lifestyle Africa is an adapted version of the Diabetes Prevention Program designed for delivery by community health workers to socioeconomically disadvantaged populations in low- and middle-income countries (LMICs). Results from trial conducted under-resourced South indicated that programme had a significant effect on reducing haemoglobin A1c (HbA1c).Objective To estimate cost implementation cost-effectiveness (in per point reduction HbA1c) inform decision-makers resources required value this intervention.Methods Interviews were held with project administrators identify activities implement intervention. A direct-measure micro-costing approach was used determine number units unit each resource. The incremental one improvement HbA1c calculated.Results intervention equated 71 United States dollars (USD) costs participant 0.26 participant.Conclusions reduced relatively little holds promise addressing chronic disease LMIC. Decision-makers should consider comparative clinical effectiveness when making resource allocation decisions.Trial Registration Trial registration at ClinicalTrials.gov (NCT03342274).

Language: Английский

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Community-based type 2 diabetes care by lay village health workers in rural Lesotho: protocol for a cluster-randomized trial within the ComBaCaL cohort study (ComBaCaL T2D TwiC)

Trials, Journal Year: 2023, Volume and Issue: 24(1)

Published: Oct. 24, 2023

Abstract Background Type 2 diabetes (T2D) poses a growing public health burden, especially in low- and middle-income countries (LMICs). Task-shifting to lay village workers (VHWs) the use of digital clinical decision support systems (CDSS) are promising approaches tackle current T2D care gap LMICs. However, evidence on effectiveness worker-led models, which VHWs initiate monitor drug treatment addition community-based screening referral services, is lacking. Methods We conducting cluster-randomized trial nested within Community-Based Chronic Disease Care Lesotho (ComBaCaL) cohort study (NCT05596773) using (TwiC) design assess VHW-led, CDSS-assisted model rural Lesotho. Participants non-pregnant members ComBaCaL with T2D. The conducted approximately 100 villages two districts managed by trained supervised VHWs. In intervention villages, offer package including lifestyle counselling, first-line oral antidiabetic, lipid-lowering, antiplatelet guided tablet-based CDSS participants who clinically eligible, as well prefer or require facility-based care. control clusters, all will be referred facility for management. primary endpoint mean glycosylated haemoglobin (HbA1c) 12 months after enrolment. Secondary endpoints include 10-year risk cardiovascular events estimated World Health Organization prediction tool. Discussion was launched May 13, 2023, has enrolled 226 at date submission (October 6, 2023). To our knowledge, first task-shifting community level, prescription medication sub-Saharan Africa, thus provide missing such this setting. operating established VHW programme. Similar worker programmes exist across Africa may benefit from findings. Trial registration ClinicalTrials.gov NCT05743387. Registered February 24 2023.

Language: Английский

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Metformin for the prevention of diabetes among people with HIV and either impaired fasting glucose or impaired glucose tolerance (prediabetes) in Tanzania: a Phase II randomised placebo-controlled trial

Diabetologia, Journal Year: 2023, Volume and Issue: 66(10), P. 1882 - 1896

Published: July 18, 2023

Abstract Aims/hypothesis In sub-Saharan Africa (SSA), 5% of adults are living with type 2 diabetes and this is rising sharply, a greater increase among people HIV. Evidence on the efficacy prevention strategies in cohort scarce. We conducted Phase II double-blind placebo-controlled trial that aimed to determine impact metformin blood glucose levels prediabetes (defined as impaired fasting [IFG] and/or tolerance [IGT]) HIV SSA. Methods Adults (≥18 years old) who were stable care found have (IFG IGT) attending hospitals Dar es Salaam, Tanzania, randomised receive sustained-release metformin, 2000 mg daily, or matching placebo between 4 November 2019 21 July 2020. Randomisation used permuted blocks. Allocation was concealed database made visible only Chief Pharmacist after consent taken. All participants, research clinical staff remained blinded allocation. Participants provided information diet lifestyle had access various health following start coronavirus disease (COVID-19) pandemic. followed up for 12 months. The primary outcome measure capillary measured h 75 g load. Analyses by intention-to-treat. Results total, 364 participants (182 each arm) group. At enrolment, arms, mean 6.37 mmol/l (95% CI 6.23, 6.50) 6.26 6.15, 6.36), respectively, oral load 8.39 8.22, 8.56) 8.24 8.07, 8.41), respectively. final assessment at months, 145/182 (79.7%) individuals compared 158/182 (86.8%) indicated they taken >95% their medicines previous 28 days ( p =0.068). visit, 6.17 6.03, 6.30) 6.30 6.18, 6.42), 7.88 7.65, 8.12) 7.71 7.49, 7.94), Using linear mixed model controlling respective baseline values, difference group (metformin–placebo) −0.08 −0.37, 0.20) 0.20 −0.17, 0.58) post Weight significantly lower arm than arm: using adjusting weight −1.47 kg −2.58, −0.35). 16/182 (8.8%) serious adverse event (Grade 3 Grade Division Acquired Immunodeficiency Syndrome [DAIDS] grading table) died 18/182 (9.9%) arm; these events either unrelated unlikely be related study drugs. Conclusions/interpretation Blood decreased over time both arms during but did not differ months follow up. Metformin therapy safe use prediabetes. A larger longer needed establish if can safely Trial registration registered International Standard Randomised Controlled Number (ISRCTN) registry www.isrctn.com/ ), number: ISCRTN76157257. Funding This funded National Institute Health Research UK aid from Government support global research. Graphical

Language: Английский

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Dyslipidemia in Adults with Type 2 Diabetes in a Rural Community in Ganadougou, Mali: A Cross-Sectional Study

Published: Jan. 28, 2023

Dyslipidemia is a disorder where abnormally lipid concentrations circulate in the bloodstream. The common type 2 diabetics (T2D) and linked with T2D comorbidities, particularly cardiovascular disease. typically characterized by elevated plasma triglyceride low high-density lipoprotein cholesterol (HDL-C) levels. There significant gap literature regarding dyslipidemia rural parts of Africa, profiles may not be routinely captured through standard surveillance activities. This study aimed to characterize prevalence demographic profile patients community Ganadougou, Mali. We performed cross-sectional 104 subjects Ganadougou between November 2021 March 2022. Demographic were collected surveys blood tests. overall was 87.5% (91/104), which did differ sex (p = .368). High low-density (LDL-C) most abnormality (78.9%, [82/104]). associated age hypertension status .013 p .036, respectively). total high LDL-C parameters significantly .029 .006, In low-resource settings such as Mali, there critical need improve infrastructure for routine screening guide its prevention intervention approaches. rates observed Gandadougou, consistent concomitant increases diseases Africa suggest that assessments should incorporated into medical care African settings.

Language: Английский

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