Epidemiological contribution to primary and secondary prevention of diabetes and obesity

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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.