NHS Prevention Programme Slashes T2D Incidence Rates

Liam Davenport

March 31, 2022

LONDON — A national healthy living programme reduced the incidence of new type 2 diabetes diagnosis across England by up to 7%, with an estimated 18,000 people saved from the damaging consequences of the disease, reveal two analyses.

The results, from the independent Diabetes Prevention: Long term Multimethod Assessment (DIPLOMA) research programme, underline the success of the NHS Diabetes Prevention Programme (DPP). Individuals who completed the 9-month scheme, to which more than one million people at risk of developing type 2 diabetes have been referred since its launch in 2016, were found to lower their risk by 37%.

The analyses were presented at the Diabetes UK Professional Conference 2022 on March 29 and 30, and early data following the transformation of the programme in response to the COVID-19 pandemic shows its successes have continued.

The DPP was "our first, and remains our biggest, undertaking," said Jonathan Valabhji, MD, national clinical director for Diabetes and Obesity, NHS England, at the opening Plenary session of the meeting. The results are "a landmark for us, in way", he added, as they give "the punchline, in a way, of the impact of the programme on type 2 diabetes incidence".

For Valabhji, "the evidence is now clear", he said in a release accompanying the results, "the NHS is preventing type 2 diabetes and is helping thousands of people to lead healthier lives".

"It is excellent to see the NHS Diabetes Prevention Programme, recently expanded as part of the NHS Long Term Plan, has helped 18,000 people avoid type 2 diabetes,” added Sajid Javid, Health and Social Care Secretary.

"It’s vital we focus on prevention and provide advice on healthy eating and exercise, as obesity can lead to a number of serious health conditions and is the second biggest cause of cancer in the UK."

Need to Place Bigger Focus on Weight Management

Valabhji agreed, saying in the plenary session: "If someone asks me what I am most concerned about for the next decade, I would have to say it is the impending crisis of what is young-onset type 2 diabetes."

"We are seeing more and more of that. We have got 122,000 people under the age of 40 with type 2 diabetes in the National Diabetes Audit. The phenotype is in some ways more aggressive and obesity is much, much more prominent."

He said: "We’ve come a long way, focusing on cardiovascular risk…but we also need now to place a much bigger focus, I believe, on weight management."

Emma Elvin, senior clinical advisor for Diabetes UK, commented: "For some people, combined lifestyle interventions, including diet, physical activity, and sustained weight loss can be very effective in reducing the risk of type 2 diabetes.

"That is why we need to ensure that all who can benefit from the programme know of it and are able to access it."

Study Details

To examine the association between uptake of the DPP and the risk of developing type 2 diabetes, Beth Parkinson, PhD, research fellow in Health Economics, University of Manchester, and colleagues collected data on all referrals to the programme. This was matched up with individual-level information on people diagnosed with type 2 diabetes in primary care up to the end of March 2020, as recorded on the National Diabetes Audit.

The team focused on referrals to the DPP between between June 1, 2016 and March 31, 2018, to allow enough time for all referrals to finish the nine-month programme, plus a year of follow-up to determine type 2 diabetes incidence. Among 182,371 referrals, 46.0% did not attend the initial assessment, while 16.8% attended only the initial assessment,18.2% attended fewer than 60% of the sessions, and 19.0% attended more than 60% of the sessions and were said to have completed the programme.

Overall, 10.9% of the cohort went on to develop type 2 diabetes - 12.5% among those who did not attend the initial assessment, 11.5% of those who attended only the initial assessment, 11.3% of people who attended <60% of the sessions, and 6.7% for those who completed the scheme. Multivariate logistic regression revealed that the risk of developing type 2 diabetes was reduced in people who attended at least the initial assessment versus those who did not, at an absolute reduction of 1.72% (p<0.00).

"So, in relative terms, this means that people who engaged in the programme in some way…were on average 14% less likely to type 2 diabetes than those who were referred but did not attend any sessions," Ms Parkinson said.

When that was broken down into level of attendance, the reduction in type 2 diabetes risk was a non-significant 0.05% in people who attended only the initial assessment. In those who attended <60% of the sessions, the reduction in risk was 0.69% (p<0.00), while in those who completed the scheme, the absolute risk reduction was 4.56% (p<0.00).

"In relative terms, that’s equivalent to a 37% lower risk of developing diabetes compared to someone who did not take up the programme," Parkinson explained.

She continued that attending less than five sessions was not significantly associated with any change in the risk of developing type 2 diabetes.

"However, beyond this we see a steady reduction in the risk of developing diabetes as session attendance increases, up to 12 sessions."

Attending all 13 sessions of the DPP was associated with a 5.7% "or a relative 47% lower risk of developing diabetes versus attending no sessions".

In the second analysis, Emma McManus, MA, also at the University of Manchester, and colleagues examined the three waves of implementation of the DPP.

The first, by March 31, 2017, enrolled 3271 general practices. This was followed by a further 1602 practices by March 31, 2018, and then another 1574 practices in the ongoing current wave. Compared with third wave practices, general practices in the first two waves had a lower rate of type 2 diabetes diagnoses between 2017 and 2019, at incidence rate ratios of 0.945 and 0.940.

Study Became Digital During Pandemic

"If you change your lifestyle, the risk of developing type 2 diabetes reduces," McManus said in the release. "Our research has shown that the [DPP] has been successful in reducing the number of new cases of diabetes."

However, Valabhji said that, as a result of the COVID-19 pandemic, the DPP had to "morph" as "group-based face-to-face" sessions were "no longer possible".

The programme was "remarkably" transformed over a "3-week window in March and April of 2020, so it became entirely remote or digital", he said. Remote delivery involved group sessions delivered via Teams or Zoom, while digital delivery was via online materials. Valabhji added that, so far, around 150,000 people have started on the DPP during the COVID era and have accessed it remotely or digitally, at 117,515 for the remote programme and 25,418 for the digital version.

Initially, the team were "interested in measuring non-inferiority in weight loss" for the remote and digital programmes versus the face-to-face intervention "but we actually have superiority, both for remote and more markedly for digital," he said, "so we’re very pleased with that".

Specifically, the average weight loss among people who completed the face-to-face programme was 3.0 kg. This compares with a weight loss of 3.3 kg in people completing the remote programme, and 5.0 kg in people who finished the digital version.

Parkinson’s and McManus’s research was funded by the National Institute for Health Research.

No relevant financial relationships declared.

Diabetes UK Professional Conference 2022: Abstracts A16 (P166) and A25 (P266). Presented March 29.

Follow Medscape on FacebookTwitterInstagram, and YouTube.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.