Effectiveness of Dietitian-led Dietary Approach to Management of Diabetes (DIAM-D) in Tertiary Care Hospital of Nepal: a Randomized Control Trial

Background:

Diabetes mellitus (DM) refers to the metabolic syndrome characterized by high blood glucose levels considering major public health problems globally (Sun et al., 2018). The global prevalence of diabetes in adults has been increasing over the decades (Guariguata et al., 2014). According to the world health organization (WHO), diabetes is the sixth leading cause of death accounting for 1.59 million deaths in 2016 (World Health Organization (WHO)., 2018). According to the International Diabetes Federation (IDF) data, it was estimated that among 18-99 years, there are 451 million people with diabetes globally. The number projected to increase to 693 million by 2045 (Cho et al., 2018). The rapid change of diabetes prevalence in many countries specially developing countries have been influenced by rapid urbanization and drastically changes towards the sedentary lifestyle(Guariguata et al., 2014). Similarly, an increase in the prevalence of diabetes is characterized by various modifiable and non-modifiable risk factors, modifiable risk factors include changes in dietary habits and sedentary lifestyle which contributed to overweight/ obesity and non-modifiable risk factors including genetic cause and age (Hussain, Claussen, Ramachandran, & Williams, 2007).

The prevalence of diabetes mellitus in the south Asian region was a rapid increase over the last two decades (R.Jayawardena et al., 2012). According to the International Diabetes Federation (IDF) data for Nepal, the prevalence of T2DM in the 20-79 years age group was 4% in 2017 and the predicted number of undiagnosed cases was 532,100. IDF estimates the prevalence projected to increase by 6.1% and 1,264,200 undiagnosed cases in 2045 in Nepal(IDF Diabetes Atlas 9th edition 2019, n.d.). Evidence from systematic review and meta-analysis done by Gyawali et al, (2014) also reported that the prevalence of diabetes is a major public health problem with a prevalence rate of 8.4% (Gyawali et al., 2015). Dhimal et al. conducted a nationwide cross-sectional population-based study carried out from 2016-1018 found that the prevalence of diabetes was 8.5%(Dhimal et al., 2019). Diabetes is the third most common non-communicable disease in Nepal, which causes 12% of all hospitalizations(Bhandari, Angdembe, Dhimal, Neupane, & Bhusal, 2014).

Problem Statement:

The prevalence of type 2 diabetes mellitus (T2DM) has drastically increased in recent years in Nepal(Kafle, Poudel, & Shrestha, 2018). T2DM is accompanied by complications such as dyslipidemia, hypertension, and obesity. Several studies have shown that these complications can be prevented if lowering the HbA1c level and which has to be maintained within normal limits(Lim, Park, Choi, Huh, & Kim, 2009).