National Diabetes Prevention Programme Research Articles

A service improvement project to improve follow up screening rates of women with gestational diabetes

Diabetes in pregnant women presents significant implications for long-term health. The best way to manage them in practice is outlined here by Joanna Stace A history of Gestational Diabetes Mellitus (GDM) can have significant implications for women's long-term health. Despite these risks, primary care rates for post-natal screening are low. A Service Improvement Project (SIP) was implemented as part of an MSc in Advanced Diabetes Care undertaken at Birmingham City University. Its aims were to improve post-natal follow-up care for women with GDM, reduce the risk of developing T2DM enhancing their long-term health. A key success of the SIP is the improved knowledge of the importance of post-natal screening amongst staff and women. Increased numbers of women being correctly coded and offered post-natal screening highlighting the importance of healthcare integration for better patient outcomes. Work continues to improve referral rates and attendance of the National Diabetes Prevention Programme with the roll out of an Electronic Care Pathway.

Factors influencing participation in an online national diabetes prevention programme: A qualitative study with attenders and educators.

To explore factors affecting participation in the pilot of the synchronous online national diabetes prevention programme (NDPP) in Ireland from the perspectives of those who attended and the educators who recruited for and delivered the programme. A qualitative study involving semi-structured interviews and focus groups with NDPP attenders (attended the assessment and at least one session) and educators (dietitians) on the programme. The Framework Method using the Theoretical Domains Framework (TDF) guided the analysis. Thirteen attenders took part in two online focus groups and five online or phone interviews. Eight educators took part. Four themes which cut across the TDF domains were identified as factors influencing participation; (i) lack of awareness of prediabetes and fear of diabetes, relating to attenders' fear of diabetes and lack of knowledge of prediabetes and diabetes prevention; (ii) perceived need for programme support to change health behaviour, concerning attenders' and educators' recognition of the need for the NDPP; (iii) trust in healthcare professionals (HCPs), relating to trust in HCPs to convey the seriousness of prediabetes and the value of diabetes prevention programmes (DPPs) and (iv) practical and personal ease of joining online, relating to the flexibility and accessibility of the synchronous online group format, the IT skills of attenders and educators and apprehension about group education. Raising awareness of prediabetes and the need for prevention programmes should be a priority for health services and HCPs. The synchronous online group format was seen as less daunting to join than a face-to-face programme and may be a useful option to encourage participation.

Characteristics of participants in the first fully online National Diabetes Prevention Programme: A quantitative survey

Background Diabetes prevention programmes (DPPs) are being implemented around the world to tackle the rise in type 2 diabetes. In 2021/22, the Health Service Executive(HSE) in Ireland piloted a fully online national diabetes prevention programme(NDPP). Characteristics and factors affecting participation may be different among people attending online DPPs compared to face-to-face programmes. The aim of this study was to describe the demographic, psychosocial and health characteristics of participants in the pilot of the online NDPP in Ireland. Methods A survey from the evaluation of the English NDPP was adapted for the Irish context with Patient and Public Involvement(PPI) input. The survey was sent (between April and June 2022) to all individuals who attended the initial assessment of the pilot NDPP (n=73). It contained questions on health status, co-morbidities, motivation to improve health, quality of life, self-efficacy, beliefs about the risk of diabetes, participation(e.g. recollection and understanding of invite, number of sessions attended), as well as demographic information. Results Response rate was 30.5% (n=22). Mean age of responders was 62 years (range 36–82 years) and over half were men (57.1%, n=12). The majority (81%, n=17) had attended 6 or more of the 14 sessions. Most (90.5% n=19) reported having family members or acquaintances with diabetes, had positive views of their current health status and high quality of life scores (71.4%, n= 15). Mental health scores were slightly higher than the national average. Over half (57.2%, n=12) were confident or very confident about participating in an online DPP. Almost all (95.2%, n=20) believed it was important to manage their risk of type 2 diabetes. Conclusions Participants in the online pilot NDPP had positive views of their general health and positive psychosocial characteristics affecting their decision to participate. These beliefs may be modifiable intervention targets to encourage participation among non-attenders in future programmes.

A qualitative evaluation of the national rollout of a diabetes prevention programme in England

BackgroundThe National Health Service Diabetes Prevention Programme (NHS DPP) was commissioned by NHS England in 2016 and rolled out in three ‘waves’ across the whole of England. It aims to help people with raised blood glucose levels reduce their risk of developing type 2 diabetes through behaviour change techniques (e.g., weight loss, dietary changes and exercise). An independent, longitudinal, mixed methods evaluation of the NHS DPP was undertaken. We report the findings from the implementation work package: a qualitative interview study with designated local leads, responsible for the local commissioning and implementation of the programme. The aim of the study was to explore how local implementation processes were enacted and adapted over time.MethodsWe conducted a telephone interview study across two time-points. Twenty-four semi-structured interviews with local leads across 19 sampled case sites were undertaken between October 2019 and January 2020 and 13 interviews with local leads across 13 sampled case sites were conducted between July 2020 and August 2020. Interviews aimed to reflect on the experience of implementation and explore how things changed over time.ResultsWe identified four overarching themes to show how implementation was locally enacted and adapted across the sampled case sites: 1. Adapting to provider change; 2. Identification and referral; 3. Enhancing uptake in underserved populations; and 4. Digital and remote service options.ConclusionThis paper reports how designated local leads, responsible for local implementation of the NHS DPP, adapted implementation efforts over the course of a changing national diabetes prevention programme, including how local leads adapted implementation during the COVID-19 pandemic. This paper highlights three main factors that influence implementation: the importance of facilitation, the ability (or not) to tailor interventions to local needs and the role of context in implementation.

Attendance, Weight Loss, and Participation in a Behavioural Diabetes Prevention Programme

BackgroundWeight loss in diabetes prevention programmes has been shown to be associated with participants’ age, socio-economic status, and ethnicity. However, little is known about how these differences relate to attendance and whether such differences can be mediated by other potentially modifiable factors. Differential effectiveness across these factors may exacerbate health inequalities.MethodProspective analysis of participant data collected by one provider of the standardised national NHS diabetes prevention programme in England. Mediation analysis was performed via a structural equation model to examine whether the number of attended sessions mediated the associations of age, socio-economic status, and ethnicity with follow-up weight. The group-level factor of number of attended sessions was examined using multiple linear regression as a benchmark; multilevel linear regression using three levels (venue, coach, and group); and fixed effects regression to account for venue-specific and coach-specific characteristics.ResultsThe associations of age, socio-economic status, and ethnicity with follow-up weight were all mediated by the number of attended sessions. Group size was associated with attendance in an inverted ‘U’ shape, and the number of days between referral and group start was negatively associated with attendance. Time of day, day of the week, and the number of past groups led by the coach were not associated with attendance.ConclusionMost of the differences in weight loss initially attributed to socio-demographic factors are mediated by the attendance of the diabetes prevention programme. Therefore, targeted efforts to improve uptake and adherence to such programmes may help alleviate inequalities.

Developing a National Diabetes Prevention Programme for the Republic of Ireland during COVID-19.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Diabetes Prevention Programme and socioeconomic inequalities in Type 2 Diabetes in England

Abstract The National Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing Type 2 Diabetes Mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH, HbA1c 42-47 mmol/mol or 6.0-6.4%). How this programme affects inequalities by age, gender, disability, ethnicity, or deprivation is not known. We used multinomial logistic regression models to compare population characteristics at three stages along the prevention programme pathway: prevalence of NDH [using survey data from UK Household Longitudinal Study (N = 794) and Health Survey for England (N = 1,383)]; identification in primary care and offer of the programme [using administrative data from the National Diabetes Audit (N = 1,267,350)]; and programme participation [using programme provider records (N = 98,024)]). Younger adults (aged under 40) [4% of the NDH population (95% CIs 2%-6%)] and older adults (aged 80 and above) [12% (95%CIs 10%-14%] were both underrepresented amongst DPP participants [2% of DPP participants (95%CIs 1.8%-2.2%) and 8% (95%CIs 7.7%-8.3%) respectively]. People with disabilities were underrepresented in the DPP [15% (95%CIs 14.9%-15.1%) vs 60% (95%CIs 58%-62%)] compared to the general population. People living in more deprived areas were under-represented [14% (95% CIs 13.7%-14.3%) vs 20% (95%CIs 16%-24%) in the general population]. Ethnic minorities were overrepresented [36% (95%CIs 35.8%-36.2%) vs 13% (95%CIs 9%-17%) in the general population] among DPP referrals, though the proportion dropped at programme completion stage [19% (95%CI 18.5%-19.5%)]. The DPP has the potential to reduce ethnic inequalities but may widen socioeconomic, age, and disability-related inequalities in T2DM. Whilst ethnic minority groups are overrepresented at identification and offer stage, efforts are required to support the completion of the programme. Programme providers should target underrepresented groups to ensure equitable access and narrow inequalities in T2DM. Key messages • The DPP intervention may result in a widening of socioeconomic and disability related inequalities amongst people with NDH as the programme had fewer adults in deprived areas and with a disability. • The programme has the potential to reduce ethnic inequalities, but efforts are required to support the completion of the programme by minority ethnic groups.

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

AimsThe English National Health Service Diabetes Prevention Programme (NHS DPP) is commissioned by NHS England and has been rolled out across England to adults identified as being at high risk of type 2 diabetes. The present scoping review aimed to identify the extent and nature of evidence to date on the NHS DPP and describe what the evidence has reported.MethodsA scoping review involving searches of various sources (including MEDLINE, CINAHL, MediArXiv, Google Scholar and GreyLit) was conducted on 31 August 2021 and repeated on 09 February 2022. Only articles reporting on the NHS DPP made available since 2015 were eligible for inclusion.Results65 articles were included. Of these, 37 were journal publications. Most articles were made available in 2018 and 2020 (total n = 25). The majority of articles reported on uptake and retention (n = 27) whilst others reported on implementation considerations (n = 24), programme outcomes (n = 21), stakeholder experience (n = 8) and screening and referral processes (n = 3). Various research methods were reported and included qualitative (n = 9) and document analysis (n = 8). Articles revealed preliminary evidence on service user characteristics, rates of referral, uptake and retention as well as how far the NHS DPP is being delivered in line with its evidence base and service specification.ConclusionsThe evidence is accumulating on NHS DPP uptake and retention most, with emerging evidence on programme outcomes (such as weight loss and HbA1c). More evidence is warranted on stakeholder experience to decipher how to overcome low initial and long‐term engagement reported by the current evidence base.

IDF21-0631 Evaluating the significance of elevated HbA1c readings in COVID-19 patients treated with Dexamethasone – a QI project

Background: One complication that patients who have contracted COVID-19 are faced with is the possibility of developing hyperglycaemia, due to an increase in insulin resistance, and/or the inhibition of the production of insulin. Moreover, emerging national research suggests that when patients are treated with Dexamethasone, the problem is compounded, with patients more likely to develop significant hyperglycaemia, even if they don’t have a pre-existing diagnosis of diabetes. Aim: To initially evaluate the merit in measuring HbA1c for all COVID-19 patients upon admission, and if indicated then achieve 100% patient HbA1c testing for COVID-19 admissions by July 2021, as well as subsequent patient retesting as follow-up within 3-6 months. Method: In order to understand the impact of the use of Dexamethasone on COVID-19 positive patients, an initial audit of 40 randomised patients was carried out and the results identified that only 39% of patients had a HbA1c recorded during their admission, of which 89% who displayed either pre-diabetic or diabetic blood sugar levels and at the time, were discharged without a clear management plan. The above evaluation provided a clear mandate to amend the existing workflow to introduce a mandatory HbA1c test during admission, which linked the Dexamethasone order set on the Trust’s electronic patient record system with the HbA1c order set, along with a general awareness and training campaign. As part of the first plan-do-study-act (PDSA) cycle, the team contacted 40 patients randomly selected in the initial data set, inviting them for a follow-up HbA1c, 3-6 months post discharge. Results: When inviting the 40 patients within the initial data-set for a follow-up HbA1c, the results demonstrated that:•32% passed away•25% declined follow-up•28% remained within healthy range•10% within pre-diabetic range•5% within diabetic range The project team are now looking at the onward support pathways for the 15% of patients in the pre-diabetic/diabetic ranges: for example, recommending self-referring into the National Diabetes Prevention Programme. The second PDSA cycle includes how to support the wider cohort of patients outside of our sample data set of approximately 175 patients using Quality Improvement methodology. Discussion: Prior to the project, diabetic status of COVID-19 patients was not routinely checked or known at either admission or after 3-6 months, and therefore there was a potential for a cohort of patients to enter, or remain within, a diabetic or pre-diabetic state unknowingly and unmanaged, with associated long-term health implications. The project confirmed that the introduction of initial and follow-up monitoring allowed for an effective diabetic screening programme in an at-risk cohort, subsequent earlier diagnosis of pre-diabetes or diabetes, and appropriate onward referral, where previously there was none. This allows for more joined up management and screening between Primary and Secondary care and the opportunity to improve patient outcomes through identifying at-risk patients and connecting them to support pathways earlier.

Influences of decisions to attend a national diabetes prevention programme from people living in a socioeconomically deprived area.

AimsTo explore key influences of decisions in participants from a socioeconomically deprived area to attend the Healthier You: NHS Diabetes Prevention Programme (NHSDPP). The NHSDPP is a lifestyle behaviour change programme for adults with prediabetes living in England.MethodsSemi‐structured interviews were conducted with 35 participants who had attended the initial assessment, but not yet started the NHSDPP; 23 were classified as “attenders,” 12 as “non‐attenders” after they were interviewed based on whether they had attended the first NHSDPP session or not. Transcribed interviews were analysed using inductive thematic analysis.ResultsSeven themes were derived from the data. The results demonstrate how understanding type 2 diabetes, making lifestyle changes, comparing themselves with others, having support and certain self‐perceptions can all affect individuals’ motivation to attend a diabetes prevention programme. Accessibility and practicalities also influenced both motivation and attendance.ConclusionsThis study identified a range of different influences on decisions to attend a diabetes prevention programme, which programme organisers and healthcare professionals should consider to maximise attendance. Initial communication from general practitioners (GPs) and initial assessments are key points where people's beliefs and understanding could be explored.

The relationship between the elevation of haemoglobin A1c level, sleep quality and sleep duration in clinically diagnosed pre-diabetic patients in a nationally representative sample.

Background/objectivesType 2 diabetes mellitus (T2DM) is one of the most common chronic illnesses in the United Kingdom accounting for approximately 15% of deaths per year. Growing evidence suggests that sleep duration and quality contributes towards this. This study aimed to determine whether there was a significant relationship between the elevation of haemoglobin A1c (HbA1c) level, sleep quality (SQ) and sleep duration (SD) in clinically diagnosed pre-diabetic patients.Subjects/methodsFollowing referral from a relevant healthcare professional, participants (n = 40) were registered on the National Health Service England, funded Healthier You: National Diabetes Prevention Programme and completed a Pittsburgh Sleep Quality Index questionnaire to evaluate SQ and SD.ResultsA Spearman’s correlation showed an association between HbA1c, SQ and SD measures. A simple linear regression showed a significant large positive association (rs = 0.913, p < 0.001) and significant regression (F (1) = 39, p < 0.001) with an R2 of 0.842 between HbA1c level and SQ. Additionally, a significant large negative association (rs = 0.757, p < 0.001) and significant regression was found (F (1) = 39, p < 0.001) with an R2 of 0.570 between HbA1c and SD.ConclusionsThis study suggests a relationship between SQ, SD and the elevation of HbA1c which may contribute towards prevalence of T2DM and may help to increase adherence to diabetes prevention programmes.

Changes in the level of knowledge of diabetes among elderly with diabetes in Slovenia in the period 2011–2020

AimsTo achieve better treatment decisions, type 2 diabetes patients need to be empowered also through knowledge increase. The aim of this study was to evaluate and compare the level of knowledge and overall perceptions of type 2 diabetes within the elderly diabetic patients before and after the National Diabetes Prevention and Care Development Programme 2010–2020. MethodsDiabetes knowledge test was used in two cross-sectional studies in 2011 and 2020 where the samples of type 2 diabetes patients 65+ were surveyed. Besides descriptive statistics, non-parametric tests and general linear model were used to compare the level of knowledge. ResultsThe comparison reveals that in the last decade the general knowledge about diabetes has not significantly changed (U = 16942, p = 0.809). The average scores in 2011 and 2020 were 7.98 ± 2.41 and 7.96 ± 2.36 respectively. The average level of knowledge has slightly worsened for patients in the age group 80+, while it remained approximately the same in the other three age groups (65−69, 70−74, 75−79). ConclusionsOur study has shown that despite the National Diabetes Prevention and Care Development Programme the knowledge of elderly diabetic patients in Slovenia remained at the same level or worsened.

On the borderline of diabetes: understanding how individuals resist and reframe diabetes risk

Medical sociologists highlight diagnosis as a critical moment in understanding the illness experience and have extended analysis to the growing focus on ‘predisease states’ in relation to policy and medical practice. The biomedicalisation of diabetes risk, labelled as ‘prediabetes’, is one predisease area Public Health England have prioritised via the roll-out of a national diabetes prevention programme (NDPP). The label and language of prediabetes frames this risk as a medical condition and this could have both social and practical consequences for how individuals manage this risk. Through data drawn from individual interviews and observations, we explore how individuals respond to the label of prediabetes and how they interpret and respond to their ‘at-risk’ status. The findings demonstrate that for some participants, the framing of risk seemed consistent with a biomedical paradigm as reflected within clinical discussions and the language used. For others, previous knowledge or experiences were drawn upon to resist, downplay and reframe their at-risk status. Our analysis reflects varying degrees of resistance where for some this seemed to mitigate against the threat of ‘biographical disruption’ associated with the risks of developing future diabetes. In such cases, respondents also resisted the notion that they were ‘candidates’. However, in some cases, there was little resistance to the label of prediabetes, yet the perceived risk was ‘low’ in the context of competing health priorities or in relation to their expectations of health status in older age. Across participants, these varied responses were reflected in corresponding resistance to key messages promoting health behaviour change.

The Fidelity of Training in Behaviour Change Techniques to Intervention Design in a National Diabetes Prevention Programme

BackgroundThe National Health Service Diabetes Prevention Programme (NHS-DPP) is a behavioural intervention for people identified as high risk for developing type 2 diabetes that has been rolled out across England. The present study evaluates whether the four commercial providers of the NHS-DPP train staff to deliver behaviour change technique (BCT) content with fidelity to intervention plans.MethodOne set of mandatory training courses across the four NHS-DPP providers (seven courses across 13 days) was audio-recorded, and all additional training materials used were collected. Recordings and training materials were coded for BCT content using the BCT Taxonomy v1. BCTs and depth of training (e.g. instruction, demonstration, practice) of BCT content was checked against providers’ intervention plans.ResultsTen trainers and 78 trainees were observed, and 12 documents examined. The number of unique BCTs in audio recordings and associated training materials ranged from 19 to 44 across providers, and staff were trained in 53 unique BCTs across the whole NHS-DPP. Staff were trained in 66% of BCTs that were in intervention plans, though two providers trained staff in approximately half of BCTs to be delivered. The most common way that staff were trained in BCT delivery was through instruction. Training delivery style (e.g. experiential versus educational) varied between providers.ConclusionObserved training evidences dilution from providers’ intervention plans. NHS-DPP providers should review their training to ensure staff are trained in all key intervention components, ensuring thorough training of BCTs (e.g. demonstrating and practicing how to deliver) to enhance BCT delivery.

Adaptions to the National Diabetes Prevention Programme lifestyle change curriculum by Hawai‘i Federally Qualified Health Centers: a qualitative descriptive study

ObjectiveThe objective of this qualitative study was to describe the community-appropriate and culturally appropriate adaptations made by lifestyle change programme (LCP) coaches to the National Diabetes Prevention Programme curriculum for...

Implementing a national diabetes prevention programme in England: lessons learned

BackgroundType 2 diabetes mellitus is preventable through lifestyle intervention. Diabetes prevention programmes (DPPs) aim to deliver prevention-based behaviour change interventions to reduce incidence. Such programmes vary from usual primary care in terms of where, how, and by whom they are delivered. Implementation is therefore likely to face new commissioning, incentive and delivery challenges. We report on the implementation of a national DPP in NHS England, and identify lessons learned in addressing the implementation challenges.MethodsIn 2017/18, we conducted 20 semi-structured telephone interviews covering 16 sampled case sites with the designated lead(s) responsible for local implementation of the programme. Interviews explored the process of implementation, including organisation of the programme, expectations and attitudes to the programme, funding, target populations and referral and clinical pathways. We drew on constant comparative methods to analyse the data and generate over-arching themes. We complemented our qualitative data with a survey focused on variation in the financial incentives used across sites to ensure usual primary care services recruited patients to new providers.ResultsWe identified five over-arching areas of learning for implementing this large-scale programme: 1) managing new providers; 2) promoting awareness of services; 3) recruiting patients; 4) incentive payments; and 5) mechanisms for sharing learning. In general, tensions appeared to be caused by a lack of clear roles/responsibilities between hierarchical actors, and lack of communication. Both local sites and the national NHS coordination team gained experience through learning by doing. Initial tensions with roles and expectations have been worked out during implementation.ConclusionsImplementing a national disease prevention programme is a major task, and one that will be increasingly faced by health systems globally as they aim to adjust to demand pressures. We provide practical learning opportunities for the wider uptake and sustainability of prevention programmes. Future implementers might wish to define clear responsibilities for each actor prior to implementation, ensure early engagement with new providers, offer mechanisms/forums for sharing learning, generate evidence and provide advice on incentive payments, and prioritise public and professional awareness of the programme.

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.

Integrating Local Knowledge into a National Programme: Evidence from a Community-Based Diabetes Prevention Education Programme.

Type 2 diabetes prevention is a major priority for healthcare services and public health. This study aimed to evaluate how a local authority in England piloted a diabetes prevention programme. The South Gloucestershire Diabetes Prevention (Pilot) Programme (SGDPP) comprised a group health education course over six weeks with subsequent support provision up to six months post-enrolment. Of the 300 patients invited onto the programme, 32% enrolled and 29% completed the full six-month programme. There was an attendance rate of 84% throughout group sessions and at a six-month follow-up. There were significant improvements across most measures at six months, including a 4 kg mean weight loss and a 3.45 mmol/mol mean HbA1c reduction. Clear goals, high quality organization and personal qualities of educators were identified as central for the programme’s success. The unit costs were similar to pilots of other healthy lifestyle programmes. The evaluation found evidence of reduced type 2 diabetes risk markers, positive impacts for dietary and physical activity, and potential cost-effectiveness for this format of group-based diabetes prevention intervention. Feedback from multiple stakeholders provided insight on how to successfully embed and scale-up delivery of diabetes prevention work. This evidence enables the integration of learning in local service delivery and provides a basis to support development of the national diabetes prevention programme.

The North West London Diabetes Transformation Programme (NWL‐DTP): the journey so far in optimising diabetes care within North West London

AbstractIn this paper we share learning and outcomes from three years of a North West London Diabetes Transformation Programme (NWL‐DTP) across eight clinical commissioning groups.We have evaluated the improvements in care of 77 382 people with diabetes and 71 562 patients with non‐diabetic hyperglycaemia (NDH) between August 2015 and August 2018, based on primary care data from 229 practices.Significant improvements in care have been achieved through active case finding, primary care improvement programmes and closer multidisciplinary working, supported by a clinical and administrative leadership team. Diabetes prevalence increased by 15% from 67 279 to 77 382 while the NDH register increased from 9071 to 71 562. There was an increase in: patients achieving all nine key care processes by 31.1%; HbA1c ≤58mmol/mol by 6.6%; blood pressure ≤140/80mmHg by 3.8%; cholesterol ≤4mmol/L by 6.8%; all three treatment targets by 4.5%; hypoglycaemia monitoring by 81.1%; collaborative care planning by 74.8%; and NDH annual review by 41.3%. North West London was the largest referrer into the National Diabetes Prevention Programme in the UK over this period.The NWL‐DTP has achieved significant improvements in diabetes care in the context of very high levels of ethnic diversity, significant social deprivation and a complex health commissioning environment. Key enablers supporting the widescale transformation have been clinical leadership, digital systems support, patient engagement and commissioner buy‐in. Further evaluation will focus on health care utilisation, costs and complications in order to understand the impact on key diabetes endpoints. Copyright © 2019 John Wiley &amp; Sons.

Health promotion in physiotherapy services using NHS health and diabetes checks

Several public health initiatives have been launched in England including NHS Health Checks and the National Diabetes Prevention programme; however, uptake has been suboptimal. Musculoskeletal problems are a large health burden and there are increasing links identified between musculoskeletal disorders and metabolic and cardiovascular disorders, which are influenced by lifestyle factors. Physiotherapists have a key role to play in public health and are an untapped resource. Methods: An enhanced health promotion service, using support staff, was implemented into a physiotherapy-led musculoskeletal service including the provision of NHS Health Checks and diabetes checks. Evaluation included descriptive statistical analysis, documentary analysis and qualitative review. Results: In total, 1550 health assessments were completed with 43% eligible for a HbA1c test and 17% were eligible for an NHS Health Check. Service evaluation feedback from patients and GPs was wholly positive and social prescribing increased. Discussion: This service describes a successful model for embedding NHS Health Checks and diabetes checks into a musculoskeletal service, providing opportunistic health promotion and behaviour change interventions and reducing the duplication of different public health initiatives. This service uses an untapped allied health professional public health workforce to support an identification of disease, behaviour change, self-care and social prescribing within the holistic management of musculoskeletal conditions.