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

Lead Research Organisation: Queen Mary, University of London
Department Name: Unlisted

Abstract

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.

Technical Summary

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.

Publications

10 25 50
 
Description Weight reduction program in Tower Hamlets
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Tower Hamlets has adopted our lifestyle intervention to deliver a weight loss strategy to a sector of the borough and this is being led with our partner Social Action for Health.
 
Description HTA Project Grant
Amount £625,008 (GBP)
Organisation National Institute for Health Research 
Department Health Technology Assessment Programme (HTA)
Sector Public
Country United Kingdom
Start 01/2012 
End 12/2013
 
Description Invited call; Vitamin D supplementation to prevent diabetes
Amount £150,000 (GBP)
Organisation Queen Mary University of London 
Sector Academic/University
Country United Kingdom
Start 11/2009 
End 11/2011
 
Description Tower Hamlets PCT/Tower Hamlets PCT|
Amount £150,000 (GBP)
Organisation Tower Hamlets Primary Care Trust (PCT) 
Sector Public
Country United Kingdom
Start 11/2009 
End 11/2011
 
Title Training manual 
Description Underpinning the behavioural based intervention a 62 page tutor guide was written detailing the content and objectives of the 6x 2 hour group sessions. 
Type Of Material Improvements to research infrastructure 
Year Produced 2007 
Provided To Others? Yes  
Impact Used for a weight reduction course in Tower Hamlets and will be availble via the web at end of study 
 
Description Diabetes Research Network prevention writing group 
Organisation University of Cambridge
Department MRC Epidemiology Unit
Country United Kingdom 
Sector Academic/University 
PI Contribution Local Diabetes Research Network leads from Barts and The London, Cambridge, Penninsula and Newcastle together with Oxford CTU have submitted a HTA grant to prevent cardiovascualr disease by treating non diabetic hyperglycaemia using metformin.
Collaborator Contribution Joint grant to HTA submitted
Impact HTA have reviewed and asked for a re-submission based on a pilot for one year and dpending on progress the main trial
Start Year 2008
 
Description NE London Diabetes Local Research Network lay panel and conferences. Havering open day, Diabetes UK local lay branches 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Primary Audience Public/other audiences
Results and Impact Lay talks on diabetes prevention strategies using lifestyle and how to engage ethnic minorities and in particular the local Bangladeshi population. We also commissoned a DVD of the Imman of the East London mosque communicating the importance of diabetes prevention in Benglai and English.

Awareness of our prevention program and an increase in knowledge
Year(s) Of Engagement Activity 2007,2008,2009