Qatar Diabetes Prevention Program (QDPP)

Qatar has one of the highest prevalence of type 2 diabetes mellitus (T2D) in the world, which will be a significant burden for the future health, economy and development of the country. The Qatar Diabetes Prevention Program (QDPP) is a multi-institutional research collaboration, combining the range of scientific and clinical expertise in Qatar, to predict, prevent and reverse T2D in Qatar by targeting those at increased diabetes risk (pre-diabetes [PreD] and gestational diabetes mellitus [GDM]), or those with early T2D. QDPP is a flagship program leveraging national initiatives to answer key questions critical to population health while driving health service development to deliver targeted interventions. QDPP will harness and integrate into the following national resources and initiatives: i. The Qatar National Diabetes Strategy plans a systematic national screening for T2D. The screening identifies those with PreD and early T2D. ii. Universal GDM screening has been implemented by the national GDM guideline, showing that nearly 25% of pregnant women develop GDM. iii. Qatar is unique in that pre-marital screening is mandatory prior to marriage; this identifies young women at risk of GDM and T2D. iv. The Primary Health Care Corporation (PHCC) wellness centers facilitate the lifestyle interventions proposed in QDPP. v. The Qatar Biobank (QBB) cohort includes individuals with PreD and early T2D. QBB participants are extensively phenotyped, including genomic and biochemical profiling. vi. A national eHealth and Data Management Strategy is being developed for Qatar focusing on facilitating public and healthcare provider interaction. QDPP leverages the potential of the above-mentioned activities and cohorts to acquire a comprehensive understanding of T2D in Qatar and to identify the most effective approaches to prevent T2D, based on behavioral, lifestyle, and medical interventions while discovering genetic and molecular markers of risk and treatment response. The cluster includes seven sub-projects: four are clinical trials, three of which target individuals at risk for T2D and a fourth that targets subjects with early T2D; two sub-projects explore the QBB cohort to identify genetic, proteomic and metabolomic markers for PreD and progression to T2D; and one cross-cutting project incorporates eHealth to support the four clinical trials. The planned clinical interventions are based on extensive expertise in diabetes research and provision of clinical services in Qatar and include key approaches in diabetes prevention and treatment, as well as novel eHealth support for lifestyle modification and adherence. QDPP Sub-projects: 1. SP1 – DEFEND: Diabetes prEvention For early oNset Dysglycemia shall identify the most effective intervention to prevent progression from PreD to T2D in Qatar. PreD prevalence in Qatar is about 20% in adults. PreD progresses to T2D at about 10% per year. The most effective T2D prevention method in Qatar is not known. DEFEND shall determine the best strategy to implement lifestyle intervention and/or medication to prevent progression of PreD to T2D in Qatar. 2. SP2 – PRIME: PRemarital Intervention to improve Metabolism. The prevalence of overweight and obesity in adult women is estimated to be about 70%. Overweight/obesity is the major risk factor for T2D and GDM. PRIME shall examine whether an early intervention in overweight/obese women intending marriage reduces GDM incidence. 3. SP3 – PROVIDE: PRevention Of deVelopment of dIabetes in those with gestational DiabEtes. Our data show that GDM affects nearly one quarter of Qatari women. An estimated 50% of women with GDM progress to T2D within five years, mostly during the first 2 years, and their children have higher risk for developing obesity and T2D. Mothers affected with GDM are therefore an important population for intervention to break this vicious cycle. PROVIDE shall identify the most effective intervention in Qatari women who have developed GDM to prevent T2D and recurrence of GDM. 4. SP4 – EDIT: Early Diabetes InTervention shall identify the most effective strategy to reverse the course of T2D resulting in T2D “remission”. T2D remission and cure are increasingly an important clinical goal that avert serious diabetes macro- and micro- vascular complications. While T2D remission can be achieved through bariatric surgery, increasing evidence shows that it is possible to reverse T2D through lifestyle intervention and selective medication use. 5. SP5 – GRID: Genetic RIsks for Diabetes shall analyze the Qatar BioBank genetic data to identify genetic risks for T2D and PreD. These risks can be validated in subjects recruited in the above 4 clinical trials. 6. SP6 – MODEL: MOlecular Markers for DiabEtes DeveLopment shall analyze proteomic and metabolomic data from 3000 participants in the QBB cohort to identify proteomic and metabolomic markers associated with PreD and T2D. Tthese markers can be validated in the subjects of the 4 clinical trials. 7. SP7 – ELM: E-Health for Lifestyle Modification supports interventions to prevent, reverse, and treat diabetes. ELM includes a) Lifestyle Decision Support System (Qatar-based Droobi APP) for lifestyle coaching and management, interacting with a personal health ecosystem that incorporates smart health sensors such as fitness wearables and weight scales; b) Wearable technologies for tracking lifestyle change; and c) eHealth Living Lab to study factors influencing technology use. CLIC: CLuster Integration, Management, and Coordination will facilitate interaction, coordination, sharing of data, cohort and samples amongst the sub-projects. CLIC will integrate data management, publication and knowledge dissemination. QDPP will, for the first time, provide for Qatar important answers regarding approaches to prevent T2D and GDM, and reverse T2D, in a high-risk population. This will have a major positive long-term health and economic impact for Qatar.

Hamad Medical Corporation