A Community-Based Diabetes Prevention and Management Education Program in a Rural Village in India PADMINI BALAGOPAL, PHD, CDE, RD 1 N. KAMALAMMA, PHD 1 THAKOR G. PATEL, MD, MACP 2 RANJITA MISRA, PHD, CHES, FMALRC 3 OBJECTIVE — In this study we evaluated a 7-month community-based nonpharmacological lifestyle intervention to prevent/reduce the risk of developing diabetes and its complications in a resource-poor village in Tamilnadu, India. RESEARCH DESIGN AND METHODS — A total of 703 village inhabitants, compris- ing adults and youth aged 10 –92 years, were provided educational intervention using “trained trainers.” Culturally and linguistically appropriate health education messages addressed diet, physical activity, and knowledge improvement. The prevalence of diabetes and the effectiveness of the intervention were assessed using select parameters. RESULTS — The crude prevalences of diabetes and pre-diabetes among adults were 5.1 and 13.5%, respectively, while the prevalence of pre-diabetes in youth aged 10 –17 years was 5.1%. Intervention reduced fasting blood glucose levels of pre-diabetic adults by 11%, pre-diabetic youth by 17%, and type 2 diabetic adults by 25%. Improvements in obesity parameters and dietary intake also occurred. A stepwise worsening of parameters progressing from the normo- glycemic state to the impaired levels of pre-diabetes and diabetes was observed. CONCLUSIONS — This study has charted the increasing prevalence of diabetes and pre- diabetes in rural India. Educational intervention was successful in reducing some of the obesity parameters and improving dietary patterns of individuals with pre-diabetes and diabetes. Diabetes Care 31:1097–1104, 2008 I ndia has the dubious distinction of having the highest prevalence of diabe- tes worldwide (1–3). Further, the number of individuals with diabetes will reach 79.4 million by 2030 with earlier age manifestations (1,2,4). Approxi- mately 70% of India’s population lives in rural areas (2) in resource-poor settings where the increasing prevalence and chronic nature of type 2 diabetes become added burdens (5). Lack of awareness and poor access to quality care increase diabe- tes-related complications (5). Lifestyle intervention is the most cost-effective strategy to prevent type 2 diabetes (5,6). However, there have been few well-designed studies in rural settings that have shown successful in- tervention in improving awareness and lifestyle. The purpose of this communi- ty-based program was to 1) assess the prevalence of type 2 diabetes and pre- diabetes and 2) evaluate the effective- ness of a nonpharmacological lifestyle intervention aimed at reducing risk fac- tors and improving disease self- management. The Diabetes Prevention and Management (DPM) program was designed to increase awareness at the grassroots level using the inclusive en- vironment of a whole village with a pop- ulation-based approach (7). Simple and practical lifestyle modifications were customized to educate the village in- habitants on type 2 diabetes risk factors and self-care. RESEARCH DESIGN AND METHODS — The study used a col- lective population approach. The dura- tion of the study was from October 2002 to April 2003. The village of Alamarathu- patti, one of the field sites of Gandhigram Rural Institute, was selected. This village had a population of 950 residents aged 10 years and of mixed socioeconomic strata (Table 1). An initial participatory rural analysis of the village enabled the involvement of the village leaders, peer educators, and resi- dents in the planning and implementation phases of the project and served to highlight resources and requirements. Trained indi- viduals performed data collection and edu- cational intervention. Face-to-face interviews were considered the most appro- priate method because 41% of respondents had less than a fifth grade education. The study was approved by the Institutional Review Board of Texas A & M University, and written informed consent was ob- tained from all participants. Sample size Although 850 residents participated in the baseline survey, 703 individuals (118 youth aged 10 –17 years and 585 adults) completed the postintervention survey questionnaire, resulting in a response rate of 74%; the attrition rate due to migra- tions and refusals was 17%. Recruitment of respondents was completed through door-to-door visitations. There were two data collection points for the study, i.e., baseline and postintervention, and data were collected by trained personnel. No monetary compensation was provided, but health appraisal data were dissemi- nated to the participants. Measurements Demographic characteristics included a personal/family history of diabetes, edu- cational level, income, diet pattern, and smoking/alcohol intake. Because of a marked resistance among the village in- habitants toward venous blood drawing, capillary blood glucose values were used ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From the 1 Gandhigram Rural Institute, Tamilnadu, India; the 2 Uniformed Services University of the Health Sciences, Bethesda, Maryland; and the 3 Department of Health and Kinesiology, Texas A&M University, College Station, Texas. Corresponding author: Ranjita Misra, 4243 TAMU, Room 158V Read Building, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843. E-mail: misra@hlkn.tamu.edu. Received for publication 24 August 2007 and accepted in revised form 24 February 2008. Published ahead of print at http://care.diabetesjournals.org on 3 March 2008. DOI: 10.2337/dc07-1680. Abbreviations: DPM, Diabetes Prevention and Management; FBG, fasting blood glucose; IFG, impaired fasting glucose; NGL, normoglycemic level; WHR, waist-to-hip ratio. © 2008 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Clinical Care/Education/Nutrition/Psychosocial Research O R I G I N A L A R T I C L E DIABETES CARE, VOLUME 31, NUMBER 6, JUNE 2008 1097