CoDiRECT-Nepal: detection, prevention and remission of type 2 diabetes: a novel community-owned dietary model

Background

This project takes a novel approach to address UN Sustainable Development Goal-3.4, to reduce premature mortality from noncommunicable diseases (NCD). Type 2 diabetes (T2D) seriousness is often under-recognised. Partly via related NCD risks, it reduces life expectancy by 6 years on average, and >10 years when diagnosed under age 40. Recent urbanisation to under-served communities, and heavily-marketed high-fat/sugar/salt foods, coupled with greater Asian predisposition to T2D at lower age and lower body weight, generates very high disease burdens. Western treatments are inaccessible and unaffordable to most peri-urban communities.

Our Diabetes Remission Clinical Trial (DiRECT) established that T2D is reversible, into remission for 2 years, for >70% by losing >10kg, and 36% overall. Five-year results show protection against medical events, despite imperfect weight loss maintenance. Invited by a Nepal community empowerment charity to help with rising disabilities from T2D in disadvantaged periurban communities, the applicants have collaborated to design a culturally-adapted nutritionally-complete diet programme, based on DiRECT, but using only low-cost Nepali traditional local foods and meals. Pilot studies (n=70) have found high acceptability and 42% T2D remissions in hospital patients.

Aims

This ‘Type-1 hybrid Effectiveness & Implementation’ project will first establish effect size among people with community-screen detected T2D, currently undiagnosed and untreated, with a 4m randomised trial and 12m observational data. It then explores the programme implementation for prevention, remission or amelioration of T2D and related metabolic drivers of NCDs, incorporating culturally-important ‘forgotten foods’.

Project plan

The programme will be delivered via existing community health volunteers with minimal call on healthcare professionals. The only test required for diagnosis, HbA1c, uses a validated portable analyser giving an immediate result. There are no costs to participants.

Detailed analysis of the intervention, suitability for large new peri-urban communities, and impacts from potentially influential sociocultural, environmental and policy factors will be explored using mixed-methods approaches. Evaluations will follow a merged Implementation Framework, with aims of optimising the programme content, delivery and policy support, in terms of community screening for T2D and prediabetes, diet programme uptake and adherence, T2D remissions as an indicator of NCD risk reduction.

The project is built on concepts of community empowerment, community engagement and community-focused implementation. Strong project management and stakeholder involvement focuses strongly on capacity building and engagement with local and national policy-makers, for scalability and sustainability. Impacts will be enhanced by making a documentary film about the project, for public and professional education and to influence policy-makers in Nepal and other countries.

Publications and output

To access publications and other outputs relating to this project, see our publications webpage.

Funding organisations

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