A look at a global initiative – Cities Changing Diabetes – driven by Novo Nordisk in association with many partners, both internationally and locally. It addresses how the way we live now is contributing to the rise of Type 2 diabetes in urban environments and brings communities together to find solutions, then share them with other cities.
Cities Changing Diabetes is a global partnership programme initiated in 2014 by Novo Nordisk, University College London (UCL) and the Steno Diabetes Center in Copenhagen, in response to the increase in urban rates of Type 2 diabetes. There are now more than 30 cities across the world (including Leicester and Manchester) that are engaged in the programme, which brings together a range of stakeholders within cities to map the challenge of Type 2 diabetes in their communities. Beyond that, the idea is for cities to share solutions and drive concrete action to tackle the challenge through tailored interventions.
In the beginning there were five cities around the world who were part of the Cities Changing Diabetes programme. University College London (UCL) undertook detailed research within the cities and identified social and cultural factors that can potentially affect a person’s risk of developing Type 2 diabetes.
Because urban environments influence how people live, move and, often what they eat, tackling the challenge of Type 2 diabetes requires work across sectors and disciplines – from the NHS to city planners. Local partners within the different cities taking part include policymakers and city authorities, academic institutions, diabetes and health communities, sports clubs and civil society organisations.
Leicester was the first UK city to join the programme and Cities Changing Diabetes Leicester is a joint working project that is funded by, and developed in collaboration by and between, the Leicester Diabetes Centre (LDC) and Novo Nordisk. The LDC is working with a broad range of local partners within the city to raise awareness of Type 2 diabetes and to educate and train communities to deliver Type 2 diabetes prevention and healthy lifestyle education within the city.
As part of the work undertaken under the initiative, Leicester City Council and the professional sports clubs in the city came together to sign a ‘Diabetes Pledge’, demonstrating their commitment to working in partnership to drive down Type 2 diabetes in Leicester. This goal is being achieved by promoting physical activity and healthy eating within the communities where the sports clubs are located and by ensuring their health and well-being initiatives are accessible, inclusive and, where possible, tailored, so as to help deliver prevention programmes to a broader range of communities. This has led to the creation of a number of health promotion ideas and events, including Walking Cricket (where participants receive coaching in cricket skills and play games of walking cricket), Healthy Goals (an education and physical activity programme) and United Leicester (a pilot health promotion programme in primary schools).
Obviously, COVID-19 has impacted on the face-to-face delivery of these, with many being paused in order to adapt delivery to a new virtual world, but to date a lot has been learned, shared and achieved.
Leicester has a large population of people of South Asian descent, a community that is already at a relatively higher risk of developing Type 2 diabetes. Developing health interventions that are culturally relevant and located within communities has enabled local organisations to engage with more at-risk populations. Wanting to promote health and wellbeing within Leicester’s South Asian communities, LDC brought together Leicester City in the Community (the community outreach arm of Leicester City Football Club) and The Centre for BME Health to engage this local population.
Barriers to engagement with South Asian communities were identified and included the location of activities, perceptions of sports clubs and who they work with, the importance of peer support and misunderstandings about the nature of physical activity (misperceived by some people as being limited to exercise such as gym workouts or sports). Based on these insights, the Healthy Goals 12-week education and physical activity programme was developed. Education sessions and facilitator- led conversations with participants around lifestyle and diet were designed to be culturally relevant to them and delivered by the LDC, while physical activities under the programme have been led by Leicester City in the Community. All-female sessions have been run as part of the initiative to empower women and give them the opportunity to take better care of their health.
The Walking Cricket series of events delivered by Leicestershire County Cricket Club has been successful in attracting older South Asian men to get more active, but the programme has been open to anyone who is keen to try out a new sport, socialise and get more physical activity in their life.
The United Leicester initiative has been delivered by Leicester’s professional sports clubs to help tackle physical inactivity and improve lifestyle behaviours for primary school children. The project, which involves Leicester Tigers, Leicester City Football Club, Leicestershire County Cricket, Leicester Riders and Leicester Hockey, aims to encourage young people to get active and learn more about healthy lifestyles, using coaches from the clubs to inspire pupils.
Through Cities Changing Diabetes Leicester, a number of Type 2 diabetes risk screening events have taken place in the city, including at local community events, sports events and workplaces, in order to help increase awareness of what Type 2 diabetes is, and to signpost those who may be at risk of developing the condition to interventions.
The programme in Leicester will now be working to empower local communities, including workplaces and places of worship, by training community champions to raise awareness of Type 2 diabetes and to conduct risk screening amongst their peers, so they can support people to reduce their risk of developing the condition. . The LDC is creating the curriculum for this training and individuals from local workplaces and faith communities have been engaged to help make sure the training is based upon their specific needs and the needs of their communities and cultures.
In Manchester, the Cities Changing Diabetes programme is a joint working project that is funded by and developed in collaboration between Health Innovation Manchester and Novo Nordisk. Work is currently taking place under the programme to understand the nature of the Type 2 diabetes challenge in Greater Manchester, which includes research being conducted by National Institute for Health Research Applied Research Collaboration – Greater Manchester to help understand which local groups are most at risk of developing Type 2 diabetes and the social and cultural determinants that relate to this. This knowledge will support the development of targeted initiatives intended to help reduce the prevalence of Type 2 diabetes in Greater Manchester.
A Novo Nordisk spokesperson explains, “The Cities Changing Diabetes programme is working to increase understanding of Type 2 diabetes and supporting a range of partners in cities across the world to come together to identify and develop targeted actions to bend the curve on rising levels of urban diabetes.
“There are now 36 cities engaged in this global network, bringing together businesses, city leaders, healthcare professionals, policy makers, universities, community leaders, people living with diabetes and other partners to share expertise and knowledge and find solutions that will help make our cities healthier.”
Sophie O’Connell, programme manager for the Cities Changing Diabetes initiative in Leicester added, “The Cities Changing Diabetes initiative has brought many partners and stakeholders across Leicester together to tackle a common cause; to improve the prevention and management of Type 2 diabetes in the city.”
“It has allowed partners to learn from one another and utilise the skills we have locally to tackle the challenge, as well as sharing insights and inspiration about how to improve the health of our communities with cities elsewhere in the world. This includes Houston, where we been able to share our experiences in Leicester and learn from their work to empower lay faith leaders to deliver diabetes prevention education to their congregations. ”
Arguably, many of us are living in what is called ‘an obesogenic environment’, but it needs to be known what drives obesity and thus the rise of T2 diabetes. There are many complex underlying factors but the main point of Cities Changing Diabetes is to improve communications between all parts of the overall community, bringing the threads together, not to see the rising tide of diagnoses of T2 diabetes lapping up to the doorstep of the NHS and just turn around walk away.