An agent-based model of the spread of behavioural risk-factors for cardiovascular disease in city-scale populations.

Cardiovascular disease (CVD) is the leading cause of mortality globally, and is the second main cause of mortality in the UK. Four key modifiable behaviours are known to increase CVD risk, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Behaviours that increase the risk of CVD can spread through social networks because individuals consciously and unconsciously mimic the behaviour of others they relate to and admire. Exploiting these social influences may lead to effective and efficient public health interventions to prevent CVD. This project aimed to construct and validate an agent-based model (ABM) of how the four major behavioural risk-factors for CVD spread through social networks in a population, and examine whether the model could be used to identify targets for public health intervention and to test intervention strategies. Previous ABMs have typically focused on a single risk factor or considered very small populations. We created a city-scale ABM to model the behavioural risk-factors of individuals, their social networks (spousal, household, friendship and workplace), the spread of behaviours through these social networks, and the subsequent impact on the development of CVD. We compared the model output (predicted CVD events over a ten year period) to observed data, demonstrating that the model output is realistic. The model output is stable up to at least a population size of 1.2M agents (the maximum tested). We found that there is scope for the modelled interventions targeting the spread of these behaviours to change the number of CVD events experienced by the agents over ten years. Specifically, we modelled the impact of workplace interventions to show that the ABM could be useful for identifying targets for public health intervention. The model itself is Open Source and is available for use or extension by other researchers.

Можно ли предотвратить или отсрочить появление диабета 2-го типа и связанных с ним осложнений у людей с промежуточной гипергликемией? Резюме

В Европейском регионе ВОЗ диабетом страдает каждый одиннадцатый взрослый. Это один из основных факторов риска развития сердечно-сосудистых заболеваний, почечной недостаточности, потери зрения и повреждения нервов. Промежуточная гипергликемия — это состояние, при котором уровни глюкозы в крови выше нормального диапазона, но ниже пороговых значений, характерных для диабета. Она связана с повышенным риском развития диабета 2-го типа, ожирения, сердечно-сосудистых заболеваний и смертности. В настоящем обзоре изучается влияние лечебных мероприятий на состояние здоровья людей с промежуточной гипергликемией. Результаты рандомизированных контролируемых испытаний показывают, что риск развития диабета 2-го типа у людей с промежуточной гипергликемией можно снизить при помощи ведения здорового образа жизни и принятия (некоторых) фармакологических препаратов. В результате анализа большинства имеющихся фактических данных не обнаружено различий в уровне смертности или других важных показателях здоровья при проведении фармакологических вмешательств или изменении образа жизни. Хотя, возможно, что периоды наблюдения были недостаточно продолжительными, чтобы заметить положительную динамику в показателях здоровья. Имеющиеся в настоящее время фактические данные свидетельствуют о том, что риск развития диабета 2-го типа можно снизить за счет проведения лечебных мероприятий на стадии промежуточной гипергликемии, однако неизвестно, как влияют эти мероприятия на показатели здоровья в долгосрочной перспективе.

Can type 2 diabetes and its associated complications be prevented or delayed in people with intermediate hyperglycaemia? Summary

Diabetes affects one in 11 adults in the WHO European Region. It is a key risk factor for cardiovascular diseases, kidney failure, vision loss and nerve damage. Intermediate hyperglycaemia is a state in which blood glucose levels are above the normal range but below the threshold for diabetes. It is associated with an increased risk for type 2 diabetes, obesity, cardiovascular diseases and mortality. This review assessed the effects of interventions for people with intermediate hyperglycaemia. Results from randomized controlled trials indicate that the risk of developing type 2 diabetes in people with intermediate hyperglycaemia is reduced by lifestyle and (some) pharmacological interventions. Most of the available evidence did not find a difference in mortality or other serious health outcomes for either pharmacological or lifestyle interventions. However, the follow-up periods may have been too short for health outcomes to have emerged. The current evidence suggests that the risk of developing type 2 diabetes is reduced through intervention at the point of in

Can type 2 diabetes and its associated complications be prevented or delayed in people with intermediate hyperglycaemia?

Diabetes affects one in 11 adults in the WHO European Region. It is a key risk factor for cardiovascular diseases, kidney failure, vision loss and nerve damage. Intermediate hyperglycaemia is a state in which blood glucose levels are above the normal range but below the threshold for diabetes. It is associated with an increased risk for type 2 diabetes, obesity, cardiovascular diseases and mortality. This review assessed the effects of interventions for people with intermediate hyperglycaemia. Results from randomized controlled trials indicate that the risk of developing type 2 diabetes in people with intermediate hyperglycaemia is reduced by lifestyle and (some) pharmacological interventions. Most of the available evidence did not find a difference in mortality or other serious health outcomes for either pharmacological or lifestyle interventions. However, the follow-up periods may have been too short for health outcomes to have emerged. The current evidence suggests that the risk of developing type 2 diabetes is reduced through intervention at the point of intermediate hyperglycaemia, but that the effects of these interventions on long-term health outcomes are unclear.

Как влияет на показатели здоровья проведение популяционного скрининга бессимптомных взрослых на сахарный диабет 2-го типа или промежуточную гипергликемию? Резюме

Диабет – это одно из самых распространенных хронических заболеваний в мире. Он приводит к болезням сердца, проблемам со зрением и почками, а также к преждевременной смертности. Промежуточная гипергликемия (ПГ) – состояние, при котором уровни глюкозы в крови выше нормального диапазона, но ниже пороговых значений, характерных для диабета, – связана с повышенным риском развития сахарного диабета 2-го типа (СД2), ожирения, сердечно-сосудистых заболеваний и смертности. В настоящем обзоре дается оценка того, может ли проведение популяционного скрининга на СД2 и ПГ повлиять на показатели здоровья. Результаты единственного недостаточно статистически мощного исследования с высокой вероятностью систематических ошибок показали отсутствие доказательств пользы проведения популяционного скрининга на СД2 для снижения показателей заболеваемости или смертности. Ни в одном исследовании не сравнивались показатели здоровья в случаях, когда лечение проводилось после обнаружения болезни в результате скрининга, и в случаях, когда лечение не проводилось совсем или проводилось после появления симптомов. В одном исследовании с низкой статистической мощностью не было обнаружено существенной разницы в показателях здоровья пациентов, одна группа которых прошла более интенсивное лечение после обнаружения болезни в результате скрининга, а другая – менее интенсивное. Таким образом, в настоящее время отсутствуют доказательства того, что скрининг на СД2 или ПГ содействует снижению показателей заболеваемости или смертности.

What is the effect of population-level screening of asymptomatic adults for type 2 diabetes mellitus or intermediate hyperglycaemia on health outcomes: summary

Diabetes mellitus is one of the world's fastest growing chronic conditions. It is associated with heart disease, eye and kidney problems, and premature death. Intermediate hyperglycaemia, a state in which blood glucose levels are above the normal range but below the threshold for diabetes, is associated with an increased risk for type 2 diabetes (T2DM), obesity, cardiovascular diseases and mortality. The review assessed whether population-level screening for intermediate hyperglycaemia and T2DM can improve health outcomes. A single, underpowered, biased study found no benefit of population-level screening for T2DM to reduce morbidity or mortality. No studies reported whether treatment after screen detection improved health outcomes compared with either no treatment or treatment after later symptomatic detection. One underpowered study found no significant difference in health outcomes between more- and less-intensive treatment after screen detection. In summary, there is currently no evidence that screening for T2DM or IHG reduces morbidity or mortality.

What is the effect of population-level screening of asymptomatic adults for type 2 diabetes mellitus or intermediate hyperglycaemia on health outcomes

Diabetes mellitus is one of the world's fastest growing chronic conditions. It is associated with heart disease, eye and kidney problems, and premature death. Intermediate hyperglycaemia, a state in which blood glucose levels are above the normal range but below the threshold for diabetes, is associated with an increased risk for type 2 diabetes (T2DM), obesity, cardiovascular diseases and mortality. The review assessed whether population-level screening for intermediate hyperglycaemia and T2DM can improve health outcomes. A single, underpowered, biased study found no benefit of population-level screening for T2DM to reduce morbidity or mortality. No studies reported whether treatment after screen detection improved health outcomes compared with either no treatment or treatment after later symptomatic detection. One underpowered study found no significant difference in health outcomes between more- and less-intensive treatment after screen detection. In summary, there is currently no evidence that screening for T2DM or IHG reduces morbidity or mortality.