Community Health Worker-Led Postpartum Diabetes Screening
- Conditions
- Diabetes Mellitus, Type 2Gestational Diabetes
- Interventions
- Behavioral: Home Based TestingBehavioral: Clinic Based Screening
- Registration Number
- NCT06209411
- Lead Sponsor
- Weill Medical College of Cornell University
- Brief Summary
Women who experience gestational diabetes are at high risk of developing type 2 diabetes mellitus in the postpartum period-especially in low- and middle-income countries like India where the burden of diabetes is high and disproportionately affects women- but few receive the World Health Organization-recommended postpartum diabetes screening test. The investigators propose a cluster randomized clinical trial to determine whether community health worker-administered, home-based testing increases uptake of postpartum diabetes screening in the urban slums of Pune, India. The proposed study will provide an acceptable and scalable model that can be used to improve postpartum diabetes screening in other low-income settings, thereby improving early detection of diabetes in women and preventing morbidity and mortality in this high-risk population.
- Detailed Description
The purpose of the project is to determine the effectiveness of a community health worker (CHW)-delivered home based oral glucose tolerance test (OGTT) (home testing arm) versus referral for clinic-based screening (referral arm) and evaluate the implementation of the CHW-delivered programs.
Design and Project Type: This hybrid type II effectiveness- implementation cluster randomized trial aims to evaluate if CHWs can improve postpartum type 2 diabetes mellitus (T2DM) screening in the urban slums of Pune, India. Slum communities will be randomized in equal number to one of two study arms. Participants in both arms will receive CHW-delivered OGTT during pregnancy to screen for GDM. For women diagnosed with gestational diabetes mellitus (GDM), the investigators will evaluate two strategies to improve T2DM screening in the first year postpartum: CHW-delivered home based OGTT (home testing arm) versus referral for clinic-based screening (referral arm).
Description of Intervention: The intervention is postpartum screening for T2DM which involves oral intake of a glucose load and subsequent measurement of fasting and postprandial point of care blood glucose measurement.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 300
Pregnant Women:
- Pregnant woman residing in one of pre-selected slum communities
- 18 years or older
- ≥ 24 weeks gestational age (as determined by self-reported last menstrual period or ultrasound)
- Meet or exceed the threshold for GDM as determined by the CHW-delivered fasting OGTT
- Agrees to study procedures, including in-person visits with the CHW postpartum if they are diagnosed with GDM
Community Health Workers:
- 18 years or older
- Willingness to participate in study procedures and recruit eligible pregnant women
- Agreement with goals of the study
- Resides in one of the study communities
- Willing to participate in surveys and interviews
Clinicians:
- 18 years or older
- Diabetes or obstetrics physicians
- In a patient-facing position for over 1 year
Ministry of Health Officials
- 18 years or older
- Employed by the Ministry of Health and Family Welfare, Maternal Health Division
Pregnant Women:
- Preexisting diabetes diagnosis prior to current pregnancy
- Unable to tolerate food/ drink and remain fasting for 8 hoursUnwilling or unable to participate in study procedures
- Unwilling or unable to provide informed consent
CHW, Clinicians, Ministry of Health Officials
- Unwilling or unable to participate in study procedures
- Unwilling or unable to provide informed consent
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Home Testing Arm Home Based Testing CHW will contact participants with GDM from communities in the home-based testing arm beginning at 6 weeks postpartum to arrange a convenient time for a home visit within the first postpartum year. During the home visit, CHW will provide 1) T2DM education, and 2) offer home-based OGTT. Referral Arm Clinic Based Screening CHW will contact participants with GDM from communities in the referral arm beginning at 6 weeks postpartum to arrange a convenient time for a home visit within the first postpartum year. During the home visit, CHW will provide 1) T2DM education and 2) referral to the postnatal clinic at a government hospital for T2DM screening.
- Primary Outcome Measures
Name Time Method Number of participants who completed OGTT during the first year postpartum Up to 1 year and 3 months
- Secondary Outcome Measures
Name Time Method Percentage of participants with abnormal OGTT who complete a single clinic visit for T2DM care Up to 2 years Number of participants who accept OGTT screening for GDM during enrollment Within 3 months of enrollment Percentage of participants with abnormal OGTT who complete a second visit by 24 months postpartum Up to 2 years Number of participants with GDM who have abnormal postpartum OGTT results Up to 1 year and 3 months Median time in months participants complete T2DM screening within the first 12 months postpartum. Up to 1 year and 3 months Number of participants with any pregnancy complications, including high infant birthweight and presence of congenital anomalies. Up to 5 months Number of women with abnormal OGTT who get tests including hemoglobin, lipid profile, creatinine. Up to 2 years
Trial Locations
- Locations (1)
Deep Griha Society
🇮🇳Pune, Maharashtra, India