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Research across contexts to understand and reduce risks associated with diabetes and multimorbidity.
Project description
The global prevalence of type-2 diabetes mellitus is around 9% among adults and about 75% of people living with diabetes live in low-income and middle-income countries (LMICs). More than one third of adults in rural Bangladesh have raised blood glucose levels meeting WHO criteria for diabetes or ‘intermediate hyperglycaemia’ (indicating risk of diabetes). There is urgent need for effective interventions to reduce the burden of diabetes.
Through MRC and Global Alliance for Chronic Disease funding, the project team designed, implemented and tested two prevention and control strategies in rural areas of Bangladesh.
The first strategy was a community mobilisation intervention based on a method of Participatory Learning and Action. Community members formed groups were guided through an 18-month process of discussion and problem solving to reduce diabetes risk. The second was an mHealth intervention where voice messages were sent to individuals’ mobile phones to promote healthy lifestyles and raise awareness of diabetes. A randomised controlled trial evaluation of these interventions showed that they greatly improved population awareness and knowledge of diabetes.
This study (the DMagic project) provided the first large-scale, population-level evidence concerning the effectiveness and cost-effectiveness of a general population approach that emphasised empowerment and community awareness raising to change behaviours and reduce diabetes risk. It also had a substantial impact on diabetes burden without major changes in diet, physical activity and care seeking in intervention villages.
In 2019 the DClare project was launched to replicate findings of the DMagic project and to scale-up the intervention to a larger population in Bangladesh, including for the first time in an urban population.
Following the success of the research conducted in Bangladesh, the Contextual Awareness, Response and Evaluation (CARE) Diabetes project in Ghana was launched in 2020. This project applies an interdisciplinary approach, including history, urban planning, social psychology and epidemiology to gain a deep contextual understanding of diabetes in urban Ghana. The project will adapt and test the feasibility of a the Participatory Learning and Action community mobilisation intervention that proved successful in Bangladesh.
It has become clear that the disease and its consequences cannot be considered in isolation from other health and social conditions and many individuals with diabetes also have other chronic health conditions. The complexities of living with ‘multimorbidity’ is the focus of the MRC-funded project in rural South Africa which seeks to understand the clustering of diseases within individuals and the role of self-monitoring and self-care.
Collaborations and partnerships in LMICs
UCL investigators worked closely with their overseas partners in conceptualising the research project, writing the funding application and implementing the work.
Work in Bangladesh is in collaboration with the Diabetic Association of Bangladesh, the largest non-governmental healthcare provider in the country with a national presence and reputation that makes large-scale research possible. The University of Ghana is an equal partner on the CARE Diabetes project and the University of the Witwatersrand leads the multimorbidity project in South Africa.
Beyond direct project partners, this body of research is supported and strengthened through collaboration with governmental, non-governmental and civil society organisations in each setting. These are key partners who influence and endorse the research and contribute to knowledge translation.
The benefits and impacts of the project activities to LMICs
This interdisciplinary, integrated approach to action oriented research on diabetes and multimorbidity will build awareness, tools and capacity to address the issues from a communities, systems, research and policy level.
The primary beneficiaries of the research will be people in LMICs who live with type two diabetes, other non-communicable diseases and multimorbidity or at risk of developing these conditions, and their families and communities.