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. 2020 Jan;43(1):152-160.
doi: 10.2337/dc19-1425. Epub 2019 Nov 12.

Early Outcomes From the English National Health Service Diabetes Prevention Programme

Jonathan Valabhji  1   2   3 , Emma Barron  4 , Dominique Bradley  5 , Chirag Bakhai  5   6 , Jamie Fagg  4 , Simon O'Neill  7 , Bob Young  7 , Nick Wareham  8 , Kamlesh Khunti  9 , Susan Jebb  10 , Jenifer Smith  4
Affiliations

Early Outcomes From the English National Health Service Diabetes Prevention Programme

Jonathan Valabhji et al. Diabetes Care. 2020 Jan.

Abstract

Objective: To assess weight and HbA1c changes in the Healthier You: National Health Service Diabetes Prevention Programme (NHS DPP), the largest DPP globally to achieve universal population coverage.

Research design and methods: A service evaluation assessed intervention effectiveness for adults with nondiabetic hyperglycemia (HbA1c 42-47 mmol/mol [6.0-6.4%] or fasting plasma glucose 5.5-6.9 mmol/L) between program launch in June 2016 and December 2018, using prospectively collected, national service-level data in England.

Results: By December 2018, 324,699 people had been referred, 152,294 had attended the initial assessment, and 96,442 had attended at least 1 of 13 group-based intervention sessions. Allowing sufficient time to elapse, 53% attended an initial assessment, 36% attended at least one group-based session, and 19% completed the intervention (attended >60% of sessions). Of the 32,665 who attended at least one intervention session and had sufficient time to finish, 17,252 (53%) completed: intention-to-treat analyses demonstrated a mean weight loss of 2.3 kg (95% CI 2.2, 2.3) and an HbA1c reduction of 1.26 mmol/mol (1.20, 1.31) (0.12% [0.11, 0.12]); completer analysis demonstrated a mean weight loss of 3.3 kg (3.2, 3.4) and an HbA1c reduction of 2.04 mmol/mol (1.96, 2.12) (0.19% [0.18, 0.19]). Younger age, female sex, Asian and black ethnicity, lower socioeconomic status, and normal baseline BMI were associated with less weight loss. Older age, female sex, black ethnicity, lower socioeconomic status, and baseline overweight and obesity were associated with a smaller HbA1c reduction.

Conclusions: Reductions in weight and HbA1c compare favorably with those reported in recent meta-analyses of pragmatic studies and suggest likely future reductions in participant type 2 diabetes incidence.

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Conflict of interest statement

Competing interests

All authors have completed the ICMJE uniform disclosure form and declare: JV is the National Clinical Director for Diabetes and Obesity at NHS England and is the Clinical Lead for the Healthier You: NHS Diabetes Prevention Programme. EB is the Head of Health Intelligence (diabetes) for Public Health England and leads analysis of the Diabetes Prevention Programme. DB is an analyst for NHS England and is actively involved in analysis of the programme. JF was the diabetes evidence and evaluation lead at Public Health England until September 2018. CB is the Primary Care Advisor to the NHS Diabetes Programme. BY is Clinical Lead of the National Diabetes Audit for England and Wales and a Trustee of Diabetes UK. KK was Chair of the Programme Development Group for the National Institute for Health and Care Excellence (NICE) public health guidance on Type 2 diabetes: prevention in people at high risk (NICE PH38). KK is also Co-Director of the Leicester Diabetes Centre (LDC), and one of the Programme Providers, Ingeus UK Ltd, provide interventions based on the type 2 diabetes prevention programme developed by LDC. NW was Chair of the Programme Development Group for NICE public health guidance on Type 2 diabetes prevention: population and community-level interventions (NICE PH35). JS represents Public Health England on the NHS England Diabetes Programme Board. SON is the Clinical Director at Diabetes UK.

KK acknowledges support from National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands and the NIHR Leicester BRC. SJ is funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and Oxford NIHR Collaboration and Leadership in Applied Health Research.

Figures

Figure 1
Figure 1
Flowchart of people at each stage in the programme
Figure 2
Figure 2
A: Mean weight change (kg) by number of sessions attended, included those for whom all data fields, except HbA1c, were complete (N=26,753). B: Mean Hba1c change (mmol/mol) by number of sessions attended, included those for whom all data fields were complete (N=16,083). Number of participants refers to the number attending exactly the given number of sessions (e.g.: Panel A; 2,200 participants attended only one intervention session before finishing the programme, 1,523 participants attended exactly two intervention sessions before finishing the programme etc.).
See this image and copyright information in PMC

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