Study protocol for the Cities Changing Diabetes programme: a global mixed-methods approach

Abstract

IntroductionUrban living has been shown to affect health in various ways. As the world is becoming more urbanised and almost two-thirds of people with diabetes now live in cities, research into the relationship between urban living, health and diabetes is key to improving the lives of many. The majority of people with diabetes have type 2 diabetes, a subset linked to overweight and obesity, decreased physical activity and unhealthy diets. Diabetes has significant consequences for those living with the condition as well as their families, relationships and wider society. Although care and management are improving, complications remain common, and diabetes is among the leading causes of vision loss, amputation, neuropathy and renal and cardiovascular disease worldwide. We present a research protocol for exploring the drivers of type 2 diabetes and its complications in urban settings through the Cities Changing Diabetes (CCD) partnership programme.Methods and analysisA global study protocol is implemented in eight collaborating CCD partner cities. In each city, academic institutions, municipal representatives and local stakeholders collaborate to set research priorities and plan implementation of findings. Local academic teams execute the study following the global study protocol presented here. A quantitative Rule of Halves analysis obtains measures of the magnitude of the diabetes burden, the diagnosis rates in each city and the outcomes of care. A qualitative Diabetes Vulnerability Assessment explores the urban context in vulnerability to type 2 diabetes and identifies social factors and cultural determinants relevant to health, well-being and diabetes.Ethics and disseminationThe protocol steers the collection of primary and secondary data across the study sites. Research ethics board approval has been sought and obtained in each site. Findings from each of the local studies as well as the result from combined multisite (global) analyses will be reported in a series of core scientific journal papers.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…SSA is often regarded as the world's fastest urbanizing region, with the global share of African urban residents projected to grow from 11.3% in 2010 to 20% in 2050 (Saghir and Santoro, 2018). The city of Johannesburg in South Africa has been a part of a world-wide initiative called "Cities Changing Diabetes," the purpose of which is to improve the management of patients with diabetes in urban areas using the principles of halves, i.e., approximately 50% of people with diabetes are diagnosed, of whom 50% receive care, of whom 50% achieve treatment target (recommended glucose levels), of whom approximately 50% would subsequently lead a life free from diabetes related complications equating to 6% of those with diabetes (Napier et al, 2017).…”

Is the Rule of Halves framework relevant for diabetes care in Copenhagen today? A register-based cross-sectional study

“… 8 The international initiative ‘Cities Changing Diabetes’ aims at improving diabetes control in several cities of high/middle-income countries and both RoH analyses and vulnerability assessments are done to identify policy entry points and target groups for those efforts. 11 This paper reports on the RoH analysis done for the City of Copenhagen, capital of Denmark.…”

A Population-Based Approach to Mapping Vulnerability to Diabetes

“…A clustering algorithm was employed to construct profiles of the survey sample who self-reported a type 2 diabetes diagnosis (including only adults 18 years or older). Thirty-five social, economic, and behavioral factors (see Appendix A ) were suggested by the general domains present in the Vulnerability Assessment coding scheme for qualitative analysis, adopted by the Cities Changing Diabetes project [ 9 ]. A 2-step procedure was employed to expand the number and type of variables included; the first step is pre-clustering to form sub-clusters that are then subjected to a more conventional, hierarchical analysis (TwoStep Cluster © , IBM SPSS v23, IBM, Armonk, NY, USA).…”