Innovative mobile-health led participatory approach to comprehensive screening and treatment of diabetes (IMPACT diabetes): rationale, design, and baseline characteristics

Abstract

Background: India has 66 million people with diabetes, of which a large proportion do not receive adequate care. The primary health centres can serve as platforms for early detection of diabetes and continuum of care. Objectives: This project evaluates a community-level technology-enabled system-level intervention based around the community health workers and primary-care physicians. We hypothesize that incorporation of a mobile clinical decision support system, with other process-level changes will improve identification and management of individuals with diabetes in primary care settings. Methods: A cluster-randomized trial in sixteen villages/peri-urban areas in Andhra Pradesh and Haryana will test the feasibility and preliminary effectiveness of this intervention. The effectiveness of the extended care intervention will be evaluated by the difference in HbA1c (glycosylated hemoglobin) measured at baseline and end-line between the two study arms. Qualitative interviews of physicians, ASHA, and community members will ascertain the intervention acceptability and feasibility. Results: A total of 1785 adults (females: 53.2%; median age: 50 years) were screened. ASHAs achieved 100% completeness of data for anthropometric, blood-pressure, and blood-glucose measures. At baseline, 63% of the participants were overweight/obese, 27.8% had elevated blood pressure, 20.3% were at high-risk for cardiovascular disease (CVD), and 21.3% had elevated blood glucose. Half of the individuals with diabetes were newly diagnosed. Conclusion: Technology enabled transfer of simple clinical procedures from physicians to nonphysician health workers can support the provision of healthcare in under-served communities. Community health workers can successfully screen and refer patients with diabetes and/or CVD to physicians in primary healthcare system.