A model of translational research for diabetes prevention in low and middle-income countries: The Diabetes Community Lifestyle Improvement Program (D-CLIP) trial

  • Mary Beth Weber
    Corresponding author at: Emory University, Rollins School of Public Health, 1518 Clifton Road, NE, Room 7040N, Atlanta, GA 30322, United States. Tel.: +1 404 712 1902; fax: +1 404 727 4590.
    Emory University, Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Program, 1462 Clifton Road, Suite 314, Atlanta, GA 30322, United States
    Search for articles by this author
  • Harish Ranjani
    Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, No: 6B, Conran Smith Road, Gopalapuram, Chennai 600086, India
    Search for articles by this author
  • Gaya Celeste Meyers
    Emory University, Rollins School of Public Health, 1518 Clifton Road, NE, CNR Building, 7th Floor, Atlanta, GA 30322, United States
    Search for articles by this author
  • Viswanathan Mohan
    Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, No: 6B, Conran Smith Road, Gopalapuram, Chennai 600086, India
    Search for articles by this author
  • K.M. Venkat Narayan
    Emory University, Rollins School of Public Health, 1518 Clifton Road, NE, CNR Building, 7th Floor, Atlanta, GA 30322, United States
    Search for articles by this author



      The Diabetes Community Lifestyle Improvement Program (D-CLIP) aims to implement and evaluate in a controlled, randomized trial the effectiveness, cost-effectiveness, and sustainability of a culturally appropriate, low-cost, and sustainable lifestyle intervention for the prevention of type 2 diabetes mellitus in India.


      D-CLIP, a translational research project adapted from the methods and curriculum developed and tested for efficacy in the Diabetes Prevention Program, utilizes innovated methods (a step-wise model of diabetes prevention with lifestyle and metformin added when needed; inclusion of individuals with isolated glucose tolerance, impaired fasting glucose, and both; classes team-taught by professionals and trained community educators) with the goals of increasing diabetes prevention, community acceptability, and long-term dissemination and sustainability of the program. The study outcomes are: diabetes incidence (primary measure of effectiveness), cost-effectiveness, changes in anthropometric measures, plasma lipids, blood pressure, blood glucose, and HbA1c, Program acceptability and sustainability will be assessed using a mixed methods approach.


      D-CLIP, a low-cost, community-based, research program, addresses the key components of translational research and can be used as a model for prevention of chronic diseases in other low and middle-income country settings ( number, NCT01283308).


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N. Engl. J. Med. 2002; 346: 393-403
        • Lindstrom J.
        • Louheranta A.
        • Mannelin M.
        • et al.
        The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity.
        Diabetes Care. 2003; 26: 3230-3236
        • Pan X.R.
        • Li G.W.
        • Hu Y.H.
        • et al.
        Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.
        Diabetes Care. 1997; 20: 537-544
        • Ramachandran A.
        • Snehalatha C.
        • Mary S.
        • et al.
        The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).
        Diabetologia. 2006; 49: 289-297
        • Detsky A.S.
        • Naglie I.G.
        A clinician's guide to cost-effectiveness analysis.
        Ann. Intern. Med. 1990; 113: 147-154
        • Garfield S.A.
        • Malozowski S.
        • Chin M.H.
        • et al.
        Considerations for diabetes translational research in real-world settings.
        Diabetes Care. 2003; 26: 2670-2674
        • Narayan K.M.
        • Gregg E.W.
        • Engelgau M.M.
        • et al.
        Translation research for chronic disease: the case of diabetes.
        Diabetes Care. 2000; 23: 1794-1798
        • Ogilvie D.
        • Craig P.
        • Griffin S.
        • et al.
        A translational framework for public health research.
        BMC Public Health. 2009; 9: 116
        • Banerji M.A.
        • Faridi N.
        • Atluri R.
        • et al.
        Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men.
        J. Clin. Endocrinol. Metab. 1999; 84: 137-144
        • Mohan V.
        • Deepa M.
        • Deepa R.
        • et al.
        Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India--the Chennai Urban Rural Epidemiology Study (CURES-17).
        Diabetologia. 2006; 49: 1175-1178
        • Unwin N.
        • Whiting D.
        • Gan D.
        • et al.
        IDF Diabetes Atlas.
        4th ed. International Diabetes Federation, 2009
        • Knowler W.C.
        • Fowler S.E.
        • Hamman R.F.
        • et al.
        10-Year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.
        Lancet. 2009; 374: 1677-1686
        • Li G.
        • Zhang P.
        • Wang J.
        • et al.
        The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study.
        Lancet. 2008; 371: 1783-1789
        • Lindstrom J.
        • Ilanne-Parikka P.
        • Peltonen M.
        • et al.
        Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.
        Lancet. 2006; 368: 1673-1679
        • Kosaka K.
        • Noda M.
        • Kuzuya T.
        Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males.
        Diabetes Res. Clin. Pract. 2005; 67: 152-162
      1. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363: 157-163
        • American Diabetes Association
        Standards of medical care in diabetes – 2010.
        Diabetes Care. 2010; 33: S11-S61
        • Diabetes Prevention Program Lifestyle Resource Core
        • Wing R.
        • Gillis B.
        The Diabetes Prevention Program's Lifestyle Change Program, Manual of Operations.
        • Viswanathan V.
        • Clementina M.
        • Nair B.M.
        • Satyavani K.
        Risk of future diabetes is as high with abnormal intermediate post-glucose response as with impaired glucose tolerance.
        J. Assoc. Physicians India. 2007; 55: 833-837
        • Deepa M.
        • Pradeepa R.
        • Rema M.
        • et al.
        The Chennai Urban Rural Epidemiology Study (CURES) – study design and methodology (urban component) (CURES-I).
        J. Assoc. Physicians India. 2003; 51: 863-870
        • The World Health Organization
        WHO Expert Committee on Diabetes Mellitus, Second Report, WHO Technical Report Series No. 646.
        World Health Organization, Geneva1980
        • Vasudev S.
        • Mohan A.
        • Mohan D.
        • et al.
        Validation of body fat measurement by skinfolds and two bioelectric impedance methods with DEXA – the Chennai Urban Rural Epidemiology Study [CURES-3].
        J. Assoc. Physicians India. 2004; 52: 877-881
        • Utzschneider K.M.
        • Prigeon R.L.
        • Faulenbach M.V.
        • et al.
        Oral disposition index predicts the development of future diabetes above and beyond fasting and 2-h glucose levels.
        Diabetes Care. 2009; 32: 335-341
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • et al.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Sudha V.
        • Radhika G.
        • Sathya R.M.
        • et al.
        Reproducibility and validity of an interviewer-administered semi-quantitative food frequency questionnaire to assess dietary intake of urban adults in southern India.
        Int. J. Food Sci. Nutr. 2006; 57: 481-493
        • Diabetes Prevention Program Research Group
        Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes.
        Diabetes Care. 2003; 26: 2518-2523
        • Strauss A.
        • Corbin J.
        Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory.
        2nd ed. Sage Publications, 1998
        • Glaser B.
        • Strauss A.
        The Discovery of Grounded Theory.
        Aldine, Chicago1967
        • Vijgen S.M.
        • Hoogendoorn M.
        • Baan C.A.
        • et al.
        Cost effectiveness of preventive interventions in type 2 diabetes mellitus: a systematic literature review.
        Pharmacoeconomics. 2006; 24: 425-441
        • Narayan K.M.
        • Zhang P.
        • Kanaya A.M.
        • et al.
        Diabetes: the pandemic and potential solutions.
        in: Jamison D.T. Breman J.G. Measham A.R. Disease Control Priorities in Developing Countries. 2nd ed. Oxford Investment Press, New York2006: 591-604 (Chapter 30)
        • Saaristo T.
        • Peltonen M.
        • Keinanen-Kiukaanniemi S.
        • et al.
        National type 2 diabetes prevention programme in Finland: FIN-D2D.
        Int. J. Circumpolar Health. 2007; 66: 101-112
        • Nichols G.A.
        • Hillier T.A.
        • Brown J.B.
        Normal fasting plasma glucose and risk of type 2 diabetes diagnosis.
        Am. J. Med. 2008; 121: 519-524
        • Robinson T.N.
        • Killen J.D.
        • Kraemer H.C.
        • et al.
        Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study.
        Ethn. Dis. 2003; 13: S65-77
        • Vishram S.
        • Crosland A.
        • Unsworth J.
        • Long S.
        Engaging women from South Asian communities in cardiac rehabilitation.
        Br. J. Community Nurs. 2007; 12: 13-18
        • Bhopal R.S.
        The inter-relationship of folk, traditional and Western medicine within an Asian community in Britain.
        Soc. Sci. Med. 1986; 22: 99-105
        • Pardhan S.
        • Mahomed I.
        Knowledge, self-help and socioeconomic factors in South Asian and Caucasian diabetic patients.
        Eye. 2004; 18: 509-513
        • Bhutta Z.A.
        • Ali S.
        • Cousens S.
        • et al.
        Alma-Ata: rebirth and revision 6 interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?.
        Lancet. 2008; 372: 972-989
        • West R.
        • Edwards M.
        • Hajek P.
        A randomized controlled trial of a “buddy” systems to improve success at giving up smoking in general practice.
        Addiction. 1998; 93: 1007-1011
        • Wing R.R.
        • Jeffery R.W.
        Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance.
        J. Consult. Clin. Psychol. 1999; 67: 132-138
        • Wallace J.P.
        • Raglin J.S.
        • Jastremski C.A.
        Twelve month adherence of adults who joined a fitness program with a spouse vs without a spouse.
        J. Sports Med. Phys. Fit. 1995; 35: 206-213
        • Unger J.B.
        • Johnson C.A.
        Social relationships and physical activity in health club members.
        Am. J. Health Promotion. 1995; 9: 340-343
        • Ball K.
        • Bauman A.
        • Leslie E.
        • Owen N.
        Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults.
        Prevent. Med. 2001; 33: 434-440