A family based trial for primary prevention of type 2 Diabetes in South Asians

Lay summary:Type 2 diabetes is a serious disease. It runs in families, but is mainly caused by being overweight and not being physically active. About 20% of British South Asians have diabetes, compared to 4% of the UK population. Weight loss and exercise programmes prevent diabetes internationally but this has not been proven, either in the UK or in UK South Asians. This research will investigate whether a family-based lifestyle change programme (based on diet and physical activity) will prevent diabetes in people living in families where there is diabetes. This will benefit the population by helping us understand how to prevent diabetes.

Wider issues: The Universities involved are active in public engagement in science. The PI (Bhopal) will take primary responsibility for ensuring dissemination of the results via the popular media, through press releases, and interviews with radio and television. Bhopal has a track record of such work. Our links with the community and professionals are excellent, and several of the investigators and collaborators will work to ensure policy makers, practitioners, and the public are directly engaged during the dissemination process.

Central obesity, a sedentary lifestyle, impaired glucose tolerance (IGT) and diabetes are highly prevalent in South Asians. Diabetes is preventable through weight loss and increasing physical activity but this has not been demonstrated either in the UK or for South Asians. This trial evaluates an intervention within the family of people with diabetes but designed to reduce weight and increase physical activity in their adult relatives at high risk of diabetes indicated by IGT, thereby preventing or delaying diabetes. The interventions will be those used internationally, but adapted for South Asians. 300 families will be randomised into intervention and control groups, each containing two people with IGT (600 people in total).The intervention group of 300 will receive 15 contacts with a trained dietician over three years, with the goal of reducing weight, achieving at least 30 minutes of physical activity daily, and making measurements. The control group of 300 will have 4 contacts with a dietician to provide health information and make measurements. The primary outcome is progression from IGT to diabetes, based on the oral glucose tolerance test (OGTT). The intervention is anticipated to reduce the 3-year incidence of diabetes from 30 percent to 15 percent. Cost effectiveness of the intervention will be calculated. Qualitative research will help in implementing the trial.