Karmacharya, Biraj, Sapkota, Sujata, Rai, Prasanna, Nikolaou, Charoula ORCID: https://orcid.org/0000-0001-6519-4174, Kasti, Roshan, Bhattarai, Jyoti, Maharjan, Rashmi, Shrestha, Abha, Shrestha, Archana, Bhattarai, Binaya, Leeds, Anthony, McIntosh, Alasdair and Lean, Michael (2024) 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. The Lancet Regional Health-Southeast Asia, 29:100465. pp. 1-9. ISSN 2772-3682 (Online) (doi:10.1016/j.lansea.2024.100465)

Preview

PDF (VoR) 47815_NIKOLAOU_A_service_evaluation_of_weight_management_for_glycaemic_control_and_remission _of_type_2_diabetes.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. Download (467kB) | Preview

Abstract

Summary
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.

Item Type:	Article
Uncontrolled Keywords:	type 2 diabetes; weight management; ethnicity; remission; traditional diet; Nepal
Subjects:	R Medicine > R Medicine (General) R Medicine > RZ Other systems of medicine S Agriculture > S Agriculture (General)
Faculty / School / Research Centre / Research Group:	Faculty of Engineering & Science Faculty of Engineering & Science > Natural Resources Institute Faculty of Engineering & Science > Natural Resources Institute > Centre for Food Systems Research > Food Systems & Nutrition
Related URLs:	Publisher
Last Modified:	05 Sep 2024 12:16
URI:	http://gala.gre.ac.uk/id/eprint/47815

Actions (login required)

View Item

Downloads