Title: Epidemiological contribution to primary and secondary prevention of diabetes and obesity
Funder: Medical Research Council

Abstract: The growing burden of disease associated with diabetes and obesity represents one of the critical public health challenges of this century. There are significant areas of uncertainty that limit the development of potential solutions. However it is clear that prevention strategies will need to incorporate individual and population-based approaches. In the first quinquennium we established projects spanning this broad prevention agenda from the environmental influences on physical activity and dietary behaviour to intensive multifactorial treatment of people with newly diagnosed diabetes. We identified individual and collective factors associated with physical activity across the life course, synthesised the literature on interventions to promote activity in young people and developed a theory-based intervention to promote activity among individuals at particular risk of the consequences of sedentary behaviour due to their family history of diabetes. In a randomised trial incorporating objective measurement we demonstrated that this intensive intervention was no more effective than brief advice and that relatively small feasible changes in activity were associated with metabolic benefits. We modelled the key uncertainties concerning screening for T2DM and established an international multi-centre trial to resolve them. We developed practical strategies to identify people with undiagnosed diabetes, quantified the cardiovascular risk among screen-detected patients and the potential for reduction of this risk, established that screening was not associated with harmful effects and described the reduction in modelled cardiovascular risk associated with intensive treatment among screen-detected patients.||In the next quinquennium, our studies of the collective, population-level influences on diet and physical activity form the basis of our contribution to UKCRC Public Health Centre of Excellence in Diet and Activity Research through our planned programme on population approaches to diet and physical activity behaviour change. Moving forward, research in the prevention programme will focus on identifying individuals at increased risk of diabetes and its complications, the individual determinants that confer this risk, and the development and evaluation of primary and secondary prevention interventions. The overall goal of this programme is to translate epidemiological knowledge into action to prevent T2DM and related metabolic disorders and to assess the cost-effectiveness of different approaches to disease prevention. Specifically, we aim to:|develop and evaluate effective ways to communicate information about health behaviours, risk factors and disease risk|identify important modifiable individual factors influencing disease risk|develop primary and secondary prevention interventions targeting one or more of these factors and to evaluate their cost-effectiveness.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE