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Study protocol for the Cities Changing Diabetes programme: a global mixed-methods approach
  1. A. David Napier1,
  2. John J Nolan2,
  3. Malene Bagger3,
  4. Louise Hesseldal3,
  5. Anna-Maria Volkmann4
  1. 1Department of Anthropology, University College London, London, UK
  2. 2Steno Diabetes Center, Copenhagen, Denmark
  3. 3Health Advocacy, Cities Changing Diabetes Programme, Novo Nordisk, Bagsvaerd, Hovedstaden, Denmark
  4. 4Department of Clinical, Educational and Health Psychology, University College London, London, UK
  1. Correspondence to Dr A. David Napier; d.napier{at}


Introduction Urban 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 analysis A 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 dissemination The 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.

  • research protocol
  • diabetes mellitus, type 2
  • characteristics, cultural
  • characteristics, social
  • mixed-methods research

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  • Contributors ADN is lead investigator and global academic lead for the study programme; responsible for the research framework and study design. He is content expert on sociocultural factors and on vulnerability. He collaborates with and provides guidance to the local academic leads and training of local fieldworkers, and will be carrying out the qualitative global analysis and interpretation. JJN is coinvestigator and content expert on the biomedical aspects of diabetes, diabetes management and care pathways. He contributes to the global research framework and provides critical input on the programme’s quantitative research and research dissemination. MB and LH are coinvestigators. They contribute to the global research framework and study design through project management and content support. They will also be supporting the data collection and providing input to the research parameters. They are responsible for the dissemination plan and helped to prepare the initial draft manuscript. AMV is coinvestigator and method expert for qualitative and mixed-method approaches to health research. She contributes to the global research framework and study design, supports the local academic teams and training of local fieldworkers and will be carrying out the qualitative global analysis and interpretation.

  • Funding Novo Nordisk has committed to fund US$20 million towards 2020.

  • Competing interests None declared.

  • Ethics approval Local approval was granted by relevant bodies in each participating city. These were: Danish Data Protection Agency (Copenhagen); National Institute of Public Health (INSP) Ethics Committee (Mexico City); Ethics Committee of Shanghai People’s Hospital (Shanghai); Ethics Committee of the Tianjin Medical University (Tianjin); IntegReview IRB (Houston); Research Ethics Board University of British Columbia (Vancouver).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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