Diabetes Prevention in Australia: 10 Years Results and Experience

Abstract

Clinical trials have demonstrated the efficacy of lifestyle modification for the prevention of type 2 diabetes mellitus but it was achieved at higher cost than can be sustained in routine health services. The first clinical trial to report was the Finnish Diabetes Prevention Study. This paper describes how Australia worked with Finnish colleagues to adapt the findings of that study to achieve a statewide diabetes prevention program. Small evaluative, effectiveness trials have been conducted in a number of countries to see if the results of the clinical trials can be replicated in routine health services. The Australian evaluative trial, Greater Green Triangle Diabetes Prevention Program is described in detail to demonstrate the ingredients for success in moving a program from one country to another. Few countries have managed to scale up from evaluative trials to statewide or national programs. The Australian experience is described in detail including lessons learned about what reduced the effectiveness, particularly the need for policy makers in government, people from the implementing organisation and researchers to work together from the start of the evaluative trial and throughout the first 5 years of a national program.

How do we identify people at high risk of Type 2 diabetes and help prevent the condition from developing?

“…Understanding how to scale up Type 2 diabetes prevention to large populations and incorporate prevention for those at high risk into routine practice is growing [21,34]. To inform this process, knowledge is required about a wide range of factors which move from sole considerations of clinical effectiveness to also encompass implementation factors (reach, effectiveness, adoption, uptake, retention, maintenance), population health factors (population effectiveness, effect on inequalities), commissioning factors (cost-effectiveness, affordability, healthcare capacity, workforce, fidelity, quality assurance) and political factors (long-term strategic commitment to prevention) [21]. Implementation at scale was taken forward through the Finland National Programme for the Prevention of Type 2 Diabetes (FIN-D2D), which covers five hospital districts and 1.5 million people [55].…”

“…Additionally, lower inclusion thresholds are associated with higher test sensitivity and lower specificity, meaning that the cohort is diluted with a higher proportion of those never destined to develop Type 2 diabetes. This leads to smaller average risk reduction with interventions (lower effectiveness) and lower cost‐effectiveness . Work has been undertaken using scenario modelling to understand the interplay of these factors when combined with variations in test performance of different combinations of formal risk assessment tools and blood tests .…”

“…This was followed by state‐wide efforts through the Life! study in Australia and the launch of a national Type 2 diabetes prevention framework in the USA . A recent development has been the NHS DPP in England, which achieved 100% geographical coverage in England in 2018 .…”

“…One of the lessons learnt from the Life! study scale‐up process was that payment models should be used to incentivize retention .…”

“…Programmes can also draw on evidence to specify core programme elements such as curricula, workforce, intensity, length, and mode of delivery, as noted in the course of the US DPP, NHS DPP and Life! scale‐up approaches . It is also critical that programmes are theoretically informed, and that commissioners and providers are clear about the theory of change that should underpin the programme.…”