Diabetes prevention in high-risk ethnic groups Dr Thomas Yates - - PowerPoint PPT Presentation

Diabetes prevention in high-risk ethnic groups

Dr Thomas Yates Professor in Physical Activity, Sedentary Behaviour and Health, University of Leicester

Aims

• Ethnic disparities in diabetes risk
• Importance of lifestyle to ethnic health
• Prevention programmes for ethnic

minorities

Per 100 Million

Diabetes since 1980

NCD Risk Factor Collaboration Lancet 2016 Commentary Yates & Khunti Nature Rev Endocrinol 2016

1 2 3 4 5 1980 2014

1980 level

108 million = 1 in 25 422 million = 1 in 11

Not explained by population growth Explained by population growth

Diabetes prevalence and incidence in the UK

1 2 3 4 5 6 7 8 9

Diabetes Audit diabetes prevalence RCGP diabetes prevalence RCGP diabetes incidence per year

White European African-Caribbean Asian

English S, et al (2016) Diabetes & Primary Care 18: 28–32 %

Consistent with other countries

Agyemang, et al. Epidemiology2011;22(4):563-567

Glucose response to mixed meals

Meal Data taken from Yates et al. The journals of gerontology. Series A 2018 doi: 10.1093/gerona/gly252

Insulin response to mixed meals

Data taken from Yates et al. The journals of gerontology. Series A 2018 doi: 10.1093/gerona/gly252

UK Biobank data

33 34 35 36 37 38 39 40 41 42 Unadjusted model Fully adjusted model

HbA1c (mmol/mol)

HbA1c

WE SA BAC 0.5 1 1.5 2 2.5 Unadjusted model Fully adjusted model

Triglycerides (mmol/L)

Triglycerides

WE SA BAC 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 Unadjusted model Fully adjusted model

Cholesterol-HDL ratio

Cholesterol-HDL ratio

WE SA BAC 0.5 1 1.5 2 2.5 3 3.5 Unadjusted model Fully adjusted model

C-reative protein (mg/L)

C-reative protein

WE SA BAC

Conclusions Part 1

• South Asian phenotype at particularly high

risk of insulin resistance and type 2 diabetes

• Risk greater than White European and
• ther ethnic groups

Part 2

Importance of body weight and lifestyle factors

BMI and diabetes prevalence

Ntuk et al. Diabetes care. 2014 Sep 1;37(9):2500-7.

Fat overspill

From www.myhealthywaist.org

Associations between physical activity and health

Celis-Morales et al. PloS one. 2013 Dec 11;8(12):e82568.

Odds of impaired glucose regulation by ethnicity and activity (Yates et al. 2012)

White European South Asian 1 2 3 4 Quartile 1 Quartile 2 Quartile 3 Quartile 4 1 0.71 0.69 0.61 3.1 1.51 1.18 0.61

P = 0.013 for interaction

OR Data taken from Yates T et al. International journal of epidemiology. 2013 18;42(2):533-40.

Impact of exercise on lipids

Arjunan et al MSSE 2013;45(7):1261-8.

Exercise and insulin resistence

20 40 60 80 100 120 140 160 180 Control Continious exercise HIIT

Chart Title

White European South Asian

Insulin (mU·L-1)

Data from the Leicester Go for IT trial

Importance of sedentary behaviour and light-intensity physical activity

Ekelund et al. bmj. 2019;366:l4570.

Leicester acute sedentary trials (n = 129)

Insulin response to breaking sitting

Difference in physical activity levels

(Yates et al. 2010, Prev Med)

MET.hr/week

5 10 15 20 25 30 35 40 45 50 Men

MET.hr/week

5 10 15 20 25 30 35 40 45 50 Women South Asian White European

Objectively assessed physical activity

Biddle et al. BMC public health. 2019 Dec;19(1):95.

Walking pace and life expectancy

Proportion reporting habitual brisk walking South Asian = 19% White European = 40% Zaccardi et al. Mayo Clinic Proceedings 2019; 94: 985-994

South Asian Risk

(Ghouri et al Diabetologia 2013)

0.5 1 1.5 2 2.5 3 3.5 Europeans South Asians

HOMA-IR

5 10 15 20 25 30 35 40 45 Europeans South Asians

Fitness (ml/kg.min)

83% of ethnic difference explained by fitness and physical activity

Over 20% of difference explained by lower levels of physical activity in South Asian groups Williams et al. Heart. 2011;97(8):655-9.

Differences in diet

Some evidence that south Asians consume a less healthy diet, including

• Less fruit, vegetables and fibre
• More processed grains (e.g. white rice)
• Higher ratio of ω-6 to ω-3

Data less consistent or clear than for physical activity

Misra et al. International journal of obesity. 2011;35(2):167

Conclusions Part 2

• South Asian get a greater health benefit

for a given improvement in body weight, physical activity or diet

• However, substantial behaviour change is

needed to normalise risk

• Low fitness and physical activity explain

much of the disease burden in South Asian communities

Can diabetes be prevented in South Asians

Modesti et al. Internal and emergency medicine. 2016 Apr 1;11(3):375-84.

Cultural barriers: Fatalism

(Lawton et al. 2006 Health Education Research)

“God has given me this disease of sugar. Whatever happens, it happens because God wants it to happen” “With age, as you know, you become weaker, and there is not much you can do about it”

Other barriers

(Horne & Tierney 2012 Preventive Medicine)

• Physical activity seen as exacerbating ill

health

• Importance of food with social occasions
• Cultural norms pertaining to gender roles
• Unfamiliar with local geography and lack of

culturally sensitive facilities

Enablers

(Horne & Tierney 2012 Preventive Medicine)

• Support from family
• Peer-support

Family based prevention programme

NIHR Programme Grant RP-PG-0606-1272 NIHR CLAHRC East Midlands

Translating prevention into routine care

1688 individuals and 54 GP practices recruited Followed up for 3 years Average increase of 400 steps/day

Impact of depression on behaviour change

Yates et al. Diabetes care. 2019 Oct 1;42(10):1847-53.

Depression and South Asians

Razieh et al. Diabetic Medicine. 2019 https://doi.org/10.1111/dme.13986

Conclusion Part 3

• Diabetes can be prevented in Black and

minority ethnic communities, but has to be tailored to cultural norms and perceptions

• Impact of depression is likely to be a key

factor of importance

Thank you

www.leicesterdiabetescentre.org.uk www.facebook.com/LeicesterDiabetesCentre @LDC_Tweets