Summary

Lambeth Diabetes Intermediate Care Team developed a short prevention course called STEPS – focused on increased activity through walking and aimed at local people who are at high risk of developing type 2 diabetes. STEPS was planned and implemented by a Diabetes Specialist Nurse and Dietician who are skilled and passionate about the delivery of accessible structured education for people living with diabetes. The programme is funded by Lambeth CCG. The course has proved very popular with GP referrals increasing year-on-year and almost 900 people have attended in the past three years. No significant changes in HbA1c, total serum cholesterol, blood pressure, weight and body mass index were found after the course and there was no progression to type 2 diabetes for most participants.

Results

For the period March 2013 – March 2016 3,152 people were referred to STEPS and 897 attended a course. Baseline and follow-up data (at least 3 months after the course) for the following clinical variables were obtained from participants' GP practices: HbA1c, total serum cholesterol, blood pressure, weight and body mass index. No significant changes were found for the clinical variables. 20% of people were found to have progressed to type 2 diabetes. The lack of significant change in clinical variables is encouraging as there was no progression to type 2 diabetes for most participants.

Challenge

Lambeth is an inner-city borough with a population of 310,000 and is one of the most deprived boroughs in London. The demographics are diverse, with large numbers of people of African-Caribbean and Portuguese heritage and more than 100 languages spoken. Based on GP registers, 15,200 people with diabetes live in Lambeth. Although the population is younger, on average, than most of the UK population, a high prevalence of diabetes is related to high levels of obesity and also the substantial BME population. There are 48 GP surgeries in Lambeth and specialist diabetes services are provided in community settings by the Lambeth Diabetes Intermediate Care Team, which includes consultants, GP specialists, diabetes specialist nurses and dieticians.

Objectives

To offer a short, education course to people in Lambeth found to be at high risk of developing type 2 diabetes. To reduce the number of high risk people in Lambeth who go on to develop the condition.

Solution

In 2011 it was decided to promote the use of HbA1c to diagnose type 2 diabetes in Lambeth. It was recognised that there would be people found to have an HbA1c between 43 – 47 mmol/mol who were therefore at high-risk of developing type 2 diabetes. It seemed important to be able to offer these people an opportunity to attend a course to provide information about diabetes and how to prevent it. This led to the development of the "STEPS to prevent diabetes" course, jointly designed by a DSN and Specialist Diabetes Dietician who were experienced in providing structured education and self-management programmes to people living with diabetes. The current evidence relating to diabetes prevention programmes and the content of existing programmes were reviewed. This suggested our approach should consist of a combination of information about diabetes, healthy food choices, increased physical activity and how to sustain lifestyle changes. To promote increased physical activity, we decided to provide each person attending a course with a pedometer. During the planning stage, inclusion and exclusion criteria were agreed and designed to be very simple. GP referrals were accepted for people with an HbA1c 43- 47mmols with no restriction to BMI or age. If people did not speak English they could be accompanied by an appropriate adult who could translate for them.

The programme curriculum was designed and written with specific aims and learning outcomes equally weighted to the following components:

1. Information on diabetes, risk factors and prevention.
2. Information regarding Healthy Food Choices and achieving a balanced diet.
3. Value of physical activity, primarily walking supported by a pedometer.
4. Personal Goal Setting.

Each STEPS course was designed to last for three hours, accommodating 15 participants, with one trained health professional to facilitate each group (either a DSN or specialist dietician). It was regarded as essential that facilitators were experienced in self and peer reflective practice. All attendees at STEPS were offered a support telephone call two weeks after the course.

Learnings

The STEPS course has proved to be very popular – although not all people referred respond to an invitation to attend. An audit aimed to assess whether STEPS attendance was associated with improvement in diabetes-relevant clinical variables between baseline at referral and post-STEPS followup. A service evaluation aimed to elicit participants' views of the programme. Participants exhibited high levels of satisfaction in terms of content, presentation, venue, and likelihood of making behavioural change. The majority of participants highlighted the general positive experience and/or clarifi cation of dietary, lifestyle, and diabetes-related information as the most valuable element of the course.

Evaluation

In 2016 a clinical audit and service evaluation for STEPS were undertaken. Data from participants attending fi ve STEPS courses in 2014 were selected for analysis. Data from 106 participants was reported.