NIHR Global Health Research Unit and Network for Diabetes and Cardiovascular disease in South Asia

Our Global Health Research Network is a partnership between research intensive organisations in Bangladesh, India, Pakistan, Sri Lanka and the UK, and key collaborators in Australia and Singapore. Our primary ambitions are to: i. improve understanding of the mechanisms underlying the high burden of Type-2 diabetes (T2D) and cardiovascular disease (CVD) in South Asians, and ii. improve prevention and control of these major diseases through personalised, health systems and policy-based interventions, that are scalable, sustainable, effective and equitable. Our research comprises four interconnected themes. Theme 1 (Population health) will determine cardiovascular and metabolic outcomes at 4 years, for the ~150,000 South Asian men and women in our Surveillance study (baseline evaluation 2018-21). Using face-face and electronic methods, we will identify ~6,800 cases of incident T2D, and ~3,100 of incident CVD. We will complete molecular phenotyping of baseline samples, and use the data to investigate how lifestyle (diet and physical activity), environmental, genomic and molecular factors drive the increased risk of T2D and CVD amongst South Asians. Theme 2 (Digital Interventions) will test whether digital intervention with i. AI driven education or ii. gamification for behaviour change reduces weight (primary endpoint) and improves quantitative measures of cardiometabolic health, amongst South Asian men and women aged 30-60 years with overweight or obesity (BMI>23kg/m2), compared to usual care over 2 years. We embed the trial within the Surveillance study (Theme 1), bringing rich baseline data for participants, and evaluation in a wide range of South Asian settings. Theme 3 (Training and care co-ordination) focuses on strengthening primary healthcare systems. We connect health surveillance to computational guidelines, care pathway engines, training and digital health interventions, linking seamlessly with work in Themes 1 and 2. We collaborate with WHO to advance international standards for computational guidelines and decision support, and develop modular digital solutions for care co-ordination and care pathway delivery for T2D and CVD, that are scalable, evidence based, interoperable and generalisable. Theme 4 (Policy and environmental interventions) addresses community- and policy-based actions for health promotion and prevention of T2D and CVD in South Asians. In partnership with Health Promotion Bureau of Sri Lanka, we evaluate ‘whole of society’ approaches to intervention that target the demand and supply-side factors identified through our policy and environmental mapping (Theme 1). Evaluation at national scale will provide powerful evidence to inform future health policy in South Asian settings. Capacity building. The research themes will be supported by a programme of capacity building at our collaborating Centres of Excellence in genetic and environmental epidemiology, as well as in digital health, health systems, health policy and implementation science research. Our programme of global health research will improve understanding of T2D and CVD in South Asians, including underlying mechanisms, approaches to identification of high-risk individuals, and scalable strategies for personalised and community wide prevention and control strategies. Results will contribute to transformational change of health promotion and disease prevention amongst South Asians, who represent ~25% of the world’s population.