Co-DiRECT Nepal: a community-based diet programme for remission of type 2 diabetes and amelioration of non-communicable disease risks

Co-DiRECT 尼泊尔：旨在缓解 2 型糖尿病和改善非传染性疾病风险的社区饮食计划

• 批准号: MR/Z000513/1
• 负责人: Mike Lean
• 金额: $ 71.73万
• 依托单位: University of Glasgow
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FZ000513%2F1
• 关键词: Co; DiRECT; Nepal; community; based

Layperson Summary Many Low and Middle Income Countries, such as Nepal, have massive and growing 'double burdens' of ill-health, as the chronic non-communicable diseases (NCD) associated with Western diets and lifestyles, most notably type 2 diabetes (T2D), are added to still-high levels of infectious diseases. Health services, except for relatively privileged people living near to private hospitals, are rudimentary. In the large peri-urban communities which have arisen from recent urban migration, modern diabetes care is inaccessible and unaffordable, and national budgets are unlikely ever to provide it.A Nepal charity, PHASE-Nepal, has pioneered community empowerment approaches to help with social welfare, education and health. Recognising the devastating effects of T2D in younger adults for families and communities, and the dramatic results of the diet intervention in our Diabetes Remission Clinical Trial (DiRECT), PHASE-Nepal invited the applicants to meet in Nepal, to consider adapting the DiRECT method as a low-cost sustainable diet programme which could be delivered within the communities to combat T2D, related NCDs and the adult weight gain which drives them. A diet plan based on DiRECT but using only traditional, local Nepali food and meals has been designed to be nutritionally complete, and pilot research has found it to be acceptable and to produce remissions of T2D in over 40% of people.The present project is built on concepts of community empowerment, community engagement and community-focused implementation. It will first test this diet approach in the real-life setting of Nepal's peri-urban communities, in larger numbers and over a 12-month period. People with undiagnosed, and untreated diabetes will be identified by a simple finger-prick screening test. Importantly, to maximise uptake and minimise costs, the screening and diet treatment will be delivered by 'Women Community Health Volunteers', members of the same communities who help with vaccination, screening and health promotion programmes.The project will document how effective the intervention is in this new setting, and explore in detail its implementation, ensuring no-one is disadvantages because of sex, wealth, caste etc. It uses surveys and interviews to identify barriers and incentives, among people with T2D, in their environment and services, and in local and national government policies. With strong local management for training and capacity-building, input from the DiRECT research team, and engagement with stakeholders and people living with T2D, we aim to make the programme attractive, affordable, effective, sustainable and widely transferable in Nepal and elsewhere. As well as conventional presentations and publication of results, a local film company will make a documentary about the project, to help spread the word and exert influence over policy-makers.

外行人总结许多尼泊尔等许多低收入国家和中等收入国家都具有巨大的“双重负担”不良健康，因为与西方饮食和生活方式相关的慢性非传染性疾病（NCD），最著名的是2型糖尿病（T2D），将其添加到不断增长的感染性疾病中。除了居住在私立医院附近的相对特权的人外，卫生服务是基本的。在最近的城市迁移中引起的大型城市郊区社区中，现代糖尿病护理是无法访问且无法承受的，而国家预算不太可能提供。认识到T2D在年轻人中对家庭和社区的毁灭性影响，以及我们糖尿病缓解临床试验（直接）饮食干预的巨大结果，邀请申请人在尼泊尔开会，考虑将直接方法适应为低成本的可持续饮食计划，可以在社区中提供与成人ncds and the t2d and thert the the Clock and the Reactive and Sublisity and Sublistion and where the Reage。基于直接但仅使用传统的当地尼泊尔食品和餐食的饮食计划旨在在营养上完成，而Pilot Research发现它是可以接受的，并且可以在40％的人群中恢复T2D。目前的项目建立在社区授权，社区参与和社区重点的实施的概念上。它将首先在尼泊尔郊区社区的现实生活中测试这种饮食方法，数量较大，在12个月的时间内。通过简单的手指筛查测试，将确定患有未诊断和未经治疗的糖尿病的人。重要的是，为了最大程度地提高吸收和最小化成本，筛查和饮食治疗将由“妇女社区健康志愿者”，帮助进行疫苗接种，筛查和健康促进计划的相同社区的成员提供。该项目将记录干预措施在这种新环境中的有效性，并确保详细范围内的范围和探索其范围内的范围，以确保其范围内的性能，并且由于性能，既有性别，因此均可进行。在有T2D的人中，在其环境和服务以及地方和国家政府政策中的激励措施。在培训和能力建设，直接研究团队的投入以及与利益相关者和T2D的人们的互动的情况下，我们的目标是使该计划在尼泊尔和其他地方具有吸引力，负担得起，有效，可持续性且可转让。除了传统的演讲和结果发布外，当地电影公司还将制作有关该项目的纪录片，以帮助传播对政策制定者的影响并发挥影响力。