Title: NIHR Global Health Research Unit and Network for Diabetes and Cardiovascular disease in South Asia
Funder: Department of Health and Social Care

Abstract: Our Global Health Research Network is a partnership between research intensive organisations in Bangladesh, India, Pakistan, Sri Lanka and the UK, and key collaborators in Australia and Singapore. Our primary ambitions are to: i. improve understanding of the mechanisms underlying the high burden of Type-2 diabetes (T2D) and cardiovascular disease (CVD) in South Asians, and ii. improve prevention and control of these major diseases through personalised, health systems and policy-based interventions, that are scalable, sustainable, effective and equitable. _x000D_ _x000D_ Our research comprises four interconnected themes. Theme 1 (Population health) will determine cardiovascular and metabolic outcomes at 4 years, for the ~150,000 South Asian men and women in our Surveillance study (baseline evaluation 2018-21). Using face-face and electronic methods, we will identify ~6,800 cases of incident T2D, and ~3,100 of incident CVD. We will complete molecular phenotyping of baseline samples, and use the data to investigate how lifestyle (diet and physical activity), environmental, genomic and molecular factors drive the increased risk of T2D and CVD amongst South Asians. Theme 2 (Digital Interventions) will test whether digital intervention with i. AI driven education or ii. gamification for behaviour change reduces weight (primary endpoint) and improves quantitative measures of cardiometabolic health, amongst South Asian men and women aged 30-60 years with overweight or obesity (BMI>23kg/m2), compared to usual care over 2 years. We embed the trial within the Surveillance study (Theme 1), bringing rich baseline data for participants, and evaluation in a wide range of South Asian settings. Theme 3 (Training and care co-ordination) focuses on strengthening primary healthcare systems. We connect health surveillance to computational guidelines, care pathway engines, training and digital health interventions, linking seamlessly with work in Themes 1 and 2. We collaborate with WHO to advance international standards for computational guidelines and decision support, and develop modular digital solutions for care co-ordination and care pathway delivery for T2D and CVD, that are scalable, evidence based, interoperable and generalisable. Theme 4 (Policy and environmental interventions) addresses community- and policy-based actions for health promotion and prevention of T2D and CVD in South Asians. In partnership with Health Promotion Bureau of Sri Lanka, we evaluate ‘whole of society’ approaches to intervention that target the demand and supply-side factors identified through our policy and environmental mapping (Theme 1). Evaluation at national scale will provide powerful evidence to inform future health policy in South Asian settings. Capacity building. The research themes will be supported by a programme of capacity building at our collaborating Centres of Excellence in genetic and environmental epidemiology, as well as in digital health, health systems, health policy and implementation science research._x000D_ _x000D_ Our programme of global health research will improve understanding of T2D and CVD in South Asians, including underlying mechanisms, approaches to identification of high-risk individuals, and scalable strategies for personalised and community wide prevention and control strategies. Results will contribute to transformational change of health promotion and disease prevention amongst South Asians, who represent ~25% of the world’s population.

Lay abstract: Diabetes and heart disease are leading causes of death and disability worldwide, and are especially common amongst people living in South Asia (Bangladesh, India, Pakistan and Sri Lanka). The impact of diabetes and heart disease on South Asian people is magnified by the limited access to high quality health care. Diabetes and heart disease are thus recognised as high priority public health challenges requiring urgent action across South Asia. _x000D_ _x000D_ Our Global Health research work aims to improve understanding of the mechanisms underlying diabetes and heart disease in South Asian populations, and to improve prevention and control of these diseases through personalised and health systems based interventions. Our research will be pursued in four complementary, interconnected themes that build on the work carried out to date:_x000D_ _x000D_ Theme 1. We will determine the health outcomes for 150,000 South Asian men and women, who were initially comprehensively assessed in 2018-21, and who have agreed to be followed long term. We will identify people who have developed diabetes or heart disease since first seen. The dataset created will allow us to study how the risk of diabetes and heart disease varies across South Asian communities, and to identify the lifestyle (eg diet and physical activity), environmental (eg access to healthy food), genetic and metabolic factors that drive diabetes and heart disease in South Asia._x000D_ _x000D_ Theme 2. Here we seek to improve health amongst high risk individuals using digital platforms to promote weight loss and improved lifestyle. We will study ~6,000 South Asian men and women with obesity, and determine how digital applications delivered through a smartphone application improve measures of heart and metabolic health, compared to normal care. _x000D_ _x000D_ Theme 3. This theme aims to strengthen health systems, through training and improved co-ordination of clinical care. We advance a multifaceted ‘Health Hub’ that delivers training, education, collection and sharing of clinical data, support for diagnosis and decision making, and delivery of clinical care. In doing so, we collaborate with the WHO, to help advance international standards for generalisable, evidence based digital health systems. _x000D_ _x000D_ Theme 4. We will evaluate community-wide intervention for health promotion in South Asia, in partnership with Health Promotion Bureau, Sri Lanka. The intervention adopts a ’whole of society approach’ though community- and policy-based actions, to improve the settings in which people and their families live. _x000D_ _x000D_ Our research focusses on a major health need for the people of South Asia. We will improve understanding of the causes for diabetes and heart disease in South Asia, and inform strategies for early detection and improved prevention. Our innovative approaches to health promotion and care delivery use platforms that are scalable, sustainable, effective and equitable. Our research has been co-designed with communities, policymakers and healthcare providers in South Asia, and are based on strong pilot data. The findings of our research offers the prospect for a major change in health promotion and disease prevention for South Asians, who represent 25% of the world’s population.

Research activity codes: 2.6 RESOURCES AND INFRASTRUCTURE (AETIOLOGY);6.6 PSYCHOLOGICAL AND BEHAVIOURAL;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CARDIOVASCULAR;METABOLIC AND ENDOCRINE