BRIDGES

Glycated haemoglobin (HbA1c) is the best surrogate of average blood glucose control in people with diabetes. Large-scale studies in the USA and UK have demonstrated that lowering HbA1c significantly reduces diabetes complications. Moreover, immediate feedback of HbA1c measurement to patients improves control. However, HbA1c measurement is unavailable in most parts of Africa, a continent with one of the highest burden of diabetes. To translate these evidences, we will provide affordable access to HbA1c measurement and relevant education in 2 African countries, aiming at a significant improvement in diabetes control. We will develop a training and cost-recovery scheme with local health authorities for long-term sustainability.

Lifestyle related diseases including diabetes, polycystic ovary syndrome (PCOS) and gestational diabetes (GDM) in women are increasing alarmingly. The financial, physical and emotional cost to the individual, the community and the government are significant. Greater insights into these preventable diseases are needed to identify barriers to behavior change and behaviors that are modifiable. This research must include an understanding of the health-related behaviors of women around diabetes including health beliefs and attitudes, the role of psychological functioning and risk perception as well as response to illness. Education and translation of these findings is the priority of this project.

People from the Indian subcontinent are more likely to get diabetes even at younger ages. This project describes a randomized trial of culturally specific, community-based lifestyle intervention for the prevention of type 2 diabetes in men and women living in Chennai, India. Lifestyle interventions are programmed to seek to prevent diseases by promoting changes in health behaviors, improved diet, increased physical activity and weight loss. The results of this program will be used to make policy and public health recommendations, which will result in broader diabetes prevention efforts.

The project will develop and implement a plan that will serve as a basis for a comprehensive approach for managing and treating diabetes in the country. The successful implementation of Micro-Clinic project will promote wellness, alleviate the economic burden of poor health, and provide a model comprehensive public health approach to the management of diabetes in the Middle East and around the world.

This study consists of 25,000 10 - 40 year old persons randomly selected from an urban population where 5000 persons with two or more risk factors will be identified by a simple questionnaire. They will receive biochemical and physical assessments and divided into a low intensity and high intensity life style modification and followed up for 3 years. They will receive the same screening for detection of end points. Expected outcome: Identify risk factors; Ascertain rate of incidence; Compare significance of new end points; Develop risk scores; Development of a low cost Primary Prevention strategy.