Diabetes Prevention in People from Bangladesh; A Pilot Trial in East London

The number of people developing diabetes as adults is growing and in Europe set to increase by at least 50% in the next 10 years. The problem is particularly intense in people of south Asian origin, where there is 3-6 times prevalence of T2D and the disease presents 10-15 years earlier compared to white Europeans. The lifetime risk for T2D in South Asians is around one in three, and in urban India recent surveys would suggest that T2D and impaired glucose tolerance (IGT) are present in 1 in 4 of all adults over the age of 20 years. Furthermore, in people under the age of 20 years of age there is an alarming increase in T2D associated with increasing prevalence of obesity in Europe and North America. This chronic disease results in increased heart attacks, strokes, loss of vision and kidney failure and in the UK accounts for approximately one tenth of the NHS health expenditure. From research in the US, Finland and India, we know it is possible to prevent diabetes with a programme of exercise and changes in diet, as well as use of a drug (metformin). We propose a research study to determine the right methods to test whether this type of programme will be successful in preventing diabetes in people at high risk of the disease in an ethnic minority group, the Bangladeshi community in east London.

The increase of diabetes worldwide has been attributed to changes in human behaviour and lifestyle over the last century on the background of genetic susceptibility. Type 2 diabetes (T2D) and the associated metabolic syndrome (hyperinsulinaemia, impaired glucose regulation, hypertension, dyslipidaemia, central obesity) is a major risk factor for cardiovascular disease (CVD). We propose to test in a pilot study the feasibility of a randomised controlled trial (RCT) of an intervention for the primary prevention of type 2 diabetes (T2D) and subsequent cardiovascular disease. A 2x2 factorial design of behavioural lifestyle modification and the use of metformin will be targeted at people of Bangladeshi origin at high risk of diabetes who have the metabolic syndrome. Participants will be identified via general practice electronic medical records using a diabetes risk score based on routinely collected data. The pilot will test the feasibility of identification and recruitment of participants and all aspects of study design, data collection and intervention. The main outcome of the pilot will be a robust protocol for the full cost-effectiveness trial.