A cluster randomised controlled trial of community groups using Participatory Learning and Action to prevent and control diabetes and intermediate hyperglycaemia in rural Bangladesh

Community mobilisation through Participatory Learning and Action (PLA) has been shown to be effective for a range of health outcomes, including diabetes. Using a cluster randomised controlled trial we evaluated the impact of a PLA community mobilisation intervention for diabetes prevention and control when implemented in rural Bangladesh in 2021-2022 and adapted to the evolving context of the COVID-19 pandemic. 108 PLA groups held a minimum of 13 meetings over a total implementation period of 20 months. Random cross-sectional samples of adults (aged ≥30 years) at baseline (pre-intervention, n = 1392) and at endline (post-intervention, n = 1343) were selected to evaluate intervention impact on the primary outcome of prevalence of intermediate hyperglycaemia and diabetes assessed through fasting blood glucose concentrations and two-hour oral glucose tolerance tests. Secondary outcomes included blood pressure, knowledge of diabetes, and behavioural outcomes, including diet, physical activity, and care-seeking. Results showed no evidence of an intervention effect on prevalence of intermediate hyperglycaemia and diabetes between study arms (adjusted difference -1.19% (95% CI -10.74, 8.36), p = 0.784). Large increases in diabetes knowledge were recorded and the intervention was associated with a significant reduction in mean diastolic blood pressure (-2.98 (-5.55, -0.41), p = 0.028) and possible reductions in the prevalence of hypertension (-7.40% (-16.03, 1.24), p = 0.0845) and abdominal obesity (-15.23% (-33.02, 2.56), p = 0.085). Although COVID-related interruptions and adaptations to implementation of PLA may have impacted effectiveness, the PLA approach to non-communicable disease prevention and control continues to show promise in resource-poor settings. Trial registration: ISRCTN42219712 - registered 31st October 2019. Status: complete.