A peer group-based lifestyle intervention programme, targeting individuals at high risk of developing type-2 diabetes, is being launched in a rural community in the State to assess the population impact of screening and interventions in reducing overall incidence.

Kerala Diabetes Prevention Programme (K-DPP) will be the first implementation trial in the country to target a rural population at high risk of developing diabetes, to develop cost-effective and community-based screening/prevention tools so that those in the pre-diabetes stage can be prevented from going on to develop full-blown diabetes.

K-DPP has been proposed by the Achutha Menon Centre for Health Science Studies (AMCHSS), the public health wing of Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), by partnering with Monash University of Australia.

The preliminary work on the project is complete and it is expected to be piloted among approximately 2,000 individuals in a rural community in Neyyattinkara taluk in the capital district soon.

“Kerala undoubtedly has the highest burden of diabetes in the country with 16.2 per cent of the population already having the disease and another significant per cent of the population in the pre-diabetes stage. In resource-poor settings like ours, it is important that along with the management of those with diabetes, we focus on the pre-diabetic population and prevent them from progressing into the diabetes state,” says K.R. Thankappan, the Director of AMCHSS.

The project is an attempt to understand if cost-effective and community-based programmes can be effective in bringing about behavioural changes in people and bring down the incidence of diabetes.

Controlled trial

K-DPP is looking at approaches which have the potential to be scaled up and implemented amongst larger populations of high-risk individuals in the country, Dr. Thankappan says.

The proposal is to conduct a cluster randomised controlled trial in 60 select wards in Neyyattinkara taluk, among individuals aged between 30 and 60 years. The ‘high-risk’ individuals will be identified using the Indian Diabetes Risk Score. These individuals will be assessed and monitored for bio-chemical, socio-demographic, and behavioural indices through follow-up clinics at 12, 24, and 36 months. The total study period will be five years.

“This is a peer-support programme which will address the socio-behavioural, lifestyle, and ecological determinants of diabetes. We have had very successful peer-support programmes in Australia amongst those with diabetes,” says Brian Oldenburg, Professor and Chair of International Public Health, School of Public Health and Preventive Medicine, Monash University, who is heading the K-DPP trial.

Prof. Oldenburg admits that while a person who is already diabetic might be more amenable to lifestyle changes, it is rather difficult to persuade and convince people who do not yet have diabetes to change their habits.

“We are looking at women as the change agents in families,” he says.

“About 22.2 per cent of the women in rural areas in Kerala have diabetes, which is quite alarming. In our cultural settings, women need peer-support and locality-based group activities to motivate them to take up lifestyle changes like a physical activity programme,” points out Dr. Thankappan.

The project tries to understand whether community-based programmes can reduce the incidence of diabetes.