The Bangladesh D:CLARE Project [Diabetes: Community-Led Awareness, Response and Evaluation]

Project Summary

Our DMagic cluster randomised controlled trial of community mobilisation through groups of men and women completing a Participatory, Learning and Action (PLA) cycle focused on diabetes prevention and control in rural Bangladesh.

After 18 months of intervention, the prevalence of diabetes and intermediate hyperglycaemia was 65% lower in intervention villages compared to control villages. Further, among individuals identified with intermediate hyperglycaemia before the intervention, the cumulative two-year incidence of diabetes was more than 60% lower in intervention villages.

The intervention is cost-effective and could save around INT$2.5 billion in health care costs annually if scaled-up nationally in Bangladesh.

The D:CLARE study will roll out the PLA intervention across six Unions in Faridpur district, as well as all the control villages from our aforementioned trial. In total, the scaled-up intervention will cover a population of approximately 215,000 people.

In partnership with the Diabetic Association of Bangladesh, who will be intervention implementers, UCL will lead a programme of implementation research with the following aims:

engage with national stakeholders to identify optimal intervention delivery mechanisms, and develop strategies to strengthen scale-up systems across Bangladesh and the region;
research PLA implementation and impact of the intervention at scale using qualitative, economic and quantitative methods;
describe the sustainability and lasting health impacts of the PLA intervention in former intervention (trial) communities to better understand what happens when direct involvement of the implementing partners is withdrawn and communities are left to run the intervention on their own;
establish the feasibility and acceptability of the PLA intervention within a different, higher-risk population in urban Bangladesh.