The NHS Diabetes Prevention Programme has reduced the incidence of new type 2 diabetes diagnoses across England by up to 7%, preventing an estimated 18,000 people from developing the disease

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

The analyses, conducted as part of the independent Diabetes Prevention—Long term Multimethod Assessment (DIPLOMA) research programme, were presented at the Diabetes UK Professional Conference 2022 on 29 and 30 March 2022.

The results underline the success of the NHS Diabetes Prevention Programme (DPP). Individuals who completed the 9-month scheme, to which more than 1 million people at risk of developing type 2 diabetes have been referred since its launch in 2016, reduced their risk of developing the condition by 37%. In addition, early data following the transformation of the programme in response to the COVID-19 pandemic showed that its successes have continued.

At the opening plenary session of the conference, Professor Jonathan Valabhji MD, Consultant Diabetologist at St Mary’s Hospital, Imperial College Healthcare NHS Trust, and National Clinical Director for Diabetes and Obesity at NHS England, said that the DPP was ‘our first, and remains our biggest, undertaking’, and that the results are ‘a landmark for us’, as they provide ‘the punchline, in a way, of the impact of the programme on type 2 diabetes incidence.’

According to Professor Valabhji, ‘the evidence is now clear … [that] the NHS is preventing type 2 diabetes and is helping thousands of people to lead healthier lives.’

Regarding the DPP, the Secretary of State for Health and Social Care, Sajid Javid, said: ‘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.

‘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.’

Bigger focus on weight management

Professor 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 added: ‘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 participation in the DPP and risk of developing type 2 diabetes, Beth Parkinson PhD, Research Fellow in Health Economics at the University of Manchester, and her colleagues collected data on all referrals to the programme. These were matched with individual-level information on people diagnosed with type 2 diabetes in primary care up to the end of March 2020, as recorded by the National Diabetes Audit.

The team focused on referrals to the DPP between between 1 June 2016 and 31 March 2018, to allow enough time for all referrals to finish the 9-month programme, plus 1 year of follow-up to determine type 2 diabetes incidence. Among 182,371 referrals, 46.0% did not attend the initial assessment, 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% of people who did not attend the initial assessment, 11.5% of those who attended only the initial assessment, 11.3% of people who attended fewer than 60% of the sessions, and 6.7% of those who completed the scheme. Multivariate logistic regression analysis 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—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 [develop] type 2 diabetes than those who were referred but did not attend any sessions’, Dr Parkinson said.

When that was broken down into level of attendance, the reduction in type 2 diabetes risk was a nonsignificant (0.05%) in people who attended only the initial assessment. In those who attended fewer than 60% of the sessions, the reduction in risk was 0.69% (p<0.00), whereas 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’, Dr Parkinson explained.

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’, she said. 

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 31 March 2017, enrolled 3271 general practices. This was followed by a further 1602 practices by 31 March 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, respectively.

Study continued remotely during the pandemic

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

However, Professor Valabhji said that, as a result of the COVID-19 pandemic, the DPP had 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, with digital delivery via online materials. Professor Valabhji added that, so far, around 150,000 people have started on the DPP during the COVID-19 era—117,515 accessing the remote programme, and 25,418 accessing the digital version.

Initially, the team were ‘interested in measuring noninferiority 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.’

The average weight loss among people who completed the face-to-face programme was 3.0 kg, compared with 3.3 kg in people completing the remote programme, and 5.0 kg in people completing the digital version.

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

This article originally appeared on Medscape, part of the Medscape Professional Network.

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