New intervention to strengthen efforts against diabetes in Vietnam

Diabetes is not just a challenge in affluent countries. Many low- and middle-income countries are struggling with rising rates of diabetes, which can reach epidemic proportions.

A new research project anchored at the Department of Anthropology is set to step up efforts against a particular type of diabetes; gestational diabetes mellitus (GDM). GDM is a growing problem across the world and especially in Southeast Asia.

Many efforts in the field of health underestimate the importance of our intimate social relationships.

With a grant of DKK 5 million from the Danish Ministry of Foreign Affairs, the project ‘Gestational Diabetes in Vietnam’ will, in close collaboration with local researchers and health care workers, investigate GDM in Vietnam's northern Thai Binh province. GDM is estimated to affect about one in five pregnant women in Vietnam, but little is known about how it is handled by pregnant women, families, and health care providers.

Gestational diabetes increases the risk of complications during pregnancy and childbirth while also increasing the risk of mother and child developing diabetes later in life. Gestational diabetes is thus an important driver of the global diabetes epidemic.

The new project will, among other activities, develop and evaluate a ‘healthy pregnancy intervention’ targeted at women with gestational diabetes and their family members.

"Many efforts in the field of health underestimate the importance of our intimate social relationships," says Professor Tine Gammeltoft from the Department of Anthropology, who is leading the project.

"We underestimate the extent to which we as humans live in deep dependency on one another. This is especially true in low- and middle-income countries where people's health care practices are, to large extents, shaped by family and kinship relationships. To ensure healthy pregnancies, it is important to take family dynamics into account.”

Local challenges

One of the challenges is to give women the right tools to be able to manage gestational diabetes. With the right diet and exercise – and good support from health workers and close relatives – the vast majority will be able to keep their blood sugar under control. However, there is a lack of concrete guidelines adapted to Vietnamese settings.

The project will fill that gap with a new ‘GDM self-care kit’ for women, which may also become a model for initiatives in other countries.

"Self-care interventions are currently being intensively promoted by the WHO and other global health actors as the new response to a range of health care challenges. With our project, we will look critically at what ‘self-care’ in pregnancy means in concrete everyday life situations and in a hierarchical family- and kinship system. The project's GDM self-care kit will be adapted to social situations where 'self-care' takes place in close interaction with others, and where the pregnant woman must take other people’s expectations and demands into account,” says Tine Gammeltoft.

Broad research efforts

The project is carried out in close cooperation with the Danish-Vietnamese strategic sector cooperation (SSC) in health and Novo Nordisk as a private sector partner.

The new project is an extension of the project ’Living Together with Chronic Disease: Informal Support for Diabetes Management in Vietnam’, which, taking type II diabetes in Vietnam as its case, examines the importance of informal care from family and friends when people live with chronic illness.

With their follow-up project, which, like the first, also involves Thai Binh University of Medicine and Pharmacy in Vietnam and the University of Southern Denmark, the researchers hope to answer three general questions:

• How do pregnant women, their family members, and health care providers experience and handle GDM?
• What role does informal support from family members play in the self-care practices of pregnant women with GDM?
• How can a tailored and targeted self-care intervention improve maternal and child health outcomes among women with GDM?

These questions will be answered through a combination of qualitative and quantitative methods. Two hundred and thirty women with GDM will be invited to take part in the intervention and compared with a similar group who receives standard maternity care.

The project will run from December 2022 to November 2025.