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iHealth-T2D, a project led by Imperial College London, is taking a fresh look at the prevention of type 2 diabetes. It is trialling an approach by which individuals at particular risk benefit from an intensive support programme aimed not just at them, but also at the relatives with whom they share and shape their daily lives.
Work in iHealth-T2D focuses more specifically on South Asians, with trials conducted in India, Pakistan, Sri Lanka and the United Kingdom. “South Asians account for a quarter of the world’s population,” says Khadija Irfan Khawaja of the Services Institute of Medical Sciences in Lahore. “Compared to Europeans, they are three times as likely to develop diabetes.”
Khawaja leads the project’s work in Pakistan, where two entities are involved: the Punjab Institute of Cardiology is also a partner. “The focus of our intervention is to find out if we can actually prevent the onset of diabetes in people who otherwise would go on to develop this condition in less than five years,” she explains.
The steps to be taken are not in doubt: weight loss, improved diets and higher levels of physical activity are known to reduce the risk substantially. The challenge lies in fostering the deep, long-term commitment that is required. “Prevention is very difficult, because it means changing your lifestyle entirely,” Khawaja notes.
According to the World Health Organization, some 422 million people around the world have diabetes. Given the condition’s impact on individuals, communities and healthcare systems, finding a way to help healthy habits take hold could therefore be an advance of global significance.
To make a real difference, such measures would have to be suitable for roll-out across entire populations, they would have to be simple, and they would have to be affordable — even for countries where the resources are particularly constrained, Khawaja underlines.
Engaging help
The intervention championed by iHealth-T2D is delivered by community health workers and provides beneficiaries with proactive support throughout a full year. It involves 22 appointments — a combination of face-to-face meetings and telephone calls — where the health workers highlight aspects of healthy living, offer practical advice and supply moral support. Several of the meetings take the shape of group sessions, which beneficiaries attend with relatives.
The response has been heartening, says Khawaja, who reports that the trial is generating momentum. She attributes this success partly to the fact that the guidance is specifically tailored to the cuisines, culture and circumstances of the targeted communities.
What’s more, she notes, there is no costly equipment involved: the main tool participants need is a tape measure — to keep tabs on their shrinking waistlines. “Waist circumference has a very strong correlation with the risk of developing diabetes and cardiovascular disease,” Khawaja explains.
Does it work?
There can be no doubt that the intensive programme works, says Khawaja — the results so far are compelling. But she adds that it is too soon to tell if this success will translate into a genuine reduction of participants' long-term risk. The trials are staggered, with individual volunteers starting the one-year scheme at different times, and their progress is monitored for three years after it ends. Conclusions can only be drawn once data at the four-year mark is available for a significant number of participants.
There is a lot to be gained. “To the individuals concerned, the difference is huge, and the potential cost savings for healthcare systems are enormous,” Khawaja underlines.
The work in iHealth-T2D has also produced benefits for the partnering institutes: “We now have very strong collaborative networks across the wider region,” Khawaja reports. “And, of course, research generates research,” she concludes, hinting at the possibility of follow-on projects and their potential advantages for the scientists, institutes and countries involved.