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Quality of Life Research

Open Access 07-04-2025 | Type 2 Diabetes

The effect of a community-based health behaviour intervention on health-related quality of life in people with Type 2 diabetes in Nepal: a Cluster Randomized Controlled Trial

Authors: Ashmita Karki, Corneel Vandelanotte, M. Mamun Huda, Lal B. Rawal

Published in: Quality of Life Research

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Abstract

Purpose

Little is known about the effectiveness of health behaviour intervention in improving health-related quality of life (HRQOL) despite HRQOL being an important outcome in Type 2 diabetes (T2DM) management. This study examined the effectiveness of a culturally appropriate health behavioural intervention in improving HRQOL of people with T2DM in Nepal.

Methods

A cluster randomized controlled trial was conducted among 481 people with T2DM from 30 randomly selected healthcare facilities in Kavrepalanchok and Nuwakot districts. The intervention group received 12 culturally tailored and group-based intervention sessions for six months whereas, the control group received usual care. The primary outcomes of this study were changes in the EuroQOL (EQ5D-3L) index score and EuroQOL visual analogue scale (EQVAS) score between baseline and six-month post-intervention. The intervention effect was assessed using generalized estimating equation models.

Results

At six-months post-intervention, there was a positive and statistically significant effect on EQVAS (β1 = 3.61, 95%CI: 0.05, 7.17) in the intervention group compared to control group. No statistically significant effect was observed in EQ5D-3L index score. A statistically significant increase in EQVAS score of 0.5 was observed per session attended by the study participants (β1 = 0.49, 95%CI: 0.01, 0.98).

Conclusion

The health behaviour intervention led to improved HRQOL. An increase in the number of intervention sessions attended was significantly associated with higher EQVAS scores, emphasizing the need for longer-term and engaging interventions that are well adhered to. Longer term assessment of change in HRQOL outcomes are needed when actual changes in HRQOL are more likely to be observed.

Trial registration

Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819).
Appendix
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Literature
1.
Gyawali, B., Sharma, R., Neupane, D., Mishra, S. R., van Teijlingen, E., & Kallestrup, P. (2015). Prevalence of Type 2 diabetes in nepal: a systematic review and meta-analysis from 2000 to 2014. Global Health Action, 8, 29088.PubMed
2.
Sagastume, D., Siero, I., Mertens, E., Cottam, J., Colizzi, C., & Peñalvo, J. L. (2022). The effectiveness of lifestyle interventions on Type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: a systematic review and meta-analysis of evidence from low- and middle-income countries. EClinicalMedicine., 53, 101650.PubMedPubMedCentral
3.
Karamanakos, G., Costa-Pinel, B., Gilis-Januszewska, A., Velickiene, D., Barrio-Torrell, F., Cos-Claramunt, X., et al. (2019). The effectiveness of a community-based, Type 2 diabetes prevention programme on health-related quality of life. The De-Plan Study. PLoS One., 14(10), e0221467.PubMedPubMedCentral
4.
Luscombe, F. A. (2000). Health-related quality of life measurement in Type 2 diabetes. Value in Health, 3(s1), 15–28.PubMed
5.
Skovlund, S. E., Lichtenberg, T. H., Hessler, D., & Ejskjaer, N. (2019). Can the routine use of patient-reported outcome measures improve the delivery of person-centered diabetes care? A review of recent developments and a case study. Current Diabetes Reports, 19(9), 84.PubMed
6.
Cochran, J., & Conn, V. S. (2008). Meta-analysis of quality of life outcomes following diabetes self-management training. The Diabetes Educator, 34(5), 815–823.PubMedPubMedCentral
7.
Aminuddin, H. B., Jiao, N., Jiang, Y., Hong, J., & Wang, W. (2021). Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with Type 2 diabetes: a systematic review and meta-analysis. International Journal of Nursing Studies, 116, 103286.PubMed
8.
Karki, A., Vandelanotte, C., Khalesi, S., Dahal, P., & Rawal, L. B. (2023). The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: a systematic review and meta-analysis. PLoS ONE, 18(10), e0293028.PubMedPubMedCentral
9.
Gyawali, B., Sharma, R., Mishra, S. R., Neupane, D., Vaidya, A., Sandbæk, A., et al. (2021). Effectiveness of a female community health volunteer-delivered intervention in reducing blood glucose among adults with Type 2 Diabetes: an open-label, cluster randomized clinical trial. JAMA Network Open, 4(2), e2035799.PubMedPubMedCentral
10.
Sunuwar, D. R., Nayaju, S., Dhungana, R. R., Karki, K., Singh Pradhan, P. M., Poudel, P., et al. (2023). Effectiveness of a dietician-led intervention in reducing glycated haemoglobin among people with Type 2 diabetes in Nepal: a single centre, open-label, randomised controlled trial. Lancet Reg Health Southeast Asia., 18, 100285.PubMedPubMedCentral
11.
Rawal, L., Dahal, P., Paudel, G., Biswas, T., Shrestha, R., Makaju, D., et al. (2023). Community-based lifestyle intervention for diabetes (Co-Lid Study) management rural Nepal: study protocol for a clustered randomized controlled trial. Trials, 24(1), 441.PubMedPubMedCentral
12.
Campbell, M. K., Piaggio, G., Elbourne, D. R., & Altman, D. G. (2012). Consort 2010 statement: extension to cluster randomised trials. BMJ: British Medical Journal., 345, e5661.PubMed
13.
World Health Organization. (1999). Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation. Part 1, diagnosis and classification of diabetes mellitus. Geneva: World Health Organization.
14.
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Suppl 1), S81-90.
15.
16.
Klein, H. A., Jackson, S. M., Street, K., Whitacre, J. C., & Klein, G. (2013). Diabetes self-management education: miles to go. Nutrition Research and Practice, 2013, 581012.
17.
Kandel, N., & Lamichhane, J. (2019). Female health volunteers of Nepal: the backbone of health care. Lancet, 393(10171), e19–e20.PubMed
18.
Balestroni, G., & Bertolotti, G. (2012). Euroqol-5D (Eq-5D): an instrument for measuring quality of life. Monaldi Archives for Chest Disease, 78(3), 155–159.PubMed
19.
20.
Andrade, C. (2020). Mean difference, standardized mean difference (Smd), and their use in meta-analysis: as simple as it gets. The Journal of Clinical Psychiatry., 81(5), 11349.
21.
Nicolucci, A., Haxhi, J., D’Errico, V., Sacchetti, M., Orlando, G., Cardelli, P., et al. (2022). Effect of a behavioural intervention for adoption and maintenance of a physically active lifestyle on psychological well-being and quality of life in patients with Type 2 diabetes: the Ides_2 randomized clinical trial. Sports Medicine (Auckland, N. Z.), 52(3), 643–654.PubMed
22.
MacDonald, C. S., Nielsen, S. M., Bjørner, J., Johansen, M. Y., Christensen, R., Vaag, A., et al. (2021). One-year intensive lifestyle intervention and improvements in health-related quality of life and mental health in persons with Type 2 diabetes: a secondary analysis of the U-turn randomized controlled trial. BMJ Open Diabetes Research & Care, 9(1), e001840.
23.
Rubin, R. R., Wadden, T. A., Bahnson, J. L., Blackburn, G. L., Brancati, F. L., Bray, G. A., et al. (2014). Impact of intensive lifestyle intervention on depression and health-related quality of life in Type 2 diabetes: the look ahead trial. Diabetes Care, 37(6), 1544–1553.PubMed
24.
Wolf, A. M., Conaway, M. R., Crowther, J. Q., Hazen, K. Y., Nadler, J. L., Oneida, B., et al. (2004). Translating lifestyle intervention to practice in obese patients with Type 2 diabetes: improving control with activity and nutrition (Ican) study. Diabetes Care, 27(7), 1570–6.PubMed
25.
Kumari, G., Singh, V., Chhajer, B., & Jhingan, A. K. (2021). Effect of lifestyle intervention holistic approach on blood glucose levels, health-related quality of life and medical treatment cost in Type 2 diabetes mellitus patients. Acta Scientiarum. Health Sciences, 43, e53729.
26.
Panisch, S., Johansson, T., Flamm, M., Winkler, H., Weitgasser, R., & Sönnichsen, A. C. (2018). The impact of a disease management programme for Type 2 diabetes on health-related quality of life: multilevel analysis of a cluster-randomised controlled trial. Diabetology and Metabolic Syndrome, 10, 28.PubMedPubMedCentral
27.
Dobson, R., Whittaker, R., Jiang, Y., Maddison, R., Shepherd, M., McNamara, C., et al. (2018). Effectiveness of text message based, diabetes self management support programme (Sms4bg): two arm, parallel randomised controlled trial. BMJ., 361, k1959.PubMedPubMedCentral
28.
29.
Cheng, L. J., Pan, T., Chen, L. A., Cheng, J. Y., Mulhern, B., Devlin, N., et al. (2024). The ceiling effects of Eq-5d-3l and 5l in general population health surveys: a systematic review and meta-analysis. Value in Health, 27(7), 986–997.PubMed
30.
Eaglehouse, Y. L., Schafer, G. L., Arena, V. C., Kramer, M. K., Miller, R. G., & Kriska, A. M. (2016). Impact of a community-based lifestyle intervention program on health-related quality of life. Quality of Life Research, 25(8), 1903–1912.PubMedPubMedCentral
31.
Jin, X., Liu, G. G., Gerstein, H. C., Levine, M. A. H., Guan, H., Li, H., et al. (2018). Minimally important difference and predictors of change in quality of life in Type 2 diabetes: a community-based survey in China. Diabetes/Metabolism Research and Reviews, 34(8), e3053.PubMed
32.
Wing, R. R. (2010). Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with Type 2 diabetes mellitus: four-year results of the look ahead trial. Archives of Internal Medicine, 170(17), 1566–1575.PubMed
33.
Nishita, C., Cardazone, G., Uehara, D. L., & Tom, T. (2013). Empowered diabetes management: life coaching and pharmacist counseling for employed adults with diabetes. Health Education & Behavior, 40(5), 581–591.
34.
McManus, E., Meacock, R., Parkinson, B., & Sutton, M. (2023). Evaluating the short-term costs and benefits of a nationwide diabetes prevention programme in England: retrospective observational study. Applied Health Economics and Health Policy, 21(6), 891–903.PubMedPubMedCentral
35.
Ishaq, R., Haider, S., Saleem, F., Bashir, S., Tareen, A. M., Mengal, M. A., et al. (2021). Diabetes-related knowledge, medication adherence, and health-related quality of life: a correlation analysis. Alternative Therapies in Health and Medicine, 27(S1), 46–53.PubMed
36.
Aziz, Z., Mathews, E., Absetz, P., Sathish, T., Oldroyd, J., Balachandran, S., et al. (2018). A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala diabetes prevention program. Implementation Science, 13(1), 97.PubMedPubMedCentral
37.
Lambrinou, E., Hansen, T. B., & Beulens, J. W. (2019). lifestyle factors, self-management and patient empowerment in diabetes care. European Journal of Preventive Cardiology., 26(2_suppl), 55–63.PubMed
38.
Lambrinou, E., Hansen, T. B., & Beulens, J. W. J. (2021). Systematic review and meta analysis of differential attrition between active and control arms in randomized controlled trials of lifestyle interventions in chronic disease. BMC Medical Research Methodology., 21(1), 122.
39.
Fitzpatrick, R., Fletcher, A., Gore, S., Jones, D., Spiegelhalter, D., & Cox, D. (1992). Quality of life measures in health Care. I: applications and issues in assessment. BMJ, 305(6861), 1074–7.PubMedPubMedCentral
40.
Hayduk, L. A., Hoben, M., & Estabrooks, C. (2024). Evidence pointing toward invalidity of the Sf-8 physical and mental scales: a fusion validity assessment. BMC Medical Research Methodology, 24(1), 274.PubMedPubMedCentral
Metadata
Title
The effect of a community-based health behaviour intervention on health-related quality of life in people with Type 2 diabetes in Nepal: a Cluster Randomized Controlled Trial
Authors
Ashmita Karki
Corneel Vandelanotte
M. Mamun Huda
Lal B. Rawal
Publication date
07-04-2025
Publisher
Springer International Publishing
Keyword
Type 2 Diabetes
Published in
Quality of Life Research
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-025-03971-6