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Physical inactivity (PIA) is a pressing public health issue globally, contributing significantly to the rise of non-communicable diseases (NCD), such as cardiovascular disease and type 2 diabetes. The World Health Organization emphasises the importance of regular physical activity (PA) for preventing and managing NCDs. Initiatives to promote active living have gained momentum, ranging from community programs to workplace wellness campaigns, all focused on reducing sedentary lifestyles in modern society. Structured Physical Activity-Dance, Exercise, and Sports (SPADES) has emerged as an innovative approach to addressing PIA and promoting holistic health. After thoroughly reviewing existing literature from PubMed and Google Scholar databases, a panel of experts developed consensus statements through in-depth discussions, and the strength of concurrence on these statements was voted on using a Likert scale. The panel reached a consensus on the best strategies for PA, dance, exercise, sports, and key factors to consider during PA. This consensus targets individuals with metabolic diseases, particularly in regions like South Asia, East Africa, the Gulf, and Latin America, where these conditions are highly prevalent. The SPADES guidelines emphasise overcoming the barriers people with metabolic disorders face in achieving adequate PA, providing tailored recommendations to improve health outcomes for this population., Competing Interests: Declarations. Conflict of Interest: Sanjay Kalra is an Editorial Board member of Advances in Therapy. Sanjay Kalra was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Sarita Bajaj, Madhur Verma, Hanjabam Barun Sharma, Kaushik, Ramaiya, and Silver Bahendeka have nothing to disclose. Ethics Statement: The consensus statement was based on reviewing the existing literature, so ethical approval was not deemed necessary. The expert participants involved in developing the consensus statement were aware of the study’s objectives, and their responses would be recorded anonymously, after which the compiled report would be published, for which they gave verbal informed consent. None of the participants declared any conflict of interest., (© 2025. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.)

Introduction: Long-acting insulin analogues are the standard of care for people with type 1 diabetes (T1D) in high-income countries but remain largely inaccessible and understudied in low-resource settings. In settings where glycaemic control is typically poor and food insecurity is common, long-acting insulin analogues may offer tangible clinical benefits for people with T1D. To determine whether insulin glargine, a long-acting insulin analogue, reduces the risk of serious hypoglycaemia and/or improves glycaemic time-in-range (TIR) versus human insulin regimens in this population, we are conducting the Human vs Analogue Insulin for Youth with Type 1 Diabetes in Low-Resource Settings randomised controlled trial., Methods and Analysis: This is a 1:1 randomised, parallel-group clinical trial comparing biosimilar insulin glargine with human insulin (Neutral Protamine Hagedorn (NPH) or premixed 70/30 insulin) in 400 youth with type 1 diabetes (T1D) recruiting in Dhaka, Bangladesh (n=250) and Mwanza, Tanzania (n=150). Blinded continuous glucose monitors will be used to assess glycaemic control in both study arms over 14-day periods at baseline and at 3, 6 and 12 months after randomisation. The co-primary outcomes are the per cent time in serious hypoglycaemia (<54 mg/dL) and TIR (70-180 mg/dL) at 6 months of follow-up. Secondary outcomes include TIR at 12 months and time-in-hypoglycaemia, time-above-range, nocturnal hypoglycaemic events and glycaemic control (ie, haemoglobin A1C (HbA1c)) at 6- and 12-months of follow-up. Treatment satisfaction and quality of life are assessed at baseline, 6- and 12 month follow-up. Additionally, the study is conducting qualitative interviews, quantitative assessments of treatment satisfaction and quality of life, as well as assessing the cost-effectiveness of analogue insulin use in low-resource settings., Ethics and Dissemination: This study was approved by the Institutional Review Board at the University of Pittsburgh (STUDY21110122), the National Health Research Ethics Committee at the National Institute for Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/4265) and the Ethical Review Committee (ERC) of Diabetic Association of Bangladesh (BADAS-ERC/EC/22/405). Research findings will be shared by the local partner organisations and institutions with relevant stakeholders including youth living with diabetes, policy makers, healthcare workers and the general public. Findings will also be shared at local, regional and international scientific meetings., Trial Registration Number: ClinicalTrials.gov: NCT05614089., Competing Interests: Competing interests: JL receives research funding from the National Institute of Diabetes and Digestive and Kidney Diseases, the Donaghue Foundation, the Commonwealth of Pennsylvania and the Helmsley Charitable Trust, all to his academic institution. He has consulted for IADA, CARES, Alosa Health and all 501c3 not-for-profit organisations. KR has leadership roles in the World Diabetes Foundation, Africa NCD Alliance and East African NCD Alliance. EA has received salary funding via research grants from Novo Nordisk A/S paid to her academic institution. She has received consulting fees for the WHO Geneva NCD Department and WHO EMRO NCD Department. MLP has received funding in the last 36 months through her organisation from the Bill and Melinda Gates Foundation, the UK Foreign and Commonwealth Development Office (FCDO, government of UK), BreakthroughT1D (formerly Juvenile Diabetes Research Foundation), Surgo Health, Children’s Investment Fund, Susan T. Buffet Foundation, Swedish International Development Agency (government of Sweden), Global AMR Innovation Fund (GAMRIF). She has received support from WomenLift Health to attend meetings and events. GDO receives salary funding from The Leona M and Harry B Helmsley Charitable Trust. Eli Lilly provided the insulin for the study and also provided unrestricted funding to the Life for a Child Program (not including salaries). All other authors have no competing interest to declare., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: The number of people living with multiple chronic conditions in sub-Saharan Africa is increasing, but health facilities are unable to meet demand. To improve health system capacity and access to care, community models of HIV care have been trialled in countries such as Tanzania and Uganda. However, no evidence exists to inform policymakers on the effectiveness and cost-effectiveness of integrated community-based models of care for HIV and chronic non-communicable conditions. This protocol outlines a within-trial economic evaluation to address this gap., Methods & Analysis: We will estimate the costs and cost-effectiveness of integrated community-based care for HIV, hypertension and diabetes compared with facility-based care within the INTE-COMM pragmatic cluster-randomised trial in Tanzania and Uganda. Analyses will adopt a 52-week time horizon, the duration of trial follow-up. The full enrolled trial sample will be analysed from a societal perspective, comprising provider and patient perspectives. Economic costs will be estimated, which includes valuing inputs such as donated goods or time foregone by participants because of receiving care. For provider costs, participant case report forms will inform resource use along with data from facilities and community sites. Resources will be valued using project accounts, facility spending, and locally available cost data. Patient costs will be estimated based on a care-seeking and cost questionnaire administered to participants. Estimated costs will be analysed with co-primary trial outcomes on plasma viral load suppression, glycaemia and blood pressure control to calculate incremental cost-effectiveness ratios (ICER). We will also calculate ICERs for secondary trial outcomes related to health-related quality of life and wellbeing. Cost drivers and outcomes will be varied within confidence bounds in a two-way sensitivity analysis. We will investigate equity impact by estimating the mean difference in outcomes between integrated community-based and facility-based care across household socio-economic quintiles and by measuring whether participants incurred catastrophic health expenditures., Trial Registration Number: The ISRCTN Registry: ISRCTN15319595. Registered on 07 June 2022: https://doi.org/10.1186/ISRCTN15319595., Competing Interests: No competing interests were disclosed., (Copyright: © 2025 Abou Jaoude GJ et al.)