Prevention of Diabetes and Related Metabolic Disorders in High Risk Groups

Programme Leaders – Prof Simon Griffin and Dr Amy Ahern

Programme members:

Amy Ahern – Programme Leader
Clare Boothby – Data Scientist
Patricia Eustachio Colombo – Visiting Researcher
Simon Griffin – Programme Leader
Laura Kudlek – PhD Student
Julia Mueller – Senior Research Associate
Cara Ruggiero – Research Associate
Qiaoxin Shi – PhD Student
Hao Tang – PhD Student
Jenny Woolston – Study Coordinator

Programme news

Read news and blogs about this programme’s research.

Objectives

This programme serves the following of the Unit Objectives as a main focus:

To develop and evaluate individual level approaches to the prevention of diabetes, obesity and related metabolic disorders in children and adults

It serves the following Unit Objectives as an element of the programme:

To investigate the causes of obesity, diabetes and related metabolic disorders
To develop understanding of mechanisms identified by population-based studies
To inform, develop and evaluate population-based approaches to improving health
To develop new methods, resources and tools for epidemiological and public health research
To build capacity for conducting, understanding and using local, national, and international epidemiology and public health research
To contribute to the translation of research evidence into policy and practice

It has identified the following Objective as a potential area of contribution:

To investigate approaches to improving global health, particularly in low and middle income countries

Research

The overall goal of our research is to reduce the health care and societal burdens of obesity and type 2 diabetes by developing and evaluating scalable individual-level interventions, targeting readily identifiable population subgroups, at key points on the diabetes disease trajectory.

We are a multidisciplinary team of epidemiologists, clinicians, psychologists, and data scientists. Supported by a mix of MRC programme funding and external funding (for example NIHR and Wellcome) we have established a programme of observational and experimental studies addressing key uncertainties that constrain policy decisions regarding the most appropriate and efficient distribution of scarce preventive resources to reduce the burden of diabetes and obesity.

Our research programme is characterised by meticulous phenotyping of participants (in particular precise measurement of behaviours), identification of modifiable determinants of behaviour and other risk factors for disease, prudent development of interventions informed by behavioural science theory, and rigorous evaluation with extended follow-up to enable assessment of important clinical endpoints and modelling to estimate cost-effectiveness and inform policy.

We focus on generating evidence and resolving uncertainties across three key challenges facing behavioural interventions for prevention and early treatment of type 2 diabetes: achieving sustained changes in behaviour; delivering cost-effective interventions with the necessary scale and reach; having a meaningful long-term impact on disease incidence and associated health care costs.

Our objectives are to:

Quantify the long long-term impact on health outcomes of feasible changes in health-related behaviours and weight.
Identify determinants of these changes in behaviours, in different groups, at different points along the disease trajectory
Develop scalable, contextually-specific interventions to support individuals to make and sustain changes in behaviours and weight.
Evaluate the long-term impact of scalable behavioural interventions on health outcomes and healthcare costs.

Central to our research is a focus on translating knowledge into action. Our studies have provided the majority of original data referred to by international recommendations concerning screening for type 2 diabetes, including the HTA report for the UK National Screening Committee, and the US Preventive Services Task Force (USPSTF) review. We also contributed data to NICE and USPSTF guidance on weight management. Through membership of expert panels we have contributed to IDF and WHO evidence reviews concerning metabolic syndrome and prevention of type 2 diabetes. Our work on prevention of type 2 diabetes has influenced national policy via Nick Wareham serving as chair and Simon Griffin as an expert witness to NICE committees developing relevant public health guidance (PHG 35 and 38). Our work on screening for type 2 diabetes and cardiovascular disease risk influences policy via membership of the NHS England Health Checks advisory board.

Dr Amy Ahern and Professor Simon Griffin co-lead the NIHR PGfAR funded programme on Scalable behavioural weight management programmes for the prevention and treatment of type 2 diabetes, which will examine the cost-effectiveness of using non-specialists (health trainers, community members) and technology (internet, phones) to deliver behavioural weight management programmes to people at high risk of developing type 2 diabetes and people with a recent diagnosis of type 2 diabetes.

Key publications

Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. Lancet Public Health, 2022. DOI: 10.1016/S2468-2667(22)00226-2
Promoting physical activity in a multiethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial. BMC Medicine, 2021. DOI: 10.1186/s12916-021-01997-4
Third‐wave cognitive behaviour therapies for weight management: a systematic review and network meta‐analysis. Obesity Reviews, 2020. DOI: 10.1111/obr.13013
The impact of adult behavioural weight management interventions on mental health: A systematic review and meta-analysis. Obesity Reviews, 2020. DOI:10.1111/obr.13150
Long-term effects of intensive multifactorial therapy in individuals with screen-detected type 2 diabetes in primary care: 10-year follow-up of the ADDITION-Europe cluster-randomised trial. Lancet Diabetes Endocrinology, 2019. DOI:10.1016/S2213-8587(19)30349-3
Evaluation of a very brief pedometer-based physical activity intervention delivered in NHS Health Checks: The VBI randomised controlled trial. PLoS Med 2019. DOI:10.1371/journal.pmed.1003046
Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. Lancet 2017. DOI:10.1016/S0140-6736(17)30647-5
Lifestyle advice combined with personalized estimates of genetic or phenotypic risk of type 2 diabetes, and objectively measured physical activity: A randomized controlled trial. Plos Medicine 2016. DOI:10.1371/journal.pmed.1002185.
Multiple behaviour change intervention and outcomes in recently diagnosed type 2 diabetes: the ADDITION-Plus randomised controlled trial. Diabetalogia 2014. DOI: 10.1007/s00125-014-3236-6
Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet 2012. DOI:10.1016/S0140-6736(12)61422-6
Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial. Lancet 2011. DOI:10.1016/S0140-6736(11)60698-3
Estimating the population impact of screening strategies for identifying and treating people at high risk of cardiovascular disease: modelling study. BMJ 2010. DOI:10.1136/bmj.c1693
Efficacy of a theory-based behavioural intervention to increase physical activity in an at-risk group in primary care (ProActive UK): a randomised trial. Lancet 2008. DOI: 10.1016/S0140-6736(08)60070-7