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.
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 |