Pushpanjali Shakya, Registered Nurse and Diabetes Educator in Nepal cum PhD candidate, Global Health, NTNU
World Diabetes Day important for awareness
Addressing World Diabetes Day on 14 November each year is imperative to create awareness about diabetes. Being one of the top four chronic diseases in the world, the word “diabetes” must be well known to most people – especially those who have been dealing with it.
Diabetes is a complex disease
Even though it is a single disease, diabetes can lead to co-morbidities like hypertension, heart disease, nephropathy, neuropathy, stroke, and diabetes foot among others. Diabetes has a dreadful impact in terms of health, emotion, and economic condition of the patient. Long term management with medical checkups, proper lifestyle modification, and adherence to medication are required in diabetes. This is costly, especially in those countries where people have to pay out of their pocket for treatment.
Treatment and prevention
Even though it cannot be cured, diabetes can be controlled with the aforementioned strategies. People can live life happily and normally for a long period even though they have diabetes. It does, however, require acceptance and adjustment in lifestyle. Another essential aspect of diabetes is that it can be prevented beforehand if we detect its risk factors on time, especially for type 2 diabetes mellitus and gestational diabetes. People with high risk of developing diabetes and people with prediabetes can be prevented from developing diabetes with simple lifestyle modification, even without taking any medications.
Preventing diabetes by detecting risk factors
Detection of prediabetes stage is vital for prevention of diabetes. There should be thorough screening among risk groups of diabetes like those having a family history of the disease, age above 45 years, obesity, co-morbidities like hypertension, among others. In addition to screening, proper counseling regarding psychological, social, and medical aspects would help people to prevent diabetes.
PhD project about diabetes in Nepal
My PhD project is aimed towards prevention of diabetes in the Nepalese population with prediabetes. The title of my project is “Effectiveness of Diabetes Prevention Education Program in the prediabetes population in Nepal: A cluster randomized controlled trial (DiPEP)”.
Working closely with the community
The project is a community based interventional study. Hence, a screening camp was the best option for us to reach the target population/participants in the allocated study sites of Dhulikhel Municipality and Patan (Lalitpur Metropolitan City). Community work needs adequate collaboration and cooperation from local stakeholders. We had several rounds of meetings and orientation programs about the project in the local government body – municipality level as well as sub-municipal levels in wards and toles (settlements). That was one of the key factors leading to successful organization of more than 150 camps in the study sites within four months (max 88 camps in December 2019). We organized four camps within a single day allocating two hours for each tole mobilizing enthusiastic research staff and community. We conducted camps in all possible areas in different time slots of the day starting from 9 am until 5 pm to include as many potential participants as possible. In every screening camp, we measured random blood sugar and HbA1c with the help of a point of care testing method after taking verbal consent for the screening. We defined our participants as prediabetes with an HbA1c ranging from 5.7- 6.4%. After detecting, we enrolled them in our intervention sessions conducted in the community.
Creating a diabetes prevention program tailored for Nepal
Diabetes prevention programs have been in existence in the Western world since the 1990s and their effectiveness has been studied thoroughly. However, developing countries like Nepal have not yet started any such programs. Hence, we developed a curriculum of four weekly sessions lasting from 1 to 1.5 hours, which is tailored to Nepalese cultural context. We trained community health care workers and volunteers to facilitate during the intervention session. However, the main intervention was conducted by a diabetes educator (myself) and other nurses who were trained specially for this intervention. We also provided a pictorial diabetes prevention brochure in the Nepali language, a diabetes prevention exercise calendar and a daily food booklet to all the participants of the intervention clusters. They were followed up by trained community health care workers and volunteers biweekly, either via phone call or by conducting follow up sessions in the community. We provided only the pictorial diabetes prevention brochure to the participants of control clusters.
The project continues – with certain COVID-19 adjustments
Because of the COVID-19 pandemic, we stopped both our screening camps and intervention sessions from mid-March 2020. After adjustments to the project following the COVID-19 situation, we could only resume group intervention sessions to remaining participants via digital media from mid-August 2020. Our trained health care workers and volunteers are with the help of our research staff following up our participants biweekly via phone call and also we are conducting monthly digital meetings. We are also having endline data collection through phone calls. It is indeed a challenge to continue the project activities during this pandemic, but we are encouraged by the positive feedback from our participants that they feel cared for even during such tough times.
The biggest task
Working for diabetes care needs immense support, collaboration, cooperation from all stakeholders like institutions, government bodies, local bodies, medical and non-medical professionals, community members, volunteers and all direct and indirect support. Let’s join hands together and mark World Diabetes Day 2020 in honor of all the people with diabetes and everybody working for diabetes care!
Norwegian Research School of Global Health 