Innovative mobile-health led Participatory Approach to Comprehensive Screening and Treatment of Diabetes (IMPACT Diabetes): Rationale, Design and Baseline Characteristics (Preprint)

BACKGROUND India has 66 million people with diabetes, of which a large proportion do not receive adequate care. The Primary Health Centres across rural and urban areas serve as platforms for continuum of care and early detection of diabetes in the population. The untapped potential of frontline health care workforce can act as a means to bridge the gaps of service demands. OBJECTIVE We aim to develop and evaluate a technology-enabled system-level intervention based around the community health workers [Accredited Social Health Activists (ASHA)] and primary-care physicians, and mobile tablet-based clinical decision support system to improve the identification and management of individuals with diabetes and cardiovascular disease (CVD) in primary care settings in India. METHODS A cluster-randomized trial in sixteen villages/peri-urban areas in Andhra Pradesh and Haryana will test the preliminary effectiveness of this intervention. An independent evaluation will compare the difference in the proportion of participants with diabetes having a 0.5% reduction in HBA1c (measured at baseline and end-line) in intervention and usual-care arm. Qualitative interviews of physicians, ASHA, and community members will ascertain the intervention acceptability and feasibility. RESULTS A total of 1785 adults over 30 years (females: 53.2%; median age: 50 years) were screened. ASHAs achieved 100% completeness of data for all 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 CVD, and 21.3% had elevated blood-glucose. Half of the individuals with diabetes were newly diagnosed. CONCLUSIONS Transfers of simple clinical procedures from physicians to non-physician health workers, with the help of technology, can support the provision of healthcare in under-served communities. The preliminary findings suggest that community health workers can successfully screen and refer patients with diabetes and/or CVD to physicians in the Indian primary healthcare system. The proposed model can be adapted for larger trial sand tested for other commonly prevalent disease conditions. CLINICALTRIAL