A large population trial conducted in Bangladesh shows that community mobilization based on education and action may be an effective tool for preventing and controlling Type 2 diabetes.
A large-scale, population-level trial conducted in Bangladesh is the first to provide strong evidence that community mobilization based on participatory learning and action may be an effective tool for preventing and controlling Type 2 diabetes.
In 2016, the global prevalence of diabetes was estimated to be 9 percent among adults, with 75 percent living in low and middle-income countries. In rural Bangladesh, roughly 20–30 percent of adults have intermediate hyperglycemia and 10 percent have diabetes. In these areas, the prevalence of diabetes (mostly Type 2 diabetes) is expected to reach 24–34 percent by 2030. Despite the high burden, awareness and knowledge is low and effective management strategies are urgently needed.
DMagic (Diabetes Mellitus: Action through community Groups or mHealth Information for better Control of population blood glucose, risk factors, knowledge and care seeking) was a three-arm, cluster-randomized trial led by Edward Fottrell of the University College London Institute for Global Health and published in The Lancet Diabetes & Endocrinology. The study aimed to separately assess the effects of community mobilization through participatory learning and action (PLA), mHealth mobile phone messaging, and usual care (control) on the incidence of diabetes. The trial was conducted in 96 villages (total population about 125,000) from June 27, 2015 to June 28, 2018.
The PLA intervention entailed 18 monthly group meetings, led by a lay facilitator who guided participants through a PLA cycle focused on Type 2 diabetes prevention and control. The mHealth intervention consisted of 14 months of twice-weekly health behavior and awareness-raising voice messages sent to participants’ mobile phones. The villages in the control group received usual care, which consists of seeking government or private care and little to no preventative public health campaigning.
The results showed facilitated community mobilization using PLA significantly reduced population prevalence of diabetes and intermediate hyperglycemia, as well as the incidence of Type 2 diabetes among the intermediate hyperglycemic cohort. The post-hoc analysis of the effect of PLA intervention on Type 2 diabetes only (i.e. not combined with intermediate hyperglycemia) showed a 48 percent reduction as compared to the control group.
Among individuals identified as having Type 2 diabetes by blood glucose testing, self-awareness of diabetes status was five times higher in the PLA group than in the control group. But while the mHealth intervention increased knowledge and awareness of Type 2 diabetes, there was no evidence that it had an impact on diabetes status.
“That disease outcome changes were only apparent in the PLA group suggests wider benefits of participatory interventions beyond the provision of information and modeled behavior,” the researchers conclude. Removal of stigma about diabetes, increased solidarity among villagers, and the sharing of information and ideas may have contributed to the PLA intervention effect. “This finding builds on existing evidence of the effectiveness of PLA on maternal, neonatal, and child health, and ours is the first assessment of this method for a non-communicable disease.”
Scale-up of PLA intervention at the national level in Bangladesh could prevent about 240,000 cases of Type 2 diabetes or intermediate hyperglycemia each year, a savings of approximately $132 million in health-care costs per year. This large, cost-effective impact suggests community mobilization might also be beneficial in other low and middle-income countries with a high burden of Type 2 diabetes.
Fottrell E, Ahmed N, Morrison J, et al. “Community groups or mobile phone messaging to prevent and control type 2 diabetes in intermediate hyperglycaemia in Bangladesh (DMagic): a cluster-randomised controlled trial.” The Lancet Diabetes & Endocrinology. Published online February 4, 2019. DOI: 10.1016/S2213-8587(19)300001-4