A Hybrid Effectiveness-Implementation Trial of the 'Power To Prevent Diabetes Program' in Bamako, Mali

Community-based diabetes prevention and control programs are effective but limited in West Africa. We assess adoption and effectiveness of a contextually adapted Diabetes Prevention Program "Power to Prevent" (DPP-P2P) in Bamako, Mali. Guided by implementation science principles, we adapted the DPP-P2P to align with Malian culture, integrating dietary and exercise modifications. Local audiovisuals and photo guides were created for healthy food preparation and exercises. Six community health centers with high diabetes rates were randomly assigned to intervention or comparison, and 429 individuals (≥ 25 years old with diabetes, hypertension, or obesity) consented to participate (intervention = 282; control = 147). Diabetes peer educators facilitated 14 bi-weekly sessions over six months. We assessed Hemoglobin A1c (HbA1c) and blood pressure and surveyed 15 key healthy lifestyle behaviors pre-and post-intervention. Retention was 77.1%, and groups especially liked the role plays, African audio-visuals, peer educator success stories, and demonstrations. In the intervention group, individuals wanting to weigh less increased from 31.5 to 58.9% (p < 0.001), exercise days rose from 3.5 to 5.6 (p < 0.001), and the desire for a healthier diet rose by 0.64 points. Average HbA1c in the intervention group dropped from 6.5% to 5.4% (p = 0.001). The intervention increased the odds of lowering blood glucose below 6.5% by 2.31 times (p = 0.020) and blood pressure below the hypertension threshold by 2.67 times (p = 0.060). The Malian-adapted DPP-P2P was well accepted by the community, increasing the adoption of healthy behaviors and reducing blood glucose and hypertension. This program could benefit Mali and Sahelian countries in tackling diabetes and hypertension.

ClinicalTrials.gov #NCT05260879. Registered 6 December 2021-Retrospectively registered (registration link: https://clinicaltrials.gov/study/NCT05260879).