Supporting and Undertaking International Public Health Research in NCD prevention

Nick Wareham

Source: Global Diabetes Plan, IDF 2011

• Training and capacity development

• Supporting epidemiological research

• Supporting public health research

• Training and capacity development

• Supporting epidemiological research

• Supporting public health research

• Cambridge Seminar on Epidemiology and Public Health aspects of Diabetes

• Free, 2 week course, Residential with resident faculty

• International with priority given to people from countries where training is difficult to obtain

• People selected on the basis of capacity to make a difference once they return to their countries of origin

The 1st Cambridge Seminar 1981

Harry Keen John Jarrett

The 11th Cambridge Seminar, 2011

Regional linked seminars

Cambridge Seminar in Hangzhou, China 2010

• Training and capacity development

• Supporting epidemiological research

• Supporting public health research

Source: The International Expert Committee. Diabetes Care 2009

The IDF Diabetes Atlas5th Edition

A summary of the figures and key findings

Prevalence of diabetes, 2011

The global burden

366 million people have diabetes in 2011; by 2030 this will have risen to 552 million

The number of people with type 2 diabetes is increasing in every country

80% of people with diabetes live in low-and middle-income countries The greatest number of people with diabetes are between 40 to 59

years of age 183 million people (50%) with diabetes are undiagnosed Diabetes caused 4.6 million deaths in 2011 Diabetes caused at least USD 465 billion dollars in healthcare

expenditures in 2011; 11% of total healthcare expenditures in adults (20-79 years)

78,000 children develop type 1 diabetes every year

WHO multinational studyInternational collaboration for study on disease outcomes

Source: Fuller et al, Diabetologia 2001

• Training and capacity development

• Supporting epidemiological research

• Supporting public health research

Source: Gillies et al, BMJ 2007

Meta-analysis of RCTs

Percentage progression to diabetes by successful achievement of intervention targets

Success score

%

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5

10

15

20

25

30

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40

45

50

0 1 2 3 4 5

Intervention Control

Rate of developing diabetes according to the number of diabetes healthy behaviour goals met

χ² test for trend p <0.001

0

1

2

3

4

5

6

7

8

0 1 2 3 4 5Number of diabetes healthy behaviour goals met

Dia

be

tes

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cid

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ce

ra

te/1

00

0 p

-yrs

Source: Simmons et al, Diabetologia 2006

Shift the whole population distribution of risk factor

• Focus on high risk individuals

• Low impact on population attributable risk (PAR) or preventable fraction

• Ineffective public health strategy

• Aim: to develop effective public health interventions for population level change in dietary and physical activity behaviour

• CEDAR Partnership: • Medical Research Council Units, University of East Anglia, University of

Cambridge • Erpho – East of England Public Health Observatory

The Indian Diabetes Prevention ProgrammesProf A Ramachandran

Source: Ramachandran et al, Diabetologia 2006

MRC-ICMR initiative

Chennai-Imperial-Cambridge

Evaluation of a scaleable and feasible mass intervention to promote lifestyle changes

Professor Jean-Claude MbanyaPresident IDF

Diabetes prevalence in Africa

Source: Mbanya et al, Lancet 2010

Felix Assah

Attendee Cambridge SeminarMPhil in EpidemiologyPhD in EpidemiologyWellcome Trust Clinical Fellow

“The Cambridge sequence … has been invaluable in providing an Introduction to NCD research and then going further to provide expert level training over a five year period. I am ready to give back to my society the knowledge and skills acquired through hands-on training of students and junior researchers.”

Rural Area in Cameroon Mbankomo

Rural lifestyle

Urban Area in CameroonBiyem-Assi, Yaounde

Urban lifestyle

Objectives

To objectively quantify physical activity levels in an urban and a rural population in Cameroon

To describe patterns of activities in these populations

to examine possible correlates of physical activity levels.

Population distribution of physical activity energy expenditure (PAEE)

0.0

05.0

1.0

15.0

2.0

25D

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ity

0 50 100 150PAEE (kJ/kg/day)

Rural Urban

Assah FK et al, Diabetes Care 2011

Activity and Clustered Metabolic Risk in Cameroon Rural and urban differences in 552 adults

zMS

-3

-2

-1

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Q1 Q2 Q3 Q4PAEE quartile

p<0.001 for trend

Source: Assah et al, Diabetes Care 2011

Domains of Physical Activity in Rural and Urban dwellers

05

01

001

502

002

50

Rural - Bafut Urban - Yaounde

Distribution of domians of PA using GPAQ

Work TravelLeisure

Assah FK et al, Unpublished, 2010

Seasonal trends of physical activity

Dark bars = Rural Light bars = Urban

Seasonal trends of physical activity

Dark bars = Rural Light bars = Urban

Some correlates of physical activity

PAEE (kJ/kg/day)

Rural (N=271) Urban (N=317)Correlates β SE p value β SE p value

Demographic and anthropometricBMI (kg/m2) -1.53 0.33 <0.001 -1.0 0.21 <0.001 Normal -- -- Overweight -11.11 3.41 0.001 -4.50 2.60 0.09 Obese -17.15 4.78 <0.001 -11.52 2.69 <0.001

Related lifestyle behavioursSmoking 0.57 5.70 0.9 12.77 3.81 0.001Alcohol drinking 5.05 3.56 0.2 4.84 2.56 0.06Fruits and vegetables <3 times/week -- -- 3 – 6 times/week 9.19 3.35 0.007 4.34 2.23 0.05 >=7 times/week 11.53 3.98 0.004 8.28 3.23 0.01

School duration (years) -0.55 0.35 0.1 -0.98 0.19 <0.001

• Training and capacity development - sustainable support for integrated programme of training and

capacity building at different levels

• Supporting epidemiological research

• Supporting public health research- focus on building global capacity to undertake translational public health research for NCD prevention