A Community-Based Diabetes Prevention Program in a Rural India

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A Community-Based Diabetes Prevention Program in a Rural India
Objective: In this study we evaluated a 7-month community-based nonpharmacological lifestyle intervention to prevent/reduce the risk of developing diabetes and its complications in a resource-poor village in Tamilnadu, India.
Research Design and Methods: A total of 703 village inhabitants, comprising adults and youth aged 10–92 years, were provided educational intervention using "trained trainers." Culturally and linguistically appropriate health education messages addressed diet, physical activity, and knowledge improvement. The prevalence of diabetes and the effectiveness of the intervention were assessed using select parameters.
Results: The crude prevalences of diabetes and pre-diabetes among adults were 5.1 and 13.5%, respectively, while the prevalence of pre-diabetes in youth aged 10–17 years was 5.1%. Intervention reduced fasting blood glucose levels of pre-diabetic adults by 11%, pre-diabetic youth by 17%, and type 2 diabetic adults by 25%. Improvements in obesity parameters and dietary intake also occurred. A stepwise worsening of parameters progressing from the normoglycemic state to the impaired levels of pre-diabetes and diabetes was observed.
Conclusions: This study has charted the increasing prevalence of diabetes and pre-diabetes in rural India. Educational intervention was successful in reducing some of the obesity parameters and improving dietary patterns of individuals with pre-diabetes and diabetes.

India has the dubious distinction of having the highest prevalence of diabetes worldwide. Further, the number of individuals with diabetes will reach 79.4 million by 2030 with earlier age manifestations. Approximately 70% of India's population lives in rural areas in resource-poor settings where the increasing prevalence and chronic nature of type 2 diabetes become added burdens. Lack of awareness and poor access to quality care increase diabetes-related complications.

Lifestyle intervention is the most cost-effective strategy to prevent type 2 diabetes. However, there have been few well-designed studies in rural settings that have shown successful intervention in improving awareness and lifestyle. The purpose of this community-based program was to 1) assess the prevalence of type 2 diabetes and pre-diabetes and 2) evaluate the effectiveness of a nonpharmacological lifestyle intervention aimed at reducing risk factors and improving disease self-management. The Diabetes Prevention and Management (DPM) program was designed to increase awareness at the grassroots level using the inclusive environment of a whole village with a population-based approach. Simple and practical lifestyle modifications were customized to educate the village inhabitants on type 2 diabetes risk factors and self-care.

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