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Prioritising Action On Diabetes In Greater Manchester

What we did

We have worked with Health Innovation Manchester, University College London, and Novo Nordisk to address some of the urban diabetes challenges in Greater Manchester. 



Why was it important?

415 million adults have diabetes worldwide, an estimated 160,000 people in Greater Manchester, these numbers are predicted to rise. The complications caused by diabetes lead to around 1,000 premature deaths each year among the population of Greater Manchester, with almost 66% of people living with type II diabetes lbeing in urban areas. There is a need for greater understanding of how urban living impacts on type II diabetes risk, prevalence and health inequalities.


Greater Manchester joined other cities across the world participating in the Global Cities Changing Diabetes Programme. Together we have worked to further understand the burden of diabetes and its social and cultural determinants to reduce the impact of type 2 diabetes on a regional and global scale.



How we did it

We conducted a mixed methods study which:


  • Applied the ‘rule of halves’ framework to routine data to identify gaps in the diagnosis and treatment of individuals with type II diabetes in Greater Manchester.
  • Explored the social and cultural factors that make certain groups of people living in Greater Manchester vulnerable or resilient to type II diabetes and its complications.



What we found


1. Estimating the ‘rule of halves’ for Greater Manchester:


  • We estimate that in Greater Manchester, adults under 40 years of age, men, those from white ethnic backgrounds and those from most deprived neighbourhoods are under-represented in care records – that is, there are likely to be more people in these groups who have diabetes than have been formally diagnosed.
  • GP practices serving a higher proportion of younger adults with diabetes (under the age of 40), and female patients, performed worse for achieving diabetes treatment targets.
  • GP practices in Greater Manchester improved the quality of their care to diabetes patients over the period of 2015-16 to 2018-19.


2. Social and cultural factors: 


Based on the findings of the ‘rule of halves’ analysis, we explored whether we could identify sub-groups of adults under the age of 40 years of age who share specific perspectives towards health, wellbeing and living with diabetes. We explored whether these perspectives create specific barriers to and opportunities for successful diabetes prevention; diagnosis, care and management; and overall health and wellbeing. We identified five different perspectives on living as a younger adult with type II diabetes, these being:


  • Stressed and calamity coping
  • Financially disadvantaged and poorly supported
  • Well-intentioned but not succeeding
  • Withdrawn and worried
  • Young and stigmatised


3. We identified a number of implications that decision-makers may wish to consider, in relation to:


  • Response to diagnosis
  • Service support
  • Lifestyle/self-management issues


This study may inform the design of future community-based initiatives that are sensitive to the different perspectives on diabetes care.



Who we worked with



Downloadable resources 



More information



Prorgramme Manager


Ross Atkinson




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