OBJECTIVE To assess weight and HbA1c changes in the Healthier You: National Health Service Diabetes Prevention Program (NHS DPP), the largest DPP globally to achieve universal population coverage. RESEARCH DESIGN AND METHODS A service evaluation assessed intervention effectiveness for adults with nondiabetic hyperglycemia (HbA1c 42–47 mmol/mol [6.0–6.4%] or fasting plasma glucose 5.5–6.9 mmol/L) between program launch in June 2016 and December 2018, using prospectively collected, national service–level data in England. RESULTS By December 2018, 324,699 people had been referred, 152,294 had attended the initial assessment, and 96,442 had attended at least 1 of 13 group-based intervention sessions. Allowing sufficient time to elapse, 53% attended an initial assessment, 36% attended at least one group-based session, and 19% completed the intervention (attended >60% of sessions). Of the 32,665 who attended at least one intervention session and had sufficient time to finish, 17,252 (53%) completed: Intention-to-treat analyses demonstrated a mean weight loss of 2.3 kg (95% CI 2.2, 2.3 kg) and an HbA1c reduction of 1.26 mmol/mol (1.20, 1.31 mmol/mol) (0.12% [0.11, 0.12%]); completer analysis demonstrated a mean weight loss of 3.3 kg (3.2, 3.4 kg) and an HbA1c reduction of 2.04 mmol/mol (1.96, 2.12 mmol/mol) (0.19% [0.18, 0.19%]). Younger age, female sex, Asian and black ethnicity, lower socioeconomic status, and normal baseline BMI were associated with less weight loss. Older age, female sex, black ethnicity, lower socioeconomic status, and baseline overweight and obesity were associated with a smaller HbA1c reduction. CONCLUSIONS Reductions in weight and HbA1c compare favorably with those reported in recent meta-analyses of pragmatic studies and suggest likely future reductions in participant type 2 diabetes incidence.

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Early Outcomes From the English National Health Service Diabetes Prevention Programme.

On the friends and family test.

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 methods A 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. Results 3623 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. Conclusions Participation 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.

/pdf/uptake-and-impact-of-the-english-national-health-service-kkjij0m2.pdf

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

Randomized control trials in those with impaired glucose tolerance have shown that the onset of Type 2 diabetes can be prevented or delayed through behavioural interventions that promote weight loss, increase physical activity, and improve the quality of nutrition. In 2016, the Healthier You: NHS Diabetes Prevention Programme was established to prevent or delay the onset of Type 2 diabetes in adults in England already identified to be at high risk, defined as having non-diabetic hyperglycaemia [HbA1c 42-47 mmol/mol (6.0-6.4%) or fasting plasma glucose 5.5-6.9 mmol/l]. This article is protected by copyright. All rights reserved.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.14083

The Healthier You: NHS Diabetes Prevention Programme: digital modes of delivery engage younger people.

Background The National Health Service (NHS) Diabetes Prevention Program is a behavior change intervention for adults in England who are identified as being at high risk of developing type 2 diabetes. The face-to-face service was launched in 2016, followed by a digital service (NHS Digital Diabetes Prevention Program [NHS-DDPP]) in 2019. A total of 4 service providers were commissioned to deliver the NHS-DDPP and were required to deliver the digital service in line with a program specification detailing the key intervention content. The fidelity of the behavior change content in the digital service (ie, the extent to which the program is delivered as intended) is currently unknown. Digital interventions may allow higher fidelity as staff do not have to be trained to deliver all intervention content. Assessing fidelity of the intervention design is particularly important to establish the planned behavior change content in the NHS-DDPP and the extent to which this adheres to the program specification. This is the first known independent assessment of design fidelity in a large-scale digital behavior change intervention. Objective This study aims to assess the fidelity of the behavior change content in each of the 4 NHS-DDPP providers’ intervention designs to the full program specification. Methods We conducted a document review of each provider’s NHS-DDPP intervention design, along with interviews with program developers employed by the 4 digital providers (n=6). Providers’ intervention design documents and interview transcripts were coded for behavior change techniques (BCTs; ie, the active ingredients of the intervention) using the Behavior Change Technique Taxonomy version 1 and underpinning theory using the Theory Coding Scheme framework. The BCTs identified in each digital provider’s intervention design were compared with the 19 BCTs included in the program specification. Results Of the 19 BCTs specified in the program specification, the 4 providers planned to deliver 16 (84%), 17 (89%), 16 (84%), and 16 (84%) BCTs, respectively. An additional 41 unspecified BCTs were included in at least one of the 4 digital providers’ intervention designs. By contrast, inconsistent use of the underpinning theory was apparent across providers, and none of the providers had produced a logic model to explain how their programs were expected to work. All providers linked some of their planned BCTs to theoretical constructs; however, justification for the inclusion of other BCTs was not described. Conclusions The fidelity of BCT content in the NHS-DDPP was higher than that previously documented for the face-to-face service. Thus, if service users engage with the NHS-DDPP, this should increase the effectiveness of the program. However, given that a clear theoretical underpinning supports the translation of BCTs in intervention designs to intervention delivery, the absence of a logic model describing the constructs to be targeted by specific BCTs is potentially problematic.

Fidelity to Program Specification of the National Health Service Digital Diabetes Prevention Program Behavior Change Technique Content and Underpinning Theory: Document Analysis

Introduction The prevalence of type 2 diabetes is rising steeply. National Health Service England (NHSE) is exploring the potential of a digital diabetes prevention programme (DDPP) and has commissioned a pilot with embedded evaluation. Methods and analysis This study aims to determine whether, and if so, how, should NHSE implement a national DDPP, using a mixed-methods pretest and post-test design, underpinned by two theoretical frameworks: the Coventry, Aberdeen and London - Refined (CALO-RE) taxonomy of behavioural change techniques for the digital interventions and the Consolidated Framework for Implementation Research (CFIR) for implementation processes. In eight pilot areas across England, adults with non-diabetic hyperglycaemia (NDH) (glycated haemoglobin (HbA1c) 42–47 mmol/mol or fasting plasma glucose 5.5–6.9 mmol/L) and adults without NDH who are overweight (body mass index (BMI) >25 kg/m2) or obese (BMI >30 kg/m2) will be referred to one of five digitally delivered diabetes prevention interventions. The primary outcomes are reduction in HbA1c and weight (for people with NDH) and reduction in weight (for people who are overweight or obese) at 12 months. Secondary outcomes include use of the intervention, satisfaction, physical activity, patient activation and resources needed for successful implementation. Quantitative data will be collected at baseline, 6 months and 12 months by the digital intervention providers. Qualitative data will be collected through semistructured interviews with commissioners, providers, healthcare professionals and patients. Quantitative data will be analysed descriptively and using generalised linear models to determine whether changes in outcomes are associated with demographic and intervention factors. Qualitative data will be analysed using framework analysis, with data pertaining to implementation mapped onto the CFIR. Ethics and dissemination The study has received ethical approval from the Public Health England Ethics and Research Governance Group (reference R&D 324). Dissemination will include a report to NHSE to inform future policy and publication in peer-reviewed journals.

https://bmjopen.bmj.com/content/bmjopen/9/5/e025903.full.pdf

Kerry Daff

Papers

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

Evaluation of the digital diabetes prevention programme pilot: uncontrolled mixed-methods study protocol.