Evidence map›Paper›PMID 42174613›Full record

Trial reportBMC medicine2026

Community health worker-led versus facility-based type 2 diabetes care in rural Lesotho: a cluster-randomized trial within the ComBaCaL cohort study.

Felix Gerber, Ravi Gupta, Giuliana Sanchez-Samaniego, Thabo Ishmael Lejone, Thesar Tahirsylaj, Fabian Raeber, Elis Belen Saavedra, Iliana Esquivel-Valdés, Mamakhala Chitja, Manthabiseng Molulela and 19 more

2 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05596773 recruitingnot on this map

Community-Based Chronic Disease Care in Rural Lesotho: The ComBaCaL Cohort Study

TypeobservationalSponsorUniversity Hospital, Basel, SwitzerlandRan2023 to 2027Enrolled17,500ConditionsNon-communicable Diseases (NCDs)
NCT05743387 naactive not recruitingnot on this map

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 T2D TwiC)

TypeinterventionalSponsorUniversity Hospital, Basel, SwitzerlandRan2023 to 2027Enrolled252ConditionsType 2 Diabetes Mellitus (T2D)ArmsT2D care package, Referral to the responsible health facility
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors.

Felix GerberDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland. felix.gerber@usb.ch.
Ravi GuptaSolidarMed Lesotho, Maseru, Lesotho.
Giuliana Sanchez-SamaniegoDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Thabo Ishmael LejoneDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Thesar TahirsylajDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Fabian RaeberDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Elis Belen SaavedraDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Iliana Esquivel-ValdésDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Mamakhala ChitjaSolidarMed Lesotho, Maseru, Lesotho.
Manthabiseng MolulelaSolidarMed Lesotho, Maseru, Lesotho.
Makhebe KhomolishoeleSolidarMed Lesotho, Maseru, Lesotho.
Mota MotaSolidarMed Lesotho, Maseru, Lesotho.
Matumaole BaneSolidarMed Lesotho, Maseru, Lesotho.
Sesale MasikeSolidarMed Lesotho, Maseru, Lesotho.
Mamorontsáne Pauline SematleSolidarMed Lesotho, Maseru, Lesotho.
Manthati MofokengSolidarMed Lesotho, Maseru, Lesotho.
Retselisitsoe MakabatengSolidarMed Lesotho, Maseru, Lesotho.
Madavida MphunyaneMinistry of Health Lesotho, Maseru, Lesotho.
Lebohang SaoMinistry of Health Lesotho, Maseru, Lesotho.
Mosa TlahaliMinistry of Health Lesotho, Maseru, Lesotho.
Malitaba LitabaMinistry of Health Lesotho, Maseru, Lesotho.
Dave Brian BaslerDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Kevin KindlerDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Irene AyakakaSolidarMed Lesotho, Maseru, Lesotho.
Pauline GrimmSolidarMed Switzerland, Lucerne, Switzerland.
Eleonora SeeligOslo Center for Biostatistics and Epidemiology, Oslo University Hospital, University of Oslo, Oslo, Norway.
Frédérique ChammartinDivision of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Niklaus Daniel Labhardt *Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Alain Amstutz *Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland. alain.amstutz@bristol.ac.uk.

Funding

Direktion für Entwicklung und Zusammenarbeit 7F-10345.01.01Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung 323530_207035Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung P500PM_221961World Diabetes Foundation WDF-1778
6 · The paper itself

Abstract

backgroundType 2 diabetes poses a growing public health burden in low- and middle-income countries, where major gaps in access to chronic care persist. Task-shifting to Community Health Workers (CHWs) and the use of digital clinical decision support systems may bridge these gaps. Randomized trials evaluating CHW-led care models in which CHWs initiate, titrate, and monitor first-line diabetes treatment are lacking.

methodsWe conducted a cluster-randomised trial nested within the ComBaCaL (Community-Based Chronic Care Lesotho) cohort (NCT05596773). The cohort spans 103 rural villages in Lesotho, managed by trained, supervised CHWs. After home-based screening of cohort participants ≥40 years old or with body mass index ≥25 kg/m

resultsFrom 13 May 2023 to 31 January 2024, 5'785 cohort participants were screened, 252 (4·4%) diagnosed with type 2 diabetes, and 103 (51 control, 52 intervention) included in the primary analysis (73·8% female, mean age 62·3 ± 12·8 years, mean HbA1c 7·2 ± 1·4%). At 12 months, HbA1c was 7·1 ± 1·9% in the control arm and 6·5 ± 1·3% in the intervention arm (adjusted mean difference -0·46%, 95%CI -1·14 to 0·22). Engagement in care was higher in the intervention arm. No relevant difference in safety outcomes was observed.

conclusionsCHW-led, clinical decision support system-assisted management of type 2 diabetes, including first-line drug prescription, may improve engagement in care and glycaemic control in rural low-resource settings. Larger studies are required to confirm these findings.

trial registrationClinicaltrials.gov: NCT05743387.

Indexed as

Community Health WorkersDiabetes Mellitus, Type 2AdultAgedCohort StudiesDecision Support Systems, ClinicalFemaleGlycated HemoglobinHumansHypoglycemic AgentsLesothoMaleMetforminMiddle AgedRural PopulationTask ShiftingGlycated HemoglobinHypoglycemic AgentsMetforminAccess to careAfricaClinical decision support systemsCommunity Health WorkersDiabetesDifferentiated service deliveryLesothoMetforminPrescription

Identifiers

PMID42174613
PMCPMC13374172

What Socratic holds

Texttitle and abstract
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.