The Bangladesh D:CLARE Project (Diabetes: Community-Led Awareness, Response and Evaluation)

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We recently completed a population health experiment in rural Bangladesh where we found that a diabetes-focused participatory community mobilisation intervention whereby ordinary community members themselves identify, prioritise and address threats to their health reduced the burden of diabetes and the risk of diabetes (known as 'intermediate hyperglycaemia') in these villages by more than 60% relative to villages where no intervention took place. Furthermore, among individuals who were at higher risk of developing diabetes, those living in community mobilisation villages were almost 60% less likely to develop the disease over two years compared to those who lived in villages where no intervention took place. These findings and our robust methods of evaluation give us confidence that exposure to the community mobilisation intervention caused this reduction in the burden of intermediate hyperglycaemia and diabetes. Furthermore, the low-cost, social intervention is cost-effective and can lead to savings in health care expenditure. Based on these findings, we wish to scale-up our intervention to cover a much larger population. Working with the Diabetic Association of Bangladesh, who will implement the intervention across a population of 215,000 people, UCL will apply epidemiological, economic, social and implementation science methods to better understand the processes, costs and impact of implementation at such a large scale. Further, we will evaluate the sustainability of groups when direct intervention from the Diabetic Association of Bangladesh is withdrawn and evaluate whether observed improvements in health last over a period of three years. Finally, a core component of our project will be engagement with governmental and non-governmental stakeholders in Bangladesh and globally to share our findings and to explore opportunities for longer-term, larger-scale implementation of the intervention.