Uptake and impact of the English National Health Service digital diabetes prevention programme: observational study

Abstract

Introduction‘Healthier You’, the National Health Service (NHS) diabetes prevention programme (DPP) offers adults in England at high risk of type 2 diabetes (T2DM) an evidence-based behavioral intervention to prevent or delay T2DM onset. This study assesses the impact of a pilot digital stream of the DPP (DDPP) on glycated hemoglobin (HbA1c) and weight.Research design and methodsA service evaluation employing prospectively collected data in a prospective cohort design in nine NHS local pilot areas across England. Participants were adults with non-diabetic hyperglycemia (NDH) (HbA1c 42–47 mmol/mol or fasting plasma glucose 5.5–6.9 mmol/L) in the 12 months prior to referral. The DDPP comprised five digital health interventions (DHI). Joint primary outcomes were changes in HbA1c and weight between baseline and 12 months. HbA1c and weight readings were recorded at referral (baseline) by general practices, and then at 12-month postregistration. Demographic data and service variables were collected from the DHI providers.Results3623 participants with NDH registered for the DDPP and of these, 2734 (75%) were eligible for inclusion in the analyses. Final (12-month) follow-up data for HbA1c were available for 1799 (50%) and for weight 1817 (50%) of registered participants. Mean change at 12 months was −3.1 (−3.4 to −2.8) kg, p<0.001 for weight and −1.6 (−1.8 to −1.4) mmol/mol, p<0.001 for HbA1c. Access to peer support and a website and telephone service was associated with significantly greater reductions in HbA1c and weight.ConclusionsParticipation in the DDPP was associated with clinically significant reductions in weight and HbA1c. Digital diabetes prevention can be an effective and wide-reaching component of a population-based approach to addressing type 2 diabetes prevention.

How the Behavior Change Content of a Nationally Implemented Digital Diabetes Prevention Program Is Understood and Used by Participants: Qualitative Study of Fidelity of Receipt and Enactment

“…Although efforts were made to secure a broad representation of participants across age, sex, and ethnic groups, it is possible that those who proactively chose to take part in the study may be more likely to have had a positive experience of the program and are not representative of all participants in the NHS-DDPP. The age and sex characteristics of our participants were similar to those of participants of the pilot NHS-DDPP [ 14 ], but our sample was characterized by lower levels of deprivation and less ethnic diversity compared with the sample of the pilot program (11% from the most deprived quintile compared with 21%, respectively, and 78% White British compared with 68%, respectively).…”

“…Systematic reviews have shown digital diabetes prevention interventions to be effective for weight loss [ 12 , 13 ] and improvements in glycemic control in patients with prediabetes [ 12 ]. In an uncontrolled pilot study of a digital version of the NHS-DPP, participation in the program was associated with clinically significant reductions in weight (–3.1 kg) and glycated hemoglobin (HbA1c) levels (–1.6 mmol/mol) at 12 months [ 14 ]. After this successful pilot, the NHS-DPP was extended in 2019 to also include a digital version of the program, the NHS Digital Diabetes Prevention Programme (NHS-DDPP).…”

What behaviour change technique content is offered to service users of the nationally implemented English NHS Digital Diabetes Prevention Programme: Analysis of multiple sources of intervention content

“…having access to a health coach) was effective in supporting behaviour change ( Webb et al, 2010 ). More recent research on the NHS-DDPP pilot found that having access to peer support and a telephone service was associated with a significantly greater reduction in weight compared to not having these features ( Ross et al, 2022 ).…”

Effectiveness of digital and remote provision of the Healthier You: NHS Diabetes Prevention Programme during the COVID‐19 pandemic

“…The pilot demonstrated that weight loss and reduction in HbA 1c were comparable to those achieved through group‐based face‐to‐face programme delivery. 3 …”