Health Education for Diabetes Prevention and Management in India

Introduction - Population-based interventions to tackle preventable risk factors could avert at least 80% of the chronic diseases such as type 2 diabetes making primary prevention a valuable and cost-effective strategy. The global burden of diabetes mellitus is most pronounced in India where socioeconomic and epidemiological transition along with a concomitant emergence of diabetes mellitus is a serious public health issue. The World Health Organization has predicted that individuals with diabetes mellitus in India will exceed 80 million in 2030, with the incidence of cases manifesting at younger ages. Objective - With 70% of India's population living in resource-poor rural areas, this study tested the effectiveness of 6-month community based diabetes prevention and management (DPM) program, in rural Gujarat, India. Research Design and Methods ¨C Community based participatory research method was used to plan and tailor the intervention by engaging community stakeholders and building trust and capacity. Trained Community Health Workers (CHWs) were used as change agents to provide health and lifestyle educations, serve as community advocates, and collect data. All project personnel underwent 4 weeks of structured training on the DPM curriculum and survey administration. Recruitment and intervention data was collected from 1638 rural Indians (81.9% response rate) using door-to-door visits by CHWs. Ten culturally and linguistically-appropriate health education messages were provided in face-to-face individual and group session to all participants. Group sessions included demonstrations of model meals and cooking techniques. Results ¨C Mean age was 41.9 ± 15.9 years. Overall point prevalence of diabetes, pre-diabetes, obesity and hypertension were 7.2%, 19.3%, 16.7%, and 28% respectively with significant differences between the low socioeconomic status (SES; agricultural workers) and the high SES (business community) due to differing diet and activity levels. Intervention significantly reduced blood glucose levels by 5.7and 14.9mg/dL for individuals with pre-diabetes and diabetes respectively, and systolic and diastolic blood pressure by 8 mmHg and 4mmHg respectively in the overall population. Knowledge of diabetes and cardiovascular disease improved by 50% in the high SES group and doubled in the low SES group; general and abdominal obesity also decreased by ≤ 1%. High rates of undiagnosed hypertension (26.1%) even in the low SES farm worker group were surprising. Among individuals with diabetes, metabolic complications such as diabetic nephropathy and chronic kidney disease were noted. Conclusion- Through collective engagement of the community, participatory programs can serve as a prototype for future prevention and management efforts which are rare/under-utilized in India.