A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self‐management among South Asians with diabetes in Manchester

Vyas, Avni; Haidery, Arfana; Wiles, Philip; Gill, Sudeep S.; Roberts, Callie; Cruickshank, J.K.

doi:10.1046/j.1464-5491.2003.01082.x

Cited by 42 publications

(49 citation statements)

References 11 publications

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“…Lack of diabetes-related knowledge has been observed among UK south Asians [93][94][95][96]. This could result from a communication gap between patients and their care providers or problems with literacy.…”

Section: Cultural Issuesmentioning

confidence: 99%

Type 2 diabetes and cardiovascular risk in the UK south Asian community

et al. 2006

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A popular hypothesis for the greater prevalence of type 2 diabetes and cardiovascular disease in UK south Asians is that they have an increased susceptibility of developing insulin resistance in response to certain environmental factors, including obesity and adoption of a sedentary lifestyle. Insulin resistance is postulated as a central feature of the metabolic syndrome, culminating in type 2 diabetes, atherosclerotic vascular disease and CHD; a pathway potentially accelerated by migration/ urbanisation. We describe and compare the prevalence of type 2 diabetes, cardiovascular disease and their associated risk factors in UK south Asian and white Caucasian populations to determine possible reasons for the increased preponderance of these diseases in south Asians, and highlight key evidence for optimal risk factor management. Finally, we describe a UK communitybased programme that attempts to reduce the morbidity and mortality from type 2 diabetes and cardiovascular disease in south Asians through a new approach to management.

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Section: Cultural Issuesmentioning

confidence: 99%

Type 2 diabetes and cardiovascular risk in the UK south Asian community

et al. 2006

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“…an additional problem is that sas are reluctant to accept that amelioration of their condition is within their control. Diabetics regularly visited by a specialist nurse or dietician showed no significant improvement in diabetes knowledge or self-management 52 , regardless of the presence of asian link workers 53 . They continued with their previous dietary habits despite detriment to glycaemic control 54 and even after suffering a cardiac event 55 .…”

Section: South Asians and Key Cvd Risk Factorsmentioning

confidence: 99%

South Asians and their increased cardiovascular risk: A review of risk factors and diet and lifestyle modification

Nicoll¹,

Henein²

2015

ICFJ

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South Asians (SAs) have a significantly higher incidence and severity of type 2 diabetes and cardiovascular disease (CVD) than Caucasians and can present with atypical ischaemic symptoms. This can present a challenge for health professionals who may not be aware of the lowered thresholds recommended for SA body mass index, waist circumference and age. Although SAs are likely to have all the hallmarks of metabolic syndrome: central obesity, insulin resistance, impaired glucose tolerance, reduced high density lipoprotein, high triglycerides and hypertension, conventional risk factors alone do not fully predict the increased CVD risk among this community. Furthermore, SAs themselves may not be aware of their increased predisposition to disease nor of the dietary and lifestyle modifications which could reduce the risk and severity of their condition. Even where some modification has been attempted, there may be cultural pressure to conform to a traditional diet and the requirements for fasting and feasting. Principally, SAs should avoid large late meals, reduce sugary sweets and drinks, alcohol and foods fried in plant oils which create damaging transfats, while increasing protein and non-fried vegetables to help glycaemic control. Chewing paan, with or without added tobacco, is a particular risk factor for both CVD and cancer, on a par with the dangers of smoking. Although not in the culture, exercise would also be of great benefit.

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“…Speculated higher than average T2DM progression rates amongst UK south Asians are supported by significant global variation in reported incident cases but robust prospective data is lacking within Westernised ethnic minority populations. Studies gauging reaction to T2DM screening within these groups is also limited [19] but suggests response rates are more likely to be influenced by cultural beliefs, social stigma attached to certain conditions, and the attitude of the local community to western health care methods [20,21]. It is essential barriers to screening activity together with the effort required to overcome them are quantified if they are to inform effective planning and implementation of culturally sensitive interventions [22].…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening

Webb

Khunti

Srinivasan

et al. 2010

Trials

121

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BackgroundEarlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in Type 2 Diabetes Mellitus (T2DM). Latent phase identification through screening requires structured, appropriately targeted population-based approaches. Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from randomised intervention trials in screen-detected T2DM cases. UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM. To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care. Here we describe the rationale and methods of a systematic community screening programme and randomised controlled trial of cardiovascular risk management within a UK multiethnic setting (ADDITION-Leicester).DesignA single-blind cluster randomised, parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care.MethodsADDITION-Leicester consists of community-based screening and intervention phases within 20 general practices coordinated from a single academic research centre. Screening adopts a universal diagnostic approach via repeated 75g-Oral Glucose Tolerance Tests within an eligible non-diabetic population of 66,320 individuals aged 40-75 years (25-75 years South Asian). Volunteers also provide detailed medical and family histories; complete health questionnaires, undergo anthropometric measures, lipid profiling and a proteinuria assessment. Primary outcome is reduction in modelled Coronary Heart Disease (UKPDS CHD) risk at five years. Seven thousand (30% of South Asian ethnic origin) volunteers over three years will be recruited to identify a screen-detected T2DM cohort (n = 285) powered to detected a 6% relative difference (80% power, alpha 0.05) between treatment groups at one year. Randomisation will occur at practice-level with newly diagnosed T2DM cases receiving either conventional (according to current national guidelines) or intensive (algorithmic target-driven multi-factorial cardiovascular risk intervention) treatments.DiscussionADDITION-Leicester is the largest multiethnic (targeting >30% South Asian recruitment) community T2DM and vascular risk screening programme in the UK. By assessing feasibility and efficacy of T2DM screening, it will inform national disease prevention policy and contribute significantly to our understanding of the health care needs of UK South Asians.Trial registrationClinicaltrial.gov (NCT00318032).

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A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self‐management among South Asians with diabetes in Manchester

Abstract: This form of secondary/primary care support did not transfer information effectively, and we suspect similar problems would arise in other similar communities. Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group.

Cited by 42 publications

References 11 publications

Type 2 diabetes and cardiovascular risk in the UK south Asian community

Type 2 diabetes and cardiovascular risk in the UK south Asian community

South Asians and their increased cardiovascular risk: A review of risk factors and diet and lifestyle modification

Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening

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