About Cities Changing Diabetes

citieschangingdiabetes.com

3.9 BILLION

66%

3.9 BILLION PEOPLE LIVE IN CITIES TODAY1

66% OF GLOBAL POPULATION WILL LIVE IN CITIES BY 20501

By 2040, 642 million of the worlds population is projected to have diabetes.2 Already, nearly two-thirds of all people with diabetes live in urban areas. It’s an emergency in slow motion.

But urban diabetes is not inevitable. We can stop diabetes ruining people’s lives.

If we work together – businesses, city leaders and planners, healthcare professionals, academics and community leaders – we can create cities which help us live more healthy lives.

NOVO NORDISK CHIEF EXECUTIVE OFFICER

MEXICO CITY MAYOR

LARS REBIEN SØRENSEN

MIGUEL ÁNGEL MANCERA ESPINOSA

When we initiated Cities Changing Diabetes early in 2014, I stood alongside the leaders of Mexico City and some of the world’s foremost researchers. We asked people to join us in a global fight against urban diabetes.

The response that we have seen has been incredible. Mexico City has been joined by more pioneering study cities: Houston, Copenhagen, Tianjin and Shanghai – a group which is home to nearly 60 million people. Diabetes is not an issue the world can take lightly. But it’s not too late for the world to wake up to what’s happening – and we need to start in cities.

The rise of urban diabetes is unrelenting, but it is not inevitable. We are beginning to understand the driving factors behind the challenge, and those of us who can make a difference are now connecting better. The world needs cities that help us live more healthily. Join us.

There is no question about it: diabetes is the number one health challenge in Mexico City. In July I set out a new strategy for obesity and diabetes. We have a lot to do, from encouraging healthy lifestyles, to supporting treatment which can avoid some of the tragic complications. diabetes is today the primary cause of death across the country.

I see Cities Changing Diabetes as an important contribution to tackling diabetes in Mexico City. For the first time, people leading some of the city’s most impactful initiatives are coming together to share and develop learning. That Dr Ahued Ortega, our city Minister of Health, travelled to help launch the programme in Copenhagen shows our desire to connect with others around the world on this issue. I’m proud that Mexico City helped launch this programme beside Novo Nordisk, and I look forward to working together to take on this significant challenge.

COPENHAGEN MAYOR OF HEALTH AND CARE

HOUSTON DIRECTOR FOR HOUSTON HEALTH DEPARTMENT

NINNA THOMSEN

STEPHEN L. WILLIAMS

In 2014, Copenhagen was named the world’s most liveable city by Monocle magazine. This is a tribute to our great political ambitions for creating an active, healthy and green city.

Houston is one of the most diverse, productive and vibrant cities in the US. Sometimes described as the energy capital of the world, we are growing fast and are number one for job creation in the US. But the rise of cities, and ours in particular, can come with a price. One of these is urban diabetes.

Yet, the challenge of urban diabetes in Copenhagen is real and still on the rise. In particular, it is a consequence of social inequality.

Copenhageners with no formal secondary school qualifications, as well as those without a job and receiving social benefits, are three times more likely to get diabetes than people of the same age with a higher education.

I’m determined that we can improve the health of all Copenhageners, and the treatment of diabetes in the city. Cities Changing Diabetes will challenge us to do more – providing new data and new routes to collaboration across our own city, as well as a window on important work in other cities across the world.

In Houston, 9% of the adult population have diabetes, significantly higher than the proportion of those living in Texas as a whole. One of the challenges with this disease is that many don’t know they have it.

I want to thank Novo Nordisk for initiating the Cities Changing Diabetes public-private partnership, and partners including the University of Texas, the Clinton Global Initiative and the American Diabetes Association for joining with us. For me this is about substance over talk, and ultimately the chance to create long-term impact by sharing what we know, learning from others and working towards a common goal.

TIANJIN DIRECTOR FOR TIANJIN HEALTH & FAMILY PLANNING COMMISSION

SHANGHAI SHANGHAI INSTITUTE OF DIABETES DIRECTOR

WANG HESHENG

PROFESSOR JIA WEIPING

Tianjin is the fifth-largest urban area in China – with a population of 11 million today that’s set to grow to nearly 15 million in the next 15 years.

As China’s National Development Plan sees tens of millions pour into cities in the next decade, it’s critical we learn from cities like ours to solve future problems.

With our economic development has come improved quality of life. But as we grow we also face challenges – and one of those is urban diabetes. The Tianjin Health & Family Planning Commission takes diabetes prevention and control very seriously, investing a lot in scientific research, clinical treatment, and community health centers. This work is paying off, yet the population with diabetes is still growing.

It’s a long journey requiring the collaboration of multiple partners, including city leaders and planners, the social sector, and academic partners: that’s why we’re pleased to be a part of Cities Changing Diabetes.

JOHANNESBURG EXECUTIVE MAYOR

VANCOUVER MAYOR

CLLR. MPHO PARKS TAU

GREGOR ROBERTSON

Shanghai is an important city, and in the top five largest cities globally, it acts as a model for many cities across the world.

Johannesburg is the metropolitan with the highest population of about 4.8 million in the Republic of South Africa.

By working with local partners and learning from other cities, Vancouver recognizes that good planning and city building play an important role in improving health outcomes for residents.

For over a decade now Shanghai has had a plan in place for chronic disease prevention and control. A huge amount is being done backed by significant healthcare resources, yet the number of patients and complications are increasing. That shows the force of the urban diabetes challenge for us.

Mayor Tau has served as a City of Johannesburg Member of the Mayoral Committee since the year 2000 – when he began driving a spatial and socio-economic transformation agenda in the City. He has headed the portfolios of Development Planning, Transport & Environment, as well as that of Finance & Economic Development, respectively. This was until he was elected the Executive Mayor in 2011.

The dynamics driving urban diabetes in Shanghai are complex: growing wealth, changing lifestyles and an ageing population, alongside a rising number of younger people getting the disease. Also fast-paced working lives can stand in the way of the management and treatment of diabetes. We all have more to learn, and more we can do. Through in-depth learning and connecting our knowledge, Cities Changing Diabetes can help us to improve even further the effectiveness of taking on diabetes in our city.

Today Johannesburg is a leader in developmental governance and on par with global cities.

Through his leadership, Johannesburg plays a prominent role in various local and international bodies. These include South African Cities Network and United Nations Special Advisory Committee on Safer Cities.

Furthermore, Mayor Tau is a member of the C40 Climate Change Network and the Metropolis network, which looks to build resilient and sustainable cities and promote healthy living amidst the pressures of urbanization and climate change completely in line with the city’s vision.

Walkable neighbourhoods, safer cycling, access to healthy local food and recreation opportunities all play a critical role in preventing diabetes, and create a more livable and healthy city for all of us.

With more than 80% of our population living in urban areas, and factors such as an aging population, social inequality, and rising incidence rates, the number of people living with diabetes is projected to increase by 62% in the province of British Columbia in the next decade and account for 10.3% of the total population.

Vancouver is pleased to join other leading cities in the Cities Changing Diabetes initiative and we look forward to working in partnership with Vancouver Costal Health and the Canadian Diabetes Association to improve the health and well-being of all of our residents.

POTENTIAL COMPLICATIONS OF UNCONTROLLED DIABETES

THE RISE IN DIABETES IS AN

EMERGENCY

BLINDNESS

HEART ATTACK TOTAL KIDNEY FAILURE

IN SLOW MOTION While some disasters happen in a split second, others can take years to develop and no one realises what is happening until it’s too late.

The global diabetes challenge falls into the second category: it’s an emergency in slow motion and unless we act now, the world will have sleepwalked into a catastrophe. This is a devastating disease and we need urgent action to face up to it.

Among the multiple reasons why the rise of diabetes is an alarming global challenge, two stand out.

The first is the impact on individuals. Although diabetes care has greatly improved in recent decades, the truth remains that the potential complications from diabetes can be devastating.

STROKE

AMPUTATION

There are still millions of people dying from the disease causing 5.0 million deaths annually.2 Others loose their eyesight, or are subject for amputations because of poorly controlled diabetes. People with diabetes are nearly four times as likely to suffer from a stroke,4 as well as being significantly more likely to suffer from heart attacks than the general population.5 The second reason is the economic and financial burden of diabetes. As health budgets continue to be placed under massive strain, the cost represented by the rise of global diabetes will present a major challenge. We cannot assume that health systems will be able to cope if we continue along the current trajectory.

For both these reasons, diabetes is not an issue the world can take lightly.

BLINDNESS 4,6 Risk: Diabetes is a leading cause of blindness.

Effective treatment: Reduces deterioration in eyesight.

TOTAL KIDNEY FAILURE7 Risk: Three times as likely.

Effective treatment: Reduces the causes of kidney failure.

STROKE4 Risk: Up to four times as likely.

Effective treatment: Reduces stroke.

HEART ATTACK8 Risk: Three times as likely, and heart disease is up to four times as likely.

Effective treatment: Reduces the risk of heart failure.

AMPUTATION 6 Risk: A leading cause of non-traumatic lower-limb amputations.

Effective treatment: Reduces the number of amputations.

PLACING THE SPOTLIGHT ON THE SOCIAL AND CULTURAL DETERMINANTS OF THE DIABETES PANDEMIC

BY PROFESSOR DAVID NAPIER, UNIVERSITY COLLEGE LONDON

Many of today’s most pressing global health problems can be understood and solved only by getting to grips with the cultural determinants, social risk factors, and environmental settings that shape health and that also drive disease. Fortunately, healthcare communities around the globe are doing so increasingly. The World Health Organisation, for example, has made addressing the social, economic and environmental determinants of health a priority area for its work in 2014 to 2019, and will now also take steps to concentrate on the cultural determinants of health and wellbeing.

We are rightly grateful for advances in the medical sciences. Biological approaches to health and illness have contributed to vast reductions in mortality and morbidity worldwide. But in general these approaches have yet to account for the strong effects of culture, society and environment on individual health. We cannot afford to ignore the impact of these factors when attempting to tackle an issue as overwhelming as the current diabetes pandemic.

Yet, diabetes research and healthcare budgets are seemingly dominated by biological under­standings of health. Many other factors – cultural, social and economic – play an important role in the lives of people with diabetes, but are not devoted the same level of attention in research and healthcare.

I believe that funding for addressing these complex factors should reflect the fact that the vast majority of diabetes-related morbidity and mortality is socially mediated.

In theory, we know how to treat the body of a diabetic person; yet diagnostic procedures and treatment outcomes remain, more often than not, unsatisfactory. Due to a dispro­ portionate focus on medical inter­ventions in the clinic, primary prevention has not received enough attention.

Yet the clinic is a place often inaccessible to those who are most vulnerable to developing diabetes, and to those suffering from its consequences. Nowadays, too many people remain undiagnosed, or (because of

complex socio-economic and cultural barriers) are prevented from accessing the treatment they need.

While today’s cities have made it possible for millions to access services and care, urban areas have also become hotspots for inequality, increasing human suffering and the burden of diabetes. This confluence of ever-growing cities and the rise in diabetes must be taken seriously as a force determining the health outcomes of increasing numbers of people across the globe. The problem is undeniably complex and will require both local and global cooperation.

“This confluence of ever-growing cities and the rise in diabetes must be taken seriously”

5.39 BILLION

GLOBAL CITIES

2.85 BILLION 2000

2035

UN GLOBAL ESTIMATES OF PEOPLE IN URBAN AREAS1

IDF GLOBAL ESTIMATES OF PEOPLE WITH DIABETES2

642 MILLION

415

ACROSS THE WORLD, OVER THE COMING DECADES MORE AND MORE PEOPLE ARE SET TO LIVE IN URBAN AREAS, INCLUDING A GROWING NUMBER OF VAST MEGACITIES.

DIABETES IS A CHALLENGE AFFECTING MORE PEOPLE AND RISING UP AGENDAS GLOBALLY, AND THE SOLUTIONS TO IT MUST BE FOUND AT A LOCAL LEVEL.

MILLION

194

MILLION

When the history of the twenty-first century is written, it will be the story of cities.

2003

Since 2014, more than half of the world’s population lives in a city.1 By 2050, urban populations are set to grow to two-thirds of the population globally.1 And the number of megacities of over 10 million inhabitants will rise from 28 today to 41 in 2030.1

All this means that managing and running cities is one of the great challenges of this century.

2040

According to the International Diabetes Federation (IDF), 415 million people around the world have diabetes, diagnosed or undiagnosed.2 By 2040, that number will have risen to 642 million.2 What’s significant about this trend is the link to urbanisation. Already, 65% of those with diabetes live in urban areas. By 2040 this is projected to increase to 74%.2

This trend is creating a wide range of new opportunities and challenges. On the one hand, people are drawn to the social and economic possibilities of urban life.

It also brings people closer to health services, meaning there’s the potential for greater health service delivery and equity.

On the other hand, urban development is putting massive strain on services and infrastructure. And it’s creating new tensions and social challenges.

2015

GLOBAL DIABETES

10.4%

OF THE GLOBAL POPULATION IS PROJECTED TO HAVE DIABETES BY 20402

2/3

OF PEOPLE WITH DIABETES LIVE IN CITIES 2

The number of people with type 2 diabetes is increasing in every country.2 The majority – 75% – of people living with diabetes live in low and middle income countries2, where cities are also growing fastest.1 The way that cities are designed and run influences how people live and can be an enabler of, or a barrier to, diabetes prevention and management.9 There is evidence that aspects of urban living may drive a significantly higher risk of diabetes, especially in low and middle income countries.9,10 These drivers play out differently in the developed and the developing world, from city to city and across different areas in cities. They span barriers to physical exercise11 to fast-paced working environments9 and poor diet,12 through to consequences of urban development such as air pollution13 and living beside noisy roads.14 This means we simply cannot tackle global diabetes unless we take on the problem in cities. Yet we believe that urban diabetes is not inevitable. To tackle it, more needs to be known about what is driving the problem.

This means we simply cannot tackle global diabetes unless we take on the problem in cities.

THE RISE OF

URBAN DIABETES Across the world, studies are beginning to expose the links between urban lifestyles and the prevalence of diabetes. It is vital that we create cities which help us live more healthily.

In VANCOUVER, the prevalence of overweight and obesity is 43%23

81% of people with diabetes in the US live in urban areas22

The population in CHINA living in urban areas is projected to increase from 54% today to 76% by 20501

88% of the population of DENMARK live in urban areas1

Obesity is HOUSTON‘S most common chronic condition affecting 32% of adults16

11.7% of people in TIANJIN are obese19 10.4% of people in SHANGHAI are obese18

MEXICO CITY has a higher rate of diabetes-related deaths compared to other Mexican regions15

14.7% of the population of MEXICO has diabetes2

In JOHANNESBURG, the projected population growth in 2011 was 3.2%24

THE AMBITION FOR CITIES CHANGING DIABETES

Cities Changing Diabetes is a response to the dramatic rise in urban diabetes across the world.

It is a first-of-its-kind partnership platform for cross-disciplinary, cross-sector collaboration.

No organisation or company can solve the challenge alone, so the programme is built on public-private partnerships between businesses, city leaders and planners, architects, healthcare professionals, academics, community leaders and others with a stake in the outcome. Working together we are setting out to create cities which help us live more healthily, and where people with diabetes can live life to the full.

CITIES CHANGING DIABETES AIMS TO Put urban diabetes at the top of the global healthcare agenda.

Experience has shown that it is possible to have great impact on the rise of a potentially devastating disease when healthcare systems are mobilised to see it as an urgent priority.

By putting the spotlight on the scale and urgency of the issue in many cities across the world, we can help health systems to prioritise the challenge of urban diabetes. ut it on the agenda of those designing and managing cities for the future.

P Urban planning has an important role to play in delivering health improvements in the way it designs and reshapes our cities.20 By helping those who design and manage cities to understand the dynamics of urban diabetes, we can equip them to develop healthier cities for the future.

Today, not enough is known about the dynamics of how urban development can drive diabetes, and how to deliver the potential health benefits that city living can bring.9 Much is being done on the ground in urban areas to tackle diabetes. The opportunity is to bring together learning from that activity to get a clearer understanding of what needs doing and to underpin future strategy and action.

THE PROGRAMME STRUCTURE

The programme is structured to understand the driving factors behind the rise of diabetes in urban areas, and to share that knowledge and apply it to real-world solutions. The programme has three interconnected elements:

MAPPING SHARING ACTION

We have set out to map the problem in a number of ‘study cities’ across the world. We have decided to start the programme by generating a body of collective knowledge about urban diabetes: what’s working today, where are the challenges and the priorities for the future.

We will share the results from these cities in order to drive wider action around the world. We will continuously share what is learnt and connect the dots between cities, so that everyone involved can gain from the experience and knowledge of others – and create solutions for their own local needs. We will use our influence and global networks to drive the issue of urban diabetes up the agenda worldwide.

We will work with partners to identify and scale up solutions to tackle diabetes in cities. The programme will enable us to catalyse action. In the study cities, we will play our part in helping to develop action plans.

And across the world the learnings will equip a wide range of partners in taking concerted and focused action on the ground in cities through health promotion and urban design.

Cities Changing Diabetes is a global fight against urban diabetes. The work in the study cities will act as a platform for the programme to grow globally. It will provide a basis to connect and learn around the challenge of urban diabetes, and to enable and inspire many more cities to join in the global fight.

MAPPING

THE RULE OF HALVES

THE CHALLENGE

In each study city, partnerships are being built involving business, city authorities, local health leaders, academic institutions and city experts. These partnerships are designed to take on the global challenge of urban diabetes through establishing local research networks and building on existing areas of expertise. We will begin with a local diabetes mapping for each city and deepen our findings through extensive qualitative research. University College London is guiding the global academic research, working with a set of distinguished research partners in each city. The programme also draws on the global experience of the Steno Diabetes Center to better understand the challenge and to design future interventions.

each city more vulnerable to diabetes and its complications. It allows us to go beyond the quantitative findings of the Rule of Halves analysis and will emphasise the behavioural and cultural drivers of urban diabetes.

Of the estimated 415 million people with diabetes

About 50% are diagnosed

Together, these two steps will unearth what can be done to improve the way diabetes is prevented, treated and managed in the cities.

Of whom about 50% receive care

Of whom about 50% achieve treatment targets

Of whom about 50% achieve desired outcomes

The second step is to conduct a qualitative vulnerability assessment. This helps us to understand what makes certain people in

According to the Rule of Halves, on average around the globe today only around 6% of people who have diabetes live their lives free of diabetes related complications.

Identify participants for vulnerability assessment

Actual rates vary in different cities across the world, so this model can be used to understand the barriers specific to tackling urban diabetes in each city. This means that the particular set of solutions to tackle urban diabetes effectively in each city will need to be localised.

The Vulnerability Assessment identifies the presence of social and cultural risk factors for developing diabetes and for suffering from diabetes and its complications.

A combination of quantitative and qualitative research will help cities understand diabetes risk factors and provide evidence-based recommendations to inform decisions about prevention and intervention.

The first step is to produce a quantitative Rule of Halves Analysis. This helps us to understand any major gaps in relation to diabetes diagnosis and care in each city.

It will indicate where efforts should be placed to have the highest impact.

Known or suspected vulnerabilities. E.g. high BMI, living alone, from urban area in nutrition transition

THE VULNERABILITY ASSESSMENT Diabetes

Diagnosed

Receive care

Achieve treatment targets

Achieve desired outcomes

The Rule of Halves2,21

QUANTITATIVE DATA

Today, many people with diabetes are not diagnosed, many who are diagnosed do not receive treatment and many who are treated do not get the best outcomes. The Rule of Halves is a framework which outlines the five hurdles to overcome to get diabetes successfully under control.

We will carry out Vulnerability Assessments in each of the Cities Changing Diabetes partnership cities to create a global archive of detailed interviews. Importantly, in this process we also want to identify better ways of getting to those who do not (or cannot) for various reasons engage with health services.

Rule of Halves analysis, household surveys

CASE FILTERS

CASE DEFINITIONS

VULNERABILITY ASSESSMENTS Semi-structured interviews conducted by trained field workers

QUALITATIVE DATA Local data contributes to global archive of interviews

ANALYSIS

Quantitative and qualitative data analysis

NEW KNOWLEDGE Insight for Intervention

This diagram shows a simplified overview of the Vulnerability Assessment process carried out in each partner city.

BUILDING THE

PARTNERSHIP The first year of the programme, 2014, saw the launch of Cities Changing Diabetes in five study cities around the world: Mexico City, Copenhagen, Houston, Tianjin and Shanghai.

Together, these cities account for nearly 60 million people, of which over 6 million may have diabetes. Initiated by Novo Nordisk, University College London and the Steno Diabetes Center, the programme now has many partners involved in the research phase across the world. In 2016 Johannesburg and Vancouver will join the partnership programme.

NOVO NORDISK

UNIVERSITY COLLEGE LONDON

STENO DIABETES CENTER

Novo Nordisk is at the forefront of one of today’s great health challenges: diabetes.

As specialists in diabetes treatment, we’re committed to finding the next generation of medicines through long-term investment in innovation. Our key contribution is to discover and develop better biological medicines, but to defeat diabetes we need to do more than supply the right medicine.

Over the last few years, UCL has put its weight behind understanding the impacts of urbanisation. Under the banner of its ‘Grand Challenge’ commitments to Global Health, Sustainable Cities, Intercultural Interaction, and Human Wellbeing, a cross-disciplinary group has sought to contribute to urban sustainability by identifying health vulnerabilities and addressing the modifiable risk factors that can reduce the impact of NCDs globally.

Steno Diabetes Center is a world leading institution in diabetes care and prevention, with a focus on the early stages of the disease. Established by Novo Nordisk A/S in 1932, we are a not for profit organisation working in partnership with the Danish healthcare system. We treat around 5600 people with diabetes.

That’s why we’re working on helping people to receive the right treatment and achieve the right outcomes. We are committed to playing our part in the global fight against diabetes, and Cities Changing Diabetes is at the heart of this commitment.

We are delighted to bring our expertise to bear through supporting research that will underpin Cities Changing Diabetes. More than that, our approach is aimed at making an impact that is sustainable into the future, giving new momentum to this global initiative.

As a partner in Cities Changing Diabetes we draw on our experience in creating innovative and sustainable approaches to tackling diabetes at the community level, our work training healthcare professional in cities across the world and our expertise in providing care in Copenhagen. We believe we can make a significant contribution to the fight against urban diabetes.

NEW PROGRAMME CITIES MEXCIO CITY

COPENHAGEN

Government of Mexico City

City of Copenhagen

Ministry of Health, Government of Mexico City National Institute of Public Health of Mexico

Danish Diabetes Association Steno Diabetes Center University of Copenhagen, Department of Public Health

HOUSTON American Diabetes Association, Houston City of Houston Department of HR and Benefits Clinton Health Matters Initiative Gateway to Care Harris County Medical Society Harris County Public Health and Environmental Services Houston Business Coalition on Health Houston Health Department The Fountain of Praise The University of Texas, School of Public Health

TIANJIN

SHANGHAI

Tianjin Human Resource and Social Security Bureau

Shanghai Diabetes Institute

Tianjin Medical Association Tianjin Medical University Tianjin Municipal Commission of Health and Family Planning

Shanghai Municipal Center for Disease Control and Prevention Shanghai Municipal Commission of Health and Family Planning

VANCOUVER City of Vancouver Vancouver Costal Health Canadian Diabetes Association (BC/Yukon)

JOHANNESBURG City of Johannesburg (METRO) University of Witswatersrand

802 BILLION

STRONG PARTNERSHIP

TO ENSURE

US

673 BILLION

HEALTHIER CITIES

In late 2015 Novo Nordisk and C40 Cities Climate Leadership Group (C40) engaged in a research-based partnership aimed at ensuring that green policies in cities are beneficial to both the state of the environment and the health of their citizens. The collaboration will see the organisations’ expertise and specialist knowledge combine to generate new insights on a range of benefits of climate action – in particular the health of city populations.

At the heart of the partnership lies the pivotal role of cities in the fight against climate change and poor health. City lifestyles are contributing to the diabetes epidemic and two thirds of the world’s 415 million people living with the condition can be found in urban areas.2 Meanwhile, the rapid rise of cities accounts for two thirds of global energy consumption and more than 70% of carbon dioxide (CO2) emissions.25

D

2015

2040

IDF GLOBAL ESTIMATES OF DIABETESRELATED HEALTH EXPENDITURE2

The C40 Cities Climate Leadership Group, now in its 11th year, connects more than 80 of the world’s greatest cities, representing 600+ million people and one quarter of the global economy. Created and led by cities, C40 is focused on tackling climate change and driving urban action that reduces greenhouse gas emissions and climate risks, while increasing the health, wellbeing and economic opportunities of urban citizens.

JOINING THE

GLOBAL FIGHT On World Diabetes Day 2014, Novo Nordisk made a rallying call for uniting to fight urban diabetes.

During 2015 the global partnership programme truly took off and created the first waves of a global movement to fight urban diabetes.

The research conducted in the five study cities was the perfect outset for the first Cities Changing Diabetes Summit held on 16–17 November 2015 in Copenhagen.

More than 300 delegates of urban planners and architects, diabetes specialists, city municipalities and leading academic institutions to mention some spend two days getting a deeper understanding to what drives the vulnerability of diabetes in cities.

Equally important solutions for creating healthier cities in the future were likewise addressed.

At the same time the Cities Changing Diabetes partnership programme welcomed two new cities: Johannesburg and Vancouver who will officially join the programme during 2016.

REFERENCES 2015 was rounded off with a research-based partnership between Novo Nordisk and C40 – Cities Climate Leadership Group.

In conclusion a very busy year in the Cities Changing Diabetes programme leaving 2015 with a solid platform to continue the fight against urban diabetes.

1. UNDESA. United Nations Department of Economic and Social Affairs. World Urbanization Prospects, the 2014 Revision, Highlights. 2014. 978-92-1-151517-6.

2. IDF. International Diabetes Federation. IDF Diabetes Atlas.

7th edn. Brussels, Belgium: International Diabetes Federation.

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3. United Nations Human Settlements Programme (UN-Habitat).

State of the World’s Cities 2012/2013: Prosperity of Cities.

4. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

5. Stevens RJ, et al. The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56).

Clin Sci 2001;101:671–9.

6. Nathan DM. Long-term complications of diabetes mellitus.

N Engl J Med 1993;328:1676–85.

7. Fishbein H, Palumbo PJ. Acute metabolic complications in diabetes. In: Diabetes in America 2nd Edition. National Diabetes Data Group, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. NIH Publication No. 95–1468; 1995.

8. Mulnier HE, et al. Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the General Practice Research Database. Diabetologia 2008;51:1639–45.

9. Editorial. Harnessing cities for metabolic health. The Lancet Diabetes & Endocrinology 2014;2:527.

10. IDF. International Diabetes Federation. IDF Diabetes Atlas. 6th edn. Brussels, Belgium: International Diabetes Federation, 2013.

11. WHO. Physical Inactivity: A Global Public Health Problem.

12. Harvard School of Public Health. Obesity Prevention source.

Obesity Causes: Globalization.

19. Zhang YW, et al. An epidemiological investigation on overweight and obesity in adults from Tianjin city.

Chinese J Epidemiol 2009;30:1147–51.

20. Ryden Y, et al. Shaping cities for health: Complexity and the planning of urban environments in the 21st century.

Lancet 2012;379:2079–108.

13. Janghorbani M, et al. Systematic review and metaanalysis of air pollution exposure and risk of diabetes. Eur J Epidemiol 2014;29:231–42.

21. Hart JT. Rule of halves: implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care. Br J Gen Pract 1992;42:116-9 and Smith WCS, et al. Control of blood pressure in Scotland: the rule of halves. BMJ 1990;300:981–3.

14. Sørensen M, et al. Long-term exposure to road traffic noise and incident diabetes: a cohort study. Environ Health Perspect 2013;121:217–22.

22. International Diabetes Federation. IDF Diabetes Atlas, 2014 update, 6th edn. Brussels, Belgium: International Diabetes Federation, 2014.

15. Sanchez-Barriga JJ. Mortality trends from diabetes mellitus in the seven socioeconomic regions of Mexico, 2000–2007.

Rev Panam Salud Publica 2010;28:368–75.

23. Statistics Canada, CANSIM. 2015. Health indicator profile by census metropolitan area, two-year period estimates (Vancouver (B.C.)). Available at http://www.statcan.gc.ca/ tables-tableaux/sum-som/l01/cst01/health117y-eng.htm Accessed 29 Mar 2016.

16. Texas: Institute for Health Policy, The University of Texas School of Public Health. Health of Houston Survey.

HHS 2010 A First Look. Houston. 2011.

17. Hammer-Helmich L, Buhelt LP, Hansen BH, Andreasen AH, Robinson KM, Glümer C. Uddrag af Sundhedsprofil 2010 for kommuner i Region Hovedstaden (i alt 29 kommuner). 2011.

18. Hou X, et al. Ten-year changes in the prevalence of overweight, obesity and central obesity among the Chinese adults in urban Shanghai, 1998–2007 – comparison of two cross-sectional surveys. BMC Public Health 2013;13:1064.

24. Statistics South Africa. 2011. City of Johannesburg. Available at http://www.statssa.gov.za/?page_id=1021&id=city-ofjohannesburg-municipality Accessed 29 Mar 2016.

25. International Energy Agency. World Energy Outlook. 2008.

JOIN THE GLOBAL FIGHT AGAINST URBAN DIABETES CitiesChangingDiabetes.com #UrbanDiabetes @CitiesDiabetes

TWO-THIRDS OF PEOPLE WITH DIABETES LIVE IN CITIES2

2/3

10,4% OF THE GLOBAL POPULATION IS PROJECTED TO HAVE DIABETES BY 20402

10.4%