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

许多低收入和中等收入国家，如尼泊尔，都面临着巨大且不断增长的“双重健康负担”，因为与西方饮食和生活方式相关的慢性非传染性疾病（NCD），尤其是2型糖尿病（T2 D），是传染病发病率居高不下的原因。除了居住在私立医院附近的相对富裕的人之外，保健服务是基本的。在最近城市移民产生的大型城市周边社区，现代糖尿病护理无法获得且负担不起，国家预算也不太可能提供。尼泊尔慈善机构PHASE-Nepal率先采用社区赋权方法，帮助提供社会福利，教育和健康。认识到2型糖尿病在年轻人中对家庭和社区的破坏性影响，以及我们的糖尿病缓解临床试验（DiRECT）中饮食干预的显著结果，PHASE-Nepal邀请申请人在尼泊尔会面，考虑将DiRECT方法作为一种低成本的可持续饮食方案，可以在社区内提供，以对抗2型糖尿病，与非传染性疾病相关的疾病以及导致这些疾病的成人体重增加。一个饮食计划的基础上，但只使用传统的，当地的尼泊尔食品和膳食已被设计为营养完整，试点研究发现，它是可以接受的，并产生缓解T2 D在超过40%的人。本项目是建立在社区赋权，社区参与和社区为重点的实施概念。它将首先在尼泊尔城市周边社区的现实生活环境中测试这种饮食方法，在12个月的时间内进行大量测试。未确诊和未经治疗的糖尿病患者将通过简单的手指针刺筛查试验进行识别。重要的是，为了最大限度地提高接受率和降低成本，筛查和饮食治疗将由“女性社区健康促进者”提供，这些社区的成员帮助接种疫苗，筛查和健康促进计划。该项目将记录干预措施在这种新环境下的有效性，并详细探索其实施情况，确保没有人因为性别，财富，它使用调查和访谈来确定T2 D患者在其环境和服务以及地方和国家政府政策中的障碍和激励措施。通过对培训和能力建设的强有力的地方管理，来自DireCT研究团队的投入，以及与利益相关者和T2 D患者的接触，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，可持续和广泛的可转让性。除了传统的介绍和公布结果外，当地一家电影公司将制作一部关于该项目的纪录片，以帮助传播信息并对决策者施加影响。

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.