Community‐based lifestyle intervention for diabetes (Co‐LID study) management in rural Nepal: study protocol for a clustered randomized controlled trial

Abstract

Background Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally

adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based cultur- ally appropriate lifestyle intervention in improving the management and care of people with T2DM.

Methods We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly

selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bag- mati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual

care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered

over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing sup- port, supervision and monitoring, follow-up from the trained community health workers, and educational materials

on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. Discussion This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. Trial registration Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.