Edward Fottrell|Naveed Ahmed|Joanna Morrison|Abdul Kuddus|Sanjit Kumer Shaha|Carina King|Hannah Jennings|Kohenour Akter|Tasmin Nahar|Hassan Haghparast?Bidgoli|A K Azad Khan|Anthony Costello|Kishwar Azad
Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh (DMagic): a cluster-randomised controlled trial
University College London|University College London|University College London|University College London|University College London|University College London
strategies needed prevent control type 2 diabetes intermediate hyperglycaemia together affect roughly third adults bangladesh aimed assess effects mhealth community mobilisation prevalence intermediate hyperglycaemia diabetes among general adult population rural bangladesh assess effect interventions incidence type 2 diabetes among people intermediate hyperglycaemia within study populationdmagic threearm clusterrandomised trial participatory community mobilisation mhealth mobile phone messaging usual care control 96 villages population roughly 125 000 bangladesh community mobilisation involved 18 monthly group meetings led lay facilitators applying participatory learning action pla cycle focused diabetes prevention control mhealth involved twiceweekly voice messages 14 months promoting behaviour change reduce diabetes risk primary outcomes combined prevalence type 2 diabetes intermediate hyperglycaemia overall population end intervention implementation period 2year cumulative incidence type 2 diabetes cohort intermediate hyperglycaemia baseline primary outcomes assessed fasting blood glucose concentrations 2h oral glucose tolerance tests among crosssection adults aged 30 years older cohort individuals identified intermediate hyperglycaemia prevalence findings based crosssectional survey end study incidence findings based 2year followup survey cohort individuals identified intermediate hyperglycaemia crosssectional survey baseline also assessed costeffectiveness interventions trial registered isrctn registry number isrctn41083256 completedthe study took place june 27 2015 june 28 2018 pla intervention running 32 villages june 2016 december 2017 mhealth intervention running 32 villages oct 21 2016 dec 24 2017 endof study prevalence assessed 11 454 individuals incidence 2100 individuals large reduction combined prevalence type 2 diabetes intermediate hyperglycaemia pla group compared control group end study adjusted stratification clustering wealth odds ratio aor 036 027048 absolute reduction 207 95 ci 146267 among 2470 adults intermediate hyperglycaemia baseline 2100 85 followedup 2 years 2year cumulative incidence diabetes cohort significantly lower pla group compared control aor 039 024065 representing absolute incidence reduction 87 35140 evidence effect mhealth combined prevalence intermediate hyperglycaemia diabetes aor 093 074116 incidence diabetes 102 073143 incremental costeffectiveness ratios pla int316 per case intermediate hyperglycaemia type 2 diabetes prevented 6518 per case type 2 diabetes prevented among individuals intermediate hyperglycaemiaour data provide strong evidence support use community mobilisation based pla prevent type 2 diabetes rural bangladeshi population despite raising knowledge awareness diabetes mhealth intervention change disease outcomes population replication studies populations priorityuk medical research council