This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
A referral to the NHS Diabetes Prevention Programme reduces someone’s chance of developing type 2 diabetes by 20%, research found. In a related paper, the same team made suggestions to improve the programme. These include better communication between professionals and service users (about the goal of the programme, for instance) and ensuring different providers all deliver consistent digital content.
The findings provide reassurance to commissioners, clinicians and patients that referral to the programme can reduce the risk of type 2 diabetes.
For more information about type 2 diabetes, visit the NHS website.
The issue: does the NHS Diabetes Prevention Programme prevent type 2 diabetes?
According to Diabetes UK, almost 3.9 million people in the UK have type 2 diabetes. The condition can lead to vision loss, heart attack and stroke, kidney problems and increased risk of cancer.
People with non-diabetic hyperglycaemia, often referred to as pre-diabetes, have high blood sugar levels and are at risk of developing type 2 diabetes. But type 2 diabetes can be prevented by improving diet and increasing exercise, as well as taking medication such as metformin. This group of people can be referred by their GP to the Diabetes Prevention Programme, which encourages healthier behaviours. The programme started in 2016 and was rolled out across England by 2018.
The NHS, Public Health England and Diabetes UK jointly led the NHS Diabetes Prevention Programme. The programme, which is delivered by non-NHS providers, takes 9 – 12 months to complete. More than 1.2 million people have been enrolled since it started.
This study investigated whether people with pre-diabetes who are referred to the programme are less likely to develop type 2 diabetes than those who receive usual care (no referral to the programme).
What’s new?
The study was based on the primary care records of people with non-diabetic hyperglycaemia. 18,470 people who were referred to the programme were matched with more than 51,331 who were not. People were matched according to their age, sex and date of diagnosis of non-diabetic hyperglycaemia.
After 3 years:
- fewer people (6.2%; 1,152 out of 18,470) who were referred to the programme developed type 2 diabetes than those who were not (6.4%; 3,280 out of 51,331)
- those referred to the programme were 20% less likely to develop type 2 diabetes than people who were not.
Why is this important?
The findings provide reassurance that referral to the NHS diabetes prevention programme is linked to a reduced risk of type 2 diabetes, a key priority for the NHS. The researchers say the programme could save the NHS money.
This study estimated lower effectiveness than previous randomised controlled trials have shown. This was expected since it explored the impact of referral rather than of attendance or completion of the programme.
What’s next?
This study was part of a project called DIPLOMA (Diabetes prevention – long-term multimethod assessment programme) that evaluated the NHS Diabetes Prevention Programme. One of the studies made the following suggestions to improve the programme.
Attendance could be improved by:
- discussions with people enrolled in the programme about their expectations, their blood sugar level and risk of type 2 diabetes, and how taking part in the programme could reduce their risk
- local champions to encourage practice staff to refer
- NHS payments to practices based on the number of referrals they make.
Delivery of the programme could be improved by:
- strong project management with closer working relationships between providers and local services
- offering people a choice of face-to-face or digital sessions.
Programme content could be improved by:
- in-depth training for programme staff on how to deliver behaviour change techniques consistently
- interactive activities delivered in small group sessions
- ensuring programme staff help people make changes to their health behaviours (for example, by helping them set goals).
You may be interested to read
This summary is based on the DIPLOMA study: Ravindrarajah R, and others. Referral to the NHS Diabetes Prevention Programme and conversion from nondiabetic hyperglycaemia to type 2 diabetes mellitus in England: A matched cohort analysis. PLoS Medicine 2023; 20: e1004177.
A paper summarising the findings from the DIPLOMA study: Bower P, and others. Diabetes prevention at scale: Narrative review of findings and lessons from the DIPLOMA evaluation of the NHS Diabetes Prevention Programme in England. Diabetic Medicine 2023; 40: e15209.
All the DIPLOMA papers can be found on the DIPLOMA website, along with videos summarising the findings.
A study examining how people understood and used the digital version of the NHS Diabetes Prevention Programme: Miles LM, and others. How the behavior change content of a nationally implemented digital diabetes prevention program is understood and used by participants: qualitative study of fidelity of receipt and enactment. Journal of Medical Internet Research 2023; 25: e41214.
A study exploring what makes people engage with the digital version of the NHS Diabetes Prevention Programme. Ross J, and others. Influences on patient uptake of and engagement with the National Health Service digital diabetes prevention programme: qualitative interview study. Journal of Medical Internet Research 2023; 25: e40961.
An NIHR Evidence article about the way the NHS Diabetes Prevention Programme is delivered.
Funding: This study was funded by the NIHR Health and Social Care Delivery Research.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
