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

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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. Underlying the increasing prevalence in Bangladesh are patterns of dietary change, changing lifestyles and increases in other risk factors like lack of exercise and smoking. Our study will 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. The first intervention will use mobile phone technology to send health promotion information and targeted diabetes prevention and management messages to the population whilst also implementing simple messages and quiz 'apps' to facilitate health provider training and decision support in relation to diabetes care. The second intervention will focus on participatory community groups, engaging communities in a series of meetings in which the population themselves identify and address factors that may increase their risks of diabetes or prevent the effective management of the disease. It is hypothesised that collective community messaging and engagement in this way will enhance awareness and trigger behaviour change leading to lower burdens of risk factors and disease indicators, measured through large community surveys. The simultaneous evaluation of the two interventions in different areas will allow a comparison of the benefits of each compared to a 'control' area that only receives standard diabetes prevention and care services. A strong focus on implementation and process evaluation will identify the likely scalability and sustainability of these interventions.