TY - JOUR
T1 - Effectiveness of a dietician-led intervention in reducing glycated haemoglobin among people with type 2 diabetes in Nepal
T2 - a single centre, open-label, randomised controlled trial
AU - Sunuwar, Dev Ram
AU - Nayaju, Suvash
AU - Dhungana, Raja Ram
AU - Karki, Kshitij
AU - Singh Pradhan, Pranil Man
AU - Poudel, Pramod
AU - Nepal, Chitrakala
AU - Thapa, Madhu
AU - Shakya, Nani Shobha
AU - Sayami, Matina
AU - Shrestha, Pradip Krishna
AU - Yadav, Renu
AU - Singh, Devendra Raj
N1 - Funding Information:
We would like to extend our gratitude to all staff of the Endocrinology Department of TUTH for their facilitation and cooperation during data collection. We are always indebted to all the people with type 2 diabetes who provided us with their time and thoughtful responses. Our sincere gratitude goes out to Ms. Sajani Shrestha, Ms. Nisha Shree Gautam, Mr. Lilamani Hayu, and Ms. Anuradha Bhatta for their support in collecting the baseline and end-line data. We would also like to thank Dr. Bipin Adhikari from the Nuffield Department of Medicine, University of Oxford, Oxford, the United Kingdom, for his kind suggestions and for proofreading the final version of the manuscript. We would also like to acknowledge the University Grants Commission (UGC) of Nepal for funding this study.
Funding Information:
The research was funded by the University Grants Commission (UGC), Nepal.We would like to extend our gratitude to all staff of the Endocrinology Department of TUTH for their facilitation and cooperation during data collection. We are always indebted to all the people with type 2 diabetes who provided us with their time and thoughtful responses. Our sincere gratitude goes out to Ms. Sajani Shrestha, Ms. Nisha Shree Gautam, Mr. Lilamani Hayu, and Ms. Anuradha Bhatta for their support in collecting the baseline and end-line data. We would also like to thank Dr. Bipin Adhikari from the Nuffield Department of Medicine, University of Oxford, Oxford, the United Kingdom, for his kind suggestions and for proofreading the final version of the manuscript. We would also like to acknowledge the University Grants Commission (UGC) of Nepal for funding this study.
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background: Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D. Methods: An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24−64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367. Findings: Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: −0.80 to −0.16), while it increased in the control group by 0.22 (95% CI: −0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: −1.04 to −0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: −36.12 to −1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group. Interpretation: The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs. Funding: The research was funded by the University Grants Commission (UGC), Nepal.
AB - Background: Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D. Methods: An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24−64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367. Findings: Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: −0.80 to −0.16), while it increased in the control group by 0.22 (95% CI: −0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: −1.04 to −0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: −36.12 to −1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group. Interpretation: The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs. Funding: The research was funded by the University Grants Commission (UGC), Nepal.
KW - Diet counselling
KW - Dietary approach
KW - Dietician delivered
KW - Dietician led
KW - Nepal
KW - Nutrition education
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85172126670&partnerID=8YFLogxK
U2 - 10.1016/j.lansea.2023.100285
DO - 10.1016/j.lansea.2023.100285
M3 - Article
C2 - 38028163
AN - SCOPUS:85172126670
VL - 18
JO - The Lancet Regional Health - Southeast Asia
JF - The Lancet Regional Health - Southeast Asia
SN - 2772-3682
M1 - 100285
ER -
