Diabetes prevention at scale: Narrative review of findings and lessons from the DIPLOMA evaluation of the NHS Diabetes Prevention Programme in England

Abstract

AimsThe NHS Diabetes Prevention Programme (NHS DPP) is a large‐scale, England‐wide behaviour change programme for people at high risk of progressing to type 2 diabetes. We summarise the findings of our six‐year DIPLOMA evaluation of its implementation and impact and highlight insights for future programmes.MethodsUsing qualitative interviews, document analysis, observation, surveys and large dataset analysis, eight interlinked work packages considered: equity of access; implementation; service delivery and fidelity; programme outcomes; comparative effectiveness and cost‐effectiveness in reducing diabetes incidence; and patient decision making and experience.ResultsDelivery of the NHS DPP encountered barriers across many aspects of the programme, and we identified inequalities in terms of the areas, organisations and patient populations most likely to engage with the programme. There was some loss of fidelity at all stages from commissioning to participant understanding. Despite these challenges, there was evidence of significant reductions in diabetes incidence at individual and population levels. The programme was cost‐effective even within a short time period.ConclusionsDespite the challenge of translating research evidence into routine NHS delivery at scale, our findings suggest that an individual‐level approach to the prevention of type 2 diabetes in a ‘high‐risk’ population was more effective than usual care. By embedding evaluation with programme delivery and working closely with the NHS DPP team, we provided actionable insights for improving communications with potential participants, supporting primary care referral, honing the delivery model with better provider relationships and more patient choice, increasing understanding of behaviour change techniques, and enriching the educational and health coaching content.

The journey towards implementation of the NHS Diabetes Prevention Programme: A personal perspective

“…DIPLOMA has provided a predominantly positive evaluation, highlighting that provision of the NHS DPP reduced the incidence of type 2 diabetes more than usual care, at both individual and population level, at a cost considered acceptable within current willingness to pay thresholds. 1 I was appointed National Clinical Director for Diabetes and Obesity at NHS England in April 2013, just over a decade ago and just as the Health and Social Care Act 2012 was first implemented and NHS England as an armslength body was created. The ensuing 10 years have been punctuated by funding opportunities, including postgeneral election UK Treasury Comprehensive Spending Reviews, which have facilitated funding of policies with the potential to improve population health.…”

“…The DIPLOMA team have demonstrated reduced type 2 diabetes incidence in both NHS DPP participants and at population level associated with programme implementation. 1 The feedback of evaluation findings and learnings into the iterative development of the programme, in particular the involvement of the DIPLOMA team at each round of re-procurement to evolve the service specification and to support provider selection, has contributed significantly to programme success and reflects successful integration of NHS and NIHR infrastructures.…”

“…In this issue of the Journal, Bower et al summarise the findings and learnings from the National Institute for Health and Care Research (NIHR) commissioned Diabetes Prevention—Long Term Multimethod Assessment programme (DIPLOMA) of the NHS Diabetes Prevention Programme (NHS DPP). DIPLOMA has provided a predominantly positive evaluation, highlighting that provision of the NHS DPP reduced the incidence of type 2 diabetes more than usual care, at both individual and population level, at a cost considered acceptable within current willingness to pay thresholds 1 …”