The Bangladesh D-Magic Trial. Diabetes Mellitus: Action Through Groups or Information for Better Control?

Background

As survival improves in low-income countries the problem of non-communicable diseases, including diabetes, increases. Diabetes currently affects between 20-30% of the population of Bangladesh either as pre-diabetes or fully expressed diabetes mellitus. The problem of diabetes and its complications is a growing concern among communities, health service providers and policymakers, yet raw data on the magnitude and underlying causes of the problem are scarce, especially in rural areas.

The aim of the study was to generate prevalence data on pre-diabetes, diabetes, and associated risk factors in rural villages in Bangladesh and explore the impacts of two interventions to improve the detection, management and prevention of diabetes in these deprived populations in Faridpur District, Bangladesh.

Aims

Primary aim

To prevent intermediate hyperglycaemia and type-2 diabetes (T2DM) and improve control of T2DM in rural Bangladesh.

Secondary aims

To evaluate the effect of a) a participatory community mobilisation intervention and b) a mHealth health promotion and awareness intervention on:

• Two year cumulative incidence of diabetes mellitus among individuals with abnormal fasting glucose

• Chronic disease risk factors of high body mass index, hypertension and physical inactivity

• Blood glucose testing uptake, diabetic status awareness and service utilisation.

Project plan

Formative phase

• To describe local understandings of diabetes mellitus and identify issues of stigma/status around body size, physical activity and diet among different genders.

• To conduct a situation analysis and describe healthcare workers’ knowledge and current practices, available equipment, current service uptake, the presence of referral systems and the use of guidelines related to diabetes mellitus in the Faridpur district and compare these to international guidelines and current practice at a large national apex diabetic hospital in Dhaka.

• To design and document the development and implementation of community mobilisation and mHealth interventions within the study context.

Evaluation phase

• To test the effect of a participatory community mobilisation intervention and a mHealth health promotion intervention on diabetes mellitus disease occurrence, management and risk factors in Faridpur district, Bangladesh.

• To describe the implementation of mHealth and participatory community groups interventions in Faridpur district in terms of replication and scale up, including the necessary roles and responsibilities of different stakeholders.

• To cost the interventions and evaluate their potential cost-effectiveness.

Dissemination phase

• To promote implementation and scale-up of community interventions (as appropriate depending on evaluation findings) through public symposia, engagement with media and through academic and health policy literature.

Impact

The D-Magic project demonstrated that both community mobilisation and mHealth strategies were successful, cost-effective interventions for raising awareness of diabetes. The PLA community mobilisation intervention led to a reduction of 20% in diabetes and intermediate hyperglycaemia. Outcomes of the D-Magic project were presented at a meeting of the South Asian Association for Regional Cooperation (SAARC) countries in 2019 as a contribution to the SAARC Declaration on Diabetes which provided recommendations for SAARC nations related to diabetes prevention and control. The team were awarded follow-on funding under the GACD Scale Up funding call.

Publications and output

GACD have published an end-of-programme report, providing a comprehensive summary of the programme and outcomes.

This project has a related case study Action for better control of diabetes in Bangladesh.

You may visit the project website for more information.