Prevention of Diabetes and Related Metabolic Disorders in High Risk Groups

肥胖症和糖尿病的患病率正在以惊人的速度增长。这些情况及其后果可能是本世纪最大的公共卫生挑战。该方案的目标是促进旨在预防糖尿病、肥胖症和相关代谢紊乱日益加重的负担的努力。为此，我们正在将流行病学知识转化为预防行动，并评估不同预防方法的有效性。这些方法的范围从初级预防，到通过筛查进行早期检测，再到为有条件的人制定和评估干预措施。|该方案的范围很广。它结合基础研究，为未来干预措施的发展提供信息。为了更好地理解为什么有些人比其他人更活跃，并了解这与当前的卫生政策有何关系。以下对两个研究主题的描述说明了这一点。首先，我们的工作已经证明，较高水平的日常体力活动可以降低患糖尿病的风险。我们正在研究个人和环境对儿童和成人(2000名儿童和15,000名诺福克中年人)体育活动的影响。通过使用地理信息系统和调查问卷以及通过加速计精确测量体力活动(测量运动和加速度)对其进行评估。与此同时，我们正在评估不同的干预措施，以促进糖尿病患者和糖尿病高危人群的体力活动，以及向个人提供有关他们体力活动水平的信息的效果。|来自该部门同事的早期工作证实，多达一半的2型糖尿病患者仍未得到诊断。许多患者在确诊时已经有了并发症的证据。因此，英国和其他国家的医疗服务机构面临的一个关键问题是，对糖尿病人群进行筛查是否符合成本效益，利用有限的医疗资源。我们代表国家筛查委员会审查了赞成和反对筛查的证据。我们开发并测试了识别糖尿病高危人群的简单方法，这些方法利用了全科医生计算机记录中常规保存的信息。然后，我们将这种方法纳入到剑桥郡及周边县15万名中年居民的筛查试验中。初步结果表明，筛查不会导致焦虑或抑郁，筛查发现的患者具有高水平的可改变的心血管风险因素，一年后这些因素会减少，特别是在支持提供强化治疗的一般做法中。

The prevalence of both obesity and diabetes is growing at an alarming rate. These conditions and their consequences probably represent the greatest public health challenge of this century. The goal of this programme is to contribute to efforts aimed at preventing the growing burden of diabetes, obesity and related metabolic disorders. To do this we are translating epidemiological knowledge into preventive action, and assessing the effectiveness of different preventive approaches. These approaches range from primary prevention, through earlier detection via screening, to the development and evaluation of interventions for those with the conditions.|The programme has a broad remit. It combines basic research to inform the development of future interventions. To better understand why some people are more active than others and to see how this relates to current health policy. This is illustrated by the following description of two of the research themes. Firstly, our work has demonstrated that higher levels of everyday physical activity reduce risk of diabetes. We are examining individual and environmental influences on physical activity in children and adults (2000 children and 15,000 middle aged adults Norfolk). They are assessed by using geographical information systems and questionnaires, as well as precise measurement of physical activity by accelerometers (measures movement & acceleration). At the same time we are evaluating different interventions to promote physical activity among people with diabetes and those at risk of developing diabetes and the effect of providing individuals with information about their levels of physical activity.|Earlier work from Unit colleagues confirmed that up to half of all people with type 2 diabetes remain undiagnosed. Many patients already have evidence of complications at diagnosis. Consequently, a key question for the health service in the UK and other countries is whether population screening for diabetes would be a cost-effective use of limited healthcare resources. We reviewed the evidence for and against screening on behalf of the National Screening Committee. We developed and tested simple methods of identifying those at high risk of having diabetes that utilise information routinely held in general practice computer records. We then incorporated this method into a trial of screening among 150,000 middle-aged residents of Cambridgeshire and surrounding counties. Preliminary results suggest that screening does not cause anxiety or depression, and patients detected by screening have high levels of modifiable cardiovascular risk factors which are reduced one year later, particularly in general practices being supported to provide intensive treatment.