A statistical model to describe longitudinal and correlated metabolic risk factors: the Whitehall II prospective study

Breeze, Penny; Squires, Hazel; Chilcott, James; Stride, Chris; Diggle, Peter J.; Brunner, Eric J.; Tabák, Ádám G.; Brennan, Alan

doi:10.1093/pubmed/fdv160

Cited by 17 publications

(18 citation statements)

References 26 publications

(27 reference statements)

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“…Individuals were sampled at random with replacement from this dataset to populate the model in which 5 000 000 individuals were simulated. In the model, each individual follows trajectories for HbA 1c , BMI, systolic blood pressure and cholesterol derived from the Whitehall II cohort . In yearly cycles, people visit their general practitioner and may be diagnosed with diabetes, hypertension or dyslipidaemia and treated accordingly.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness of population‐based, community, workplace and individual policies for diabetes prevention in the UK

et al. 2017

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AimTo analyse the cost‐effectiveness of different interventions for Type 2 diabetes prevention within a common framework.MethodsA micro‐simulation model was developed to evaluate the cost‐effectiveness of a range of diabetes prevention interventions including: (1) soft drinks taxation; (2) retail policy in socially deprived areas; (3) workplace intervention; (4) community‐based intervention; and (5) screening and intensive lifestyle intervention in individuals with high diabetes risk. Within the model, individuals follow metabolic trajectories (for BMI, cholesterol, systolic blood pressure and glycaemia); individuals may develop diabetes, and some may exhibit complications of diabetes and related disorders, including cardiovascular disease, and eventually die. Lifetime healthcare costs, employment costs and quality‐adjusted life‐years are collected for each person.ResultsAll interventions generate more life‐years and lifetime quality‐adjusted life‐years and reduce healthcare spending compared with doing nothing. Screening and intensive lifestyle intervention generates greatest lifetime net benefit (£37) but is costly to implement. In comparison, soft drinks taxation or retail policy generate lower net benefit (£11 and £11) but are cost‐saving in a shorter time period, preferentially benefit individuals from deprived backgrounds and reduce employer costs.ConclusionThe model enables a wide range of diabetes prevention interventions to be evaluated according to cost‐effectiveness, employment and equity impacts over the short and long term, allowing decision‐makers to prioritize policies that maximize the expected benefits, as well as fulfilling other policy targets, such as addressing social inequalities.

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Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness of population‐based, community, workplace and individual policies for diabetes prevention in the UK

et al. 2017

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“…The model incorporates individual‐level trajectories for BMI, HbA 1c , 2‐h glucose, fasting plasma glucose, systolic blood pressure, total cholesterol and HDL cholesterol. The trajectories are based upon statistical analysis of the Whitehall II cohort . The model was designed to simulate a representative sample of the UK population, by using individuals from survey data from the 2011 Health Survey for England .…”

Section: Methodsmentioning

confidence: 99%

The impact of Type 2 diabetes prevention programmes based on risk‐identification and lifestyle intervention intensity strategies: a cost‐effectiveness analysis

et al. 2017

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Aims To develop a cost-effectiveness model to compare Type 2 diabetes prevention programmes targeting different at-risk population subgroups with a lifestyle intervention of varying intensity.Methods An individual patient simulation model was constructed to simulate the development of diabetes in a representative sample of adults without diabetes from the UK population. The model incorporates trajectories for HbA 1c , 2-h glucose, fasting plasma glucose, BMI, systolic blood pressure, total cholesterol and HDL cholesterol. Patients can be diagnosed with diabetes, cardiovascular disease, microvascular complications of diabetes, cancer, osteoarthritis and depression, or can die. The model collects costs and utilities over a lifetime horizon. The perspective is the UK National Health Service and personal social services. We used the model to evaluate the population-wide impact of targeting a lifestyle intervention of varying intensity to six population subgroups defined as high risk for diabetes.Results The intervention produces 0.0003 to 0.0009 incremental quality-adjusted life years and saves up to £1.04 per person in the general population, depending upon the subgroup targeted. Cost-effectiveness increases with intervention intensity. The most cost-effective options are to target individuals with HbA 1c > 42 mmol/mol (6%) or with a high Finnish Diabetes Risk (FINDRISC) probability score (> 0.1). ConclusionThe model indicates that diabetes prevention interventions are likely to be cost-effective and may be costsaving over a lifetime. In the model, the criteria for selecting at-risk individuals differentially impact upon diabetes and cardiovascular disease outcomes, and on the timing of benefits. These findings have implications for deciding who should be targeted for diabetes prevention interventions.

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“…Full details of this analysis are described elsewhere. 278 The characteristics of the Whitehall II cohort 277 (civil servants living in London) are likely to differ significantly from that of the STOP Diabetes population. However, there are, to our knowledge, no available longitudinal surveys of populations with ID on which to base a similar analysis, and no other analysis of metabolic trajectories takes into account the correlations between risk factors that make the Whitehall model 277 so powerful.…”

Section: Long-term Longitudinal Trajectories Of Metabolic Factorsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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A statistical model to describe longitudinal and correlated metabolic risk factors: the Whitehall II prospective study

Cited by 17 publications

References 26 publications

Cost‐effectiveness of population‐based, community, workplace and individual policies for diabetes prevention in the UK

Cost‐effectiveness of population‐based, community, workplace and individual policies for diabetes prevention in the UK

The impact of Type 2 diabetes prevention programmes based on risk‐identification and lifestyle intervention intensity strategies: a cost‐effectiveness analysis

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

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