A service evaluation of weight management for glycaemic control and remission of type 2 diabetes using traditional food in Nepal (Ho-DIRECT NEPAL): a single-arm trial

IF 5 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet regional health. Southeast Asia Pub Date : 2024-08-17 DOI:10.1016/j.lansea.2024.100465
Biraj Karmacharya , Sujata Sapkota , Prasanna Rai , Charoula Nikolaou , Roshan Kasti , Jyoti Bhattarai , Rashmi Maharjan , Abha Shrestha , Archana Shrestha , Binaya Bhattarai , Anthony R. Leeds , Alasdair McIntosh , Michael E.J. Lean
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Abstract

Background

Remission of early type 2 diabetes (T2D) is possible; however, diet programmes proven effective are unaffordable in many southeast Asian populations where T2D is more frequent and more aggressive at lower body weight and younger age. We evaluate an entirely food-based service.

Methods

This study employed a single-arm intervention and follow-up design for intervention evaluation in existing hospital people with T2D of under 5 years known duration. Individuals attending a diabetes clinic in Kathmandu with early T2D (<5 years) aged 30–70 years, BMI ≥23 kg/m2, were offered a low-cost nutritionally complete diet-programme, using traditional Nepali foods to provide 8-weeks ∼850 kcal/day weight loss induction, and then weight maintenance. The participants received 4-weekly dietetic appointments (30–45 min) and verbo-pictorial leaflets using household measures. Glucose-lowering medications (49/70 at baseline) were stopped at baseline or soon after. The study was registered as ISRCTN10671396, testing a traditional food-based intervention for weight loss and T2D remission.

Findings

For 70 individuals (45 female) invited between March 19, 2022 and September 19, 2023, baseline mean (SD) age was 48.6 (9.9) years, bodyweight 74.6 (9.5) kg, BMI 29.7 (3.6) kg/m2, known diabetes duration 2.5 (1.9) years, HbA1c on treatment 8.1 (1.6) %. At 12, 24 and 52 weeks respectively, evaluating n = 44, 46, 45, bodyweight was 70.1 (8.5), 69.8 (8.9), 70.0 (8.8) kg, HbA1c 6.8 (0.9), 6.9 (1.5), 7.1 (1.3) %; HbA1c <6.5% was recorded for 46%, 48% and 36% and remission of T2D (HbA1c <6.5% off medication >3 months) in 43%, 39% and 29%. The main reported adherence barriers were fears of weakness, hunger, and inconvenience during travel. Incentives were ease of the diet, reduced doses and costs of medications, and improved appearance.

Interpretation

Traditional food-based weight management can valuably improve control, reduce medication needs, and generate remissions of established T2D, but adherence barriers must be overcome to optimise outcomes.

Funding

All Saints Educational Trust, England.

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尼泊尔利用传统食品控制血糖和缓解 2 型糖尿病的体重管理服务评估(Ho-DIRECT NEPAL):单臂试验
背景早期 2 型糖尿病(T2D)的缓解是可能的;然而,在东南亚的许多人群中,T2D 的发病率更高,且在体重较轻和年龄较小的人群中更具侵袭性。我们对一项完全以食物为基础的服务进行了评估。方法这项研究采用单臂干预和随访设计,对已知病程不足 5 年的现有医院 T2D 患者进行干预评估。在加德满都一家糖尿病诊所就诊的早期 T2D(5 年)患者年龄在 30-70 岁之间,体重指数≥23 kg/m2,他们接受了一项低成本、营养全面的饮食计划,该计划使用传统的尼泊尔食品,提供为期 8 周、每天 850 千卡热量的减肥诱导,然后维持体重。参与者每 4 周接受一次营养师预约(30-45 分钟),并利用家庭措施获得文字图片传单。降糖药物(基线时为 49/70)在基线时或不久后停止使用。研究结果在2022年3月19日至2023年9月19日期间受邀的70人(45名女性)中,基线平均(标清)年龄为48.6(9.9)岁,体重为74.6(9.5)公斤,体重指数为29.7(3.6)公斤/平方米,已知糖尿病病程为2.5(1.9)年,治疗期间的HbA1c为8.1(1.6)%。12 周、24 周和 52 周时,评估 n = 44、46、45,体重分别为 70.1 (8.5)、69.8 (8.9)、70.0 (8.8) kg,HbA1c 分别为 6.8 (0.9)、6.9 (1.5)、7.46%、48% 和 36% 的患者 HbA1c 为 6.5%,43%、39% 和 29% 的患者 T2D 缓解(停药 3 个月后 HbA1c 为 6.5%)。据报告,坚持治疗的主要障碍是担心身体虚弱、饥饿和旅行不便。解释传统的以食物为基础的体重管理可有效改善控制、减少药物需求并使已确诊的 T2D 患者病情缓解,但必须克服坚持治疗的障碍,才能取得最佳效果。
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