Comprehensive intervention for diabetes prevention and control in Mixtec Region

Objectives

To strengthen the type 2 diabetes and hypertension care continuum in the Mixtec region (across 3 states) by implementing a comprehensive, culturally grounded care and prevention programme for the most vulnerable indigenous populations, supported by implementation research to guide scale-up.

Approach

This project will strengthen prevention, early detection, and comprehensive management of type 2 diabetes and hypertension in highly vulnerable Indigenous communities. The project design—combining culturally adapted community interventions based on anthropological assessments (including primary prevention), health systems strengthening, digital innovations, and a robust implementation research component—represents a significant contribution to reducing health inequities and improving access to quality services. The focus is mainly on the Indigenous population but with the scope directed towards the entire population of the targeted Mixtec region (approx. 2 million people).

Main activities - Reducing risk factors (ultra-processed foods, physical inactivity, poverty, lack of information) associated with diabetes and hypertension incidence at the community level through culturally appropriate community campaigns (based on anthropological assessment), engagement with relevant ministries on food and water provision (including the Ministry of Public Education to enhance the National School Feeding Program to effectively serve indigenous children residing in the Mixtec region).

• Increasing diagnosis of prediabetes, type 2 diabetes, gestational diabetes mellitus and hypertension and providing timely management through identification of high-risk populations, development of culturally appropriate diabetes awareness programme (based on anthropological assessment), training healthcare professionals and community health workers in culturally appropriate screening, detection, and care, and establishment of referral system for newly diagnosed patients.

• Providing and sustaining adequate care to diagnosed patients through implementation of a telemedicine programme to provide long-distance care; creation and implementation of electronic health records for the registration and follow-up of patients to strengthen the continuity of care.

• Ensuring timely diagnosis of complications and improving the navigation of patients with complications through online training of healthcare professionals and community health workers on early detection and management of complications (including referral criteria and telemedicine support), establishment and deployment of mobile units with diagnostic tools for complications (provided by the Ministry of Health), and review and optimisation of referral systems for specialised care.

• Facilitating the sustainability, scalability and reproducibility of the project through the development of training manuals and national diabetes protocol for Indigenous peoples; as well as conducting implementation research including cost-effectiveness analysis for advocacy purposes and continued resource allocation with relevant ministries.

Expected results

• 515 primary care health facilities enhanced to provide diabetes care.

• 750,000 screened for diabetes, 93,000 diagnosed with pre-diabetes, 45,000 diagnosed with diabetes and put on treatment.

• 23,320 pregnant women screened for hyperglycaemia in pregnancy (HIP) and 3,264 pregnant women diagnosed with HIP.

• 10 mobile units established with diagnostic equipment for complications.

• 2,200 healthcare professionals trained; 362 community health workers trained.

• 1,200,000 people reached by awareness activities and 25 advocacy meetings with policymakers held.

• Production of comprehensive implementation research including anthropological assessments and cost-effectiveness analysis, baseline and endline assessments to guide implementation and potential scale-up, including 4 articles published.