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Intermediate hyperglycaemia, diabetes and blood pressure in rural Bangladesh: Five-year post-randomisation follow-up of the DMagic cluster-randomised controlled trial

Fottrell, Edward; King, Carina; Ahmed, Naveed; Shaha, Sanjit Kumer; Morrison, Joanna; Pires, Malini; Kuddus, Abdul; ... Azad, Kishwar; + view all (2022) Intermediate hyperglycaemia, diabetes and blood pressure in rural Bangladesh: Five-year post-randomisation follow-up of the DMagic cluster-randomised controlled trial. The Lancet Regional Health - Southeast Asia , Article 100122. 10.1016/j.lansea.2022.100122. (In press). Green open access

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Abstract

Summary Background: The DMagic trial showed that participatory learning and action (PLA) community mobilisation delivered through facilitated community groups, and mHealth voice messaging interventions improved diabetes knowledge in Bangladesh and the PLA intervention reduced diabetes occurrence. We assess intervention effects three years after intervention activities stopped. Methods: Five years post-randomisation, we conducted a cross-sectional survey among a random sample of adults aged ≥30-years living in the 96 DMagic villages, and a cohort of individuals identified with intermediate hyperglycaemia at the start of the DMagic trial in 2016. Primary outcomes were: 1) the combined prevalence of intermediate hyperglycaemia and diabetes; 2) five-year cumulative incidence of diabetes among the 2016 cohort of individuals with intermediate hyperglycaemia. Secondary outcomes were: weight, BMI, waist and hip circumferences, blood pressure, knowledge and behaviours. Primary analysis compared outcomes at the cluster level between intervention arms relative to control. Findings: Data were gathered from 1623 (82%) of the randomly selected adults and 1817 (87%) of the intermediate hyperglycaemia cohort. 2018 improvements in diabetes knowledge in mHealth clusters were no longer observable in 2021. Knowledge remains significantly higher in PLA clusters relative to control but no difference in primary outcomes of intermediate hyperglycaemia and diabetes prevalence (OR (95%CI) 1.23 (0.89, 1.70)) or five-year incidence of diabetes were observed (1.04 (0.78, 1.40)). Hypertension (0.73 (0.54, 0.97)) and hypertension control (2.77 (1.34, 5.75)) were improved in PLA clusters relative to control. Interpretation: PLA intervention effect on intermediate hyperglycaemia and diabetes was not sustained at 3 years after intervention end, but benefits in terms of blood pressure reduction were observed.

Type: Article
Title: Intermediate hyperglycaemia, diabetes and blood pressure in rural Bangladesh: Five-year post-randomisation follow-up of the DMagic cluster-randomised controlled trial
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.lansea.2022.100122
Publisher version: https://doi.org/10.1016/j.lansea.2022.100122
Language: English
Additional information: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Keywords: Diabetes, Bangladesh, Cardiovascular risk, Community intervention, Prevention, Control, Cluster randomised controlled trial, Rural
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10161814
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