A National Digital Diabetes Prevention Programme: Feasible, acceptable and effective?

Abstract

Background Type 2 Diabetes (T2DM) is a global public health priority affecting 425 million adults with 352 million more at risk of developing T2DM. Intensive group programmes focusing on weight loss and physical activity can prevent or postpone the development of T2DM, but certain groups (e.g working age) find it difficult to attend sessions. Digital options offer a flexible alternative with the potential to widen access and increase uptake. The National Health Service of England (NHSE) has initiated a pilot of a national digital Diabetes Prevention Programme (DPP) to determine its feasibility, acceptability and impact. This is the first national digital DPP in the world, and lessons learnt will be of interest internationally. Methods Single arm, pre-post design located in 9 geographic areas with a total population of 5.6 million adults. Adults identified in primary care as being at risk of T2DM were referred to a digital diabetes prevention intervention (DDPI). Baseline data included demographic details (age, gender, ethnicity, highest level of education achieved) and clinical data (weight (kg), Body Mass Index (BMI) and glycated haemoglobin (HbA1c mmol/mol)). Clinical data were collected at baseline, 6 and 12 months, with the primary outcome change in HbA1c at 12 months. Results The programme was effectively implemented in all 9 areas with a total of 5,053 referrals. 3,228 (64%) of those referred registered with a DDPI. Mean baseline values for registered patients was BMI 31.1, Weight 87.7 kg and HbA1c 43.4 mmol/mol. To date, 2,687 patients have reached the 6 month point, of whom 867 dropped out. Mean (95% CI) HbA1c change was -1.6 (-1.8 to -1.4) mmol/mol (n = 1,264) and mean (95% CI) weight change was -4 (-4.3 to -3.7) kg (n = 1,184). Conclusions A national digital DPP is feasible, acceptable to patients and healthcare providers, and appears to be associated with beneficial impacts on HbA1c and weight in those who participate. Key messages A digital DPP is feasible, acceptable and associated with reductions in weight and HbA1c amongst participants. A digital DPP could be a useful part of a public health strategy to combat T2DM.

The English national health service diabetes prevention programme (NHS DPP): A scoping review of existing evidence

“…19,[21][22][23][24][25][26][27][28][29][30] The remaining articles comprised six presentations, [31][32][33][34][35][36] three abstracts, 31,37,38 three reports, 35,39,40 one CPD module, 41 a news article, 42 an information sheet 43 and a case study. 44 Most of these articles were a commentary in design, with the others including pre-post studies, 25 cohort studies (retrospective/prospective), 23,24 mixedmethods research, 19 case studies 41 and cross-sectional surveys. 27 More and more evidence is accumulating in this area since three were made available in 2017.…”

“…Eight articles were identified focusing on stakeholder experience. 25,36,[44][45][46][47][48][49] Four incorporated qualitative research methods such as semi-structured interviews 45,46,48,49 or a combination of interviews, focus groups and cross-sectional survey. 49 One presented a case study, 44 another they termed qualitative insight through anecdotal data and focus groups, 36 a participant survey 47 and the other presented findings on stakeholder experience from a pre-post design.…”

“…49 One presented a case study, 44 another they termed qualitative insight through anecdotal data and focus groups, 36 a participant survey 47 and the other presented findings on stakeholder experience from a pre-post design. 25 All these articles were published between 2018 and 2022.…”

“…35 In regard to uptake more broadly, rates vary including ~45% (of 154,000) people taking up spaces 30 and 64% (of 5053) registering for the programme. 25 For the digital delivery of the NHS DPP rates are higher at 68% (of 5337) uptake. 29,31 Knowles 2019 comment on how uptake is higher among primary care referrals.…”

“…38 Murray 2019 report 2687 of 3233 people reached the 6-week timepoint. 25 Howarth 2020 report 34% attended 60% of sessions. 24 Another article comment on a 79% retention rate at 3 months for the digital delivery.…”