# Diabetes management using a clinical guideline versus usual practice: a feasibility trial-based qualitative study among Ayurvedic practitioners and patients in Nepal

## TL;DR

A study in Nepal explored how Ayurvedic doctors and patients experienced managing diabetes with a new clinical guideline versus usual practice, finding the guideline approach more beneficial.

## Contribution

The study developed and tested a clinical guideline for managing diabetes in Ayurvedic practice, a novel approach in Nepal.

## Key findings

- The evidence-based clinical guideline for diabetes was well-received and seen as more beneficial than usual practice.
- Participants identified challenges in trial conduct, including recruitment and documentation, which need addressing in future studies.

## Abstract

Type 2 diabetes mellitus (T2DM) is common in Nepal, where many people seek primary care through Ayurveda, a widely practiced traditional medical system. However, concerns remain about variability in clinical practice and the quality of care provided by Ayurvedic practitioners. No evidence-based clinical practice guideline (EB-CPG) currently exists for managing T2DM in Ayurveda. To address this, an EB-CPG was developed, and a feasibility trial was conducted to inform a future definitive cluster randomized controlled trial evaluating whether the EB-CPG would improve T2DM management compared to usual clinical practice.

To explore the experiences and perspectives of Ayurvedic practitioners and patients regarding the two treatment groups (EB-CPG-based care versus usual clinical practice) and participation in the feasibility trial.

Constructivist qualitative study.

Semistructured interviews were conducted with Ayurvedic practitioners and patients. Data were analyzed thematically using an inductive approach and the framework method.

A total of 41 Ayurvedic practitioners and patients were interviewed. Common themes identified across both groups included facilitators and challenges in the trial patient recruitment, challenges in usual clinical care, experiences with EB-CPG-based care (predominantly positive), ease and difficulties of monthly follow-ups, and pros and cons of patient diaries for assessing medication compliance. Practitioner-specific themes included the diverse populations they serve; patients’ motivations for choosing Ayurveda over Western medicine; their motivations for trial participation; balancing clinical duties with the trial demands; confusion about trial roles and responsibilities; and other trial-related issues such as understanding processes and documentation, support and communication, coordination with data collectors, and finances and other resources.

The EB-CPG-based approach for managing T2DM by Ayurvedic practitioners in Nepal was well-received and perceived as more beneficial than usual clinical practice. Trial experiences and perspectives were largely positive; however, several challenges related to trial conduct should be addressed in future studies, including the definitive cluster trial.

Managing diabetes with or without a clinical guideline: views of Ayurvedic doctors and patients from a feasibility trial in Nepal

Type 2 diabetes is a common health problem in Nepal. Many people seek treatment through Ayurveda, a traditional system of medicine. However, there is no guideline to help Ayurvedic doctors manage diabetes, and the care provided can vary widely. To help improve care, researchers developed a clinical guideline based on the best available scientific evidence. They then ran a feasibility trial to help plan a larger study that will test whether the guideline improves diabetes management compared to usual practice. This study explored what Ayurvedic doctors and patients thought about the two types of care used in the feasibility trial: one based on the new guideline and the other following usual practice. Researchers also wanted to understand their experiences of taking part in the trial. Researchers interviewed 41 participants, including both doctors and patients. Key findings included what helped or made it difficult to recruit patients into the feasibility trial, challenges with usual care, mostly positive views about care based on the new guideline, ease and difficulties of monthly follow-up visits, and the pros and cons of using patient diaries to record medicine use. Doctors also talked about the wide range of patients they treat, why people choose Ayurveda over Western medicine, and their own reasons for joining the trial. They discussed challenges such as balancing regular duties with the trial work, confusion about their roles, understanding procedures and paperwork, communication and coordination, and access to support and resources. In conclusion, the new guideline-based approach for managing diabetes by Ayurvedic doctors in Nepal was well-received and seen as more helpful than usual care. Most experiences of the feasibility trial were positive, but some challenges in how the trial was carried out were identified. These should be addressed in future studies, including the planned larger trial.