Summary
The Leicester Diabetes Centre (LDC) was selected as a provider, together with public sector contract specialist Ingeus, for NHS England's Healthier You: NHS Diabetes Prevention Programme which will eventually be rolled out across the entire country. The centre's group education programme Let's Prevent is set to become the one of the first interventions in the UK that demonstrates that a structured educational programme reduces the number of people at high risk of type 2 diabetes. It was originally piloted across two Leicestershire towns where 3,000 people at high risk of type 2 diabetes received tailored, personalised help, including education on healthy eating and lifestyle, losing weight and bespoke physical exercise programmes, all of which together have been proven to reduce the risk of developing the disease. LDC was selected to become a provider, together with public sector contract specialist Ingeus, for NHS England's Healthier You: NHS Diabetes Prevention Programme. The programme was based on DESMOND, the first national structured education programme for type 2 diabetes to meet NICE criteria.
Results
The uptake was hugely popular as a total of 880 people from 44 GP surgeries took part. People who attended the main session and one other reduced their risk of the condition by 60% and these who attended all of the programme were 80% less likely to develop type 2 diabetes. Research has shown Let's Prevent has the potential to reduce the chances of one in four people at risk of type 2 diabetes from getting the condition.
Challenge
The Impact Diabetes report in 2012 projected that the NHS's annual spending on diabetes in the UK will increase from £9.8bn to £16.9bn over the next 25 years. The cost of treating diabetes complications was also predicted to almost double from the current total of £7.7bn to £13.5bn by 2035/6. Type 2 diabetes is mainly linked to lifestyle and largely avoidable, yet the number of people with the condition is spiralling, with national figures predicted to rise from 2.5 million to more than four million by 2025. There is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting.
Objectives
To establish whether the use of a structured lifestyle modification programme (based on the DESMOND programme) prevents those with pre-diabetes going on to develop type 2 diabetes. To provide an appropriate structured education programme to target lifestyle modification and behaviour change and a culturally sensitive structured education for the Black Minority and Ethnic (BME) community.
Solution
A screening programme was run on 44 different GP practice databases to identify those 40-75 of European origin or aged 25-75 of South Asian origin or those who have previous Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT). Those most at risk received a letter from their GP inviting them to attend a screening session to see if they have pre-diabetes. Each practice was randomised to either the educational intervention (structured lifestyle modification programme) or control arm of the study and patients from the practice received treatment accordingly. The first group of patients was invited to attend an educational session of either one six-hour or two three-hour sessions initially, followed by an optional yearly refresher session. Those in the control arm received standard patient care and information. The educational sessions were held in small groups and, where necessary, an interpreter was available. All participants within the study received annual health checks for three years and the information was passed on to their GP for their records.
Learnings
Researchers compared the study with other programmes that have been rolled out across the rest of the world and concluded: "While we know programmes have worked in other countries such as the US and Finland – they have been very costly and in the USA they have really struggled to implement the programme with only, with very small numbers of at risk people attending. Let's Prevent provides a cost-effective model of diabetes prevention that can be directly implemented and commissioned within a community setting." Many patients said they had adapted long-term changes to their lifestyles which were having positive effects on their health and their diet, which in many cases will be enough to delay the diagnosis or completely prevent type 2 diabetes from developing. Once the programme is rolled out nationally the findings will be reported as part of the NHS Prevention Programme which will be accountable for national figures and will be subject to vigorous audit reports.
Evaluation
The research was published in the Journal of Public Health which reported on the progress on the development of the Let's Prevent programme. An abstract of the study 'A Community Based Primary Prevention Programme for Type 2 Diabetes in the UK: A Cluster Randomised Controlled Trial' was also featured at the World Diabetes Congress in Vancouver last year.
