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Type 2 Diabetes Mellitus (DM)ComBaCaL DMNCT05743387

Community-based, eHealth Supported Type 2 Diabetes Care by Lay Village Health Workers in Rural Lesotho

A study testing DM care package and Referral to the responsible health facility in people with Type 2 Diabetes Mellitus (DM), run by University Hospital, Basel, Switzerland at 2 sites in 2 countries.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

This cluster-randomized intervention is embedded in the ComBaCaL (Community-Based Chronic disease care Lesotho) cohort study (EKNZ ID AO_2022-00058, clinicaltrials.gov ID NCT05596773, Lesotho NH-REC ID 210-2022), a platform for the investigation of chronic diseases and their management in rural Lesotho that is… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Type 2 Diabetes Mellitus (DM)
What is being tested?
DM care package and Referral to the responsible health facility
Could I receive a placebo?
No, everyone receives an active treatment
How many people
252 participants
Where
2 sitesin 2 countries
Study dates
13 May 2023to 31 Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Participant of the ComBaCaL cohort study (signed informed consent available)
  • Living with DM, defined as reporting intake of antidiabetic medication or being newly diagnosed during screening via standard diagnostic algorithm

Who cannot join

  • Known type 1 diabetes mellitus
  • Reported pregnancy

Trial locations and contacts

2 sites in 2 countries.

2 sites in 2 countries

Lesotho1 site
  • SolidarMed Lesotho

    Maseru

Other trials in Lesotho

Switzerland1 site
  • University of Basel, Division of Clinical Epidemiology

    Basel, 4051

Other trials in Switzerland

About this study

Official title: Community-based, eHealth Supported Type 2 Diabetes Care by Lay Village Health Workers in Rural Lesotho Protocol for a Cluster-randomized Trial Within the ComBaCaL Cohort Study (ComBaCaL DM TwiC)

This cluster-randomized intervention is embedded in the ComBaCaL (Community-Based Chronic disease care Lesotho) cohort study (EKNZ ID AO_2022-00058, clinicaltrials.gov ID NCT05596773, Lesotho NH-REC ID 210-2022), a platform for the investigation of chronic diseases and their management in rural Lesotho that is maintained by local lay village health workers (VHWs).

The overall objective of the ComBaCaL cohort study and nested TwiCs is to assess the impact of eHealthsupported, lay-led chronic disease control measures in rural Lesotho.

In this DM TwiC, the effect, safety and feasibility of a community-based DM care package (which includes the offer of first-line oral antidiabetic and lipid-lowering treatment for uncomplicated DM by lay VHWs in comparison to facility-based care after community-based screening and diagnosis) will be evaluated.

Read the detailed description

Globally, 9.3% of the adult population or 436 million individuals were estimated to be living with diabetes in 2019. Until 2045 this number is expected to increase by more than 50% to over 700 million. Four out of five people affected by diabetes are currently living in low- and middle-income countries (LMICs). Over 90% of all diabetes cases are due to type 2 diabetes (DM) which is also the main driver of the projected increase in overall diabetes cases. The increase in DM prevalence is caused by ageing populations and changing lifestyles with decreasing levels of physical activity and higher caloric diets and associated obesity.

This cluster-randomized intervention is embedded in the ComBaCaL (Community-Based Chronic disease care Lesotho) cohort study (EKNZ ID AO_2022-00058, clinicaltrials.gov ID NCT05596773, Lesotho NH-REC ID 210-2022), a platform for the investigation of chronic diseases and their management in rural Lesotho that is maintained by local lay village health workers (VHWs).

In this trial, using the Trials within Cohorts (TwiCs) approach, it will be analyzed whether an LHW-led model could be capacitated to safely and effectively provide first-line management (including oral antidiabetic, lipid-lowering treatment and lifestyle counselling) at community-level.

In villages randomized to the intervention arm, lay Village Health Workers (VHWs) operating within the existing Ministry of Health (MoH) village health worker system will be capacitated to screen for and diagnose DM, to provide lifestyle counselling, to prescribe and to monitor first-line antidiabetic and lipid-lowering treatment for uncomplicated DM and to provide treatment support for complicated DM, supported by a tailored clinical decision support application in their villages.

The control group consists of people diagnosed with DM living in villages that are also part of the ComBaCaL cohort but not sampled for the intervention (control villages), where VHWs will only screen for and diagnose DM with subsequent standardized counselling and referral to the closest health facility if DM is present, but no village-based prescriptions.

The overall objective of the ComBaCaL cohort study and nested TwiCs is to assess the impact of eHealthsupported, lay-led chronic disease control measures in rural Lesotho.

Being tested
DM care package, Referral to the responsible health facility
Keywords
Lesotho, Southern Africa, Diabetes, Community-based care, Community Health Workers, Non-communicable diseases
Medical subject headings
Diabetes Mellitus, Type 2, Diabetes Mellitus, Noncommunicable Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • DM care packageOther

    DM care package including lifestyle counselling, firstline antidiabetic (metformin) and lipid-lowering (statin) treatment for uncomplicated DM and treatment support and regular check-ups for complicated DM at village-level. Guidance will be provided via the CDS application. In case of complicated disease referral to the closest health facility for further management.

  • Referral to the responsible health facilityOther

    VHWs will refer participants to the responsible health facility for therapeutic management. The CDS application supports clinical decision making and documentation for screening, diagnosis and referral, but not prescription/provision and monitoring of antidiabetic or lipid-lowering medication for uncomplicated DM patients or treatment support for complicated DM patients.

Study groups in NCT05743387
Study groupRoleWhat they receive
Intervention villagesActive comparatorIn the intervention villages, VHWs will offer * a DM care package including lifestyle counselling, firstline antidiabetic (metformin) and lipid-lowering (statin) treatment for uncomplicated DM and treatment support and regular check-ups for complicated DM at village-level according to clinical algorithms based on international guidelines for primary healthcare management of DM and the updated Lesotho Standard Treatment Guidelines. * Direct guidance for treatment initiation, drug prescription, counselling and monitoring will be provided via the CDS application. * In case of complicated disease (i.e. if treatment targets are not reached with metformin alone), unclear diagnosis, relevant comorbidities or presence of clinical alarm signs or symptoms, participants will be referred to the closest health facility for further management.
Receives: Other: DM care package
Control villagesActive comparatorIn control villages, VHWs will refer participants to the responsible health facility for therapeutic management after enrolment and baseline assessment.
Receives: Other: Referral to the responsible health facility

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean HbA1c (in percent)

    Mean HbA1c (in percent)

    Measured: 12 months after enrolment

Secondary outcomes (10)
  1. Change in 10-year CVD risk estimated

    Change in 10-year CVD risk estimated using the World Health Organization (WHO) CVD risk prediction tool

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

  2. Mean HbA1c (in percent)

    Mean HbA1c (in percent)

    Measured: 6 months after enrolment

  3. Change in mean fasting blood glucose (FBG) (mmol/l)

    Change in mean fasting blood glucose (FBG) (mmol/l)

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

  4. Change in proportion of participants with an HbA1c below 8%

    Change in proportion of participants with an HbA1c below 8%

    Measured: 6 and 12 months after enrolment

  5. Change in proportion of participants with an FBG below 7 mmol/l

    Change in proportion of participants with an FBG below 7 mmol/l

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

  6. Change in number of CVD risk factors

    Change in number of CVD risk factors (such as smoking status, BMI, abdominal circumference, blood lipid status, blood pressure, dietary habits and physical activity)

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

  7. Linkage to care: Change in proportion of participants not taking treatment at enrolment who have initiated pharmacological antidiabetic treatment

    Change in proportion of participants not taking treatment at enrolment who have initiated pharmacological antidiabetic treatment

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

  8. Engagement in care: Change in proportion of participants who are engaged in care

    Change in proportion of participants who are engaged in care, defined as reporting intake of antidiabetic medication as per prescription of a healthcare provider or reaching treatment targets without intake of medication

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

  9. Change in self-reported adherence to antidiabetic medication

    Change in self-reported adherence to antidiabetic medication

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

  10. Occurrence of Serious Adverse Events (SAEs) and Adverse Events of Special Interest (AESIs)

    Occurrence of Serious Adverse Events (SAEs) and Adverse Events of Special Interest (AESIs)

    Measured: 6, 12, 18, 24, 30, 36, 42 and 48 months after enrolment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Feb 2023
  2. Study start13 May 2023
  3. Primary completion23 Mar 2025
  4. Study completion31 Dec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
Cluster-randomized controlled trial nested within the ComBaCaL cohort study following a trial within cohort (TwiC) approach. 50% of the villages being part of the overarching ComBaCaL cohort will be randomized stratified by district and access to health facility to receive the intervention.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
252 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05743387
Sponsor's protocol ID
AO_2022-00077; am23Labhardt
Acronym
ComBaCaL DM
Status last verified
Sep 2026
First submitted
14 Feb 2023
Last updated
10 Sep 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: * An anonymized key dataset necessary for reproducing the primary and key secondary endpoints will be made freely available in an appropriate repository, such as zenodo.org, alongside the publication of the study results. Besides removal of variables not required for key analysis, we will remove participant identifier, study site and exact date information. Requests for access to more detailed data may be made to the corresponding author by submitting a proposal, which will be reviewed by the trial consortium. * The statistical report for the primary and key secondary endpoints and the code to produce it will be published together with the data set.

Publications

  • Gerber F, Gupta R, Lejone TI, Tahirsylaj T, Lee T, Kohler M, Haldemann MI, Raber F, Chitja M, Manthabiseng M, Khomolishoele M, Mota M, Bane M, Sematle PM, Makabateng R, Mphunyane M, Phaaroe S, Basler D, Kindler K, Seelig E, Briel M, Chammartin F, Labhardt ND, Amstutz A. Community-based type 2 diabetes care by lay village health workers in rural Lesotho: protocol for a cluster-randomized trial within the ComBaCaL cohort study (ComBaCaL T2D TwiC). Trials. 2023 Oct 24;24(1):688. doi: 10.1186/s13063-023-07729-8.

    PubMed 37875943
  • Gerber F, Gupta R, Sanchez-Samaniego G, Lejone TI, Tahirsylaj T, Raeber F, Saavedra EB, Esquivel-Valdes I, Chitja M, Molulela M, Khomolishoele M, Mota M, Bane M, Masike S, Sematle MP, Mofokeng M, Makabateng R, Mphunyane M, Sao L, Tlahali M, Litaba M, Basler DB, Kindler K, Ayakaka I, Grimm P, Seelig E, Chammartin F, Labhardt ND, Amstutz A. Community health worker-led versus facility-based type 2 diabetes care in rural Lesotho: a cluster-randomized trial within the ComBaCaL cohort study. BMC Med. 2026 May 22;24(1):400. doi: 10.1186/s12916-026-04943-4.

    PubMed 42174613

Questions about this trial

What is this clinical trial studying?

A study testing DM care package and Referral to the responsible health facility in people with Type 2 Diabetes Mellitus (DM), run by University Hospital, Basel, Switzerland at 2 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 10 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Lesotho, Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean HbA1c (in percent) (time frame: 12 months after enrolment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05743387, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Sep 2026.

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