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Study Shows Diabetes Prevention Programme Reduced Development of T2D by 20%

Research showed that the NHS Diabetes Prevention Programme has had success helping thousands of people avoid type 2 diabetes (T2D). Those with prediabetes referred to the programme were one fifth less likely to develop type 2 diabetes, according to a new study.

More than 4.9 million people in the UK have diabetes, with 13.6 million people currently at increased risk of type 2 diabetes in the UK. "If nothing changes, we predict that 5.5 million people will have diabetes in the UK by 2030," warned Diabetes UK. The disease is estimated to cause 20,000 early deaths per year.

The authors of the new study, published in PLOS Medicine, explained that "people with prediabetes (nondiabetic hyperglycaemia [NDH]) are at high risk of developing type 2 diabetes mellitus".

In England, the NHS Diabetes Prevention Programme is offered to adults with NDH, with lifestyle advice to help reduce the risk of developing type 2 diabetes. The programme is intended to reduce the yearly cost of type 2 diabetes to the NHS by £8.8 billion, which is almost 9% of its budget, explained Diabetes UK.

NHS National Clinical Director for Diabetes and Obesity, Professor Jonathan Valabhji, highlighted that type 2 diabetes is a "growing problem" with millions of people affected. It is linked not only to kidney failure, amputation, heart attack, stroke, and many of the common types of cancer, but "also adds pressure to NHS services", he stressed. "So doing nothing is not an option for the NHS."

Professor Evangelos Kontopantelis, from data science and health services research at University Manchester and co-author of the study, said: "Type 2 diabetes is a major public health concern which has been rising globally, with over 3 million people in the UK currently diagnosed with it. Previous studies have shown that both lifestyle modifications through diet and physical activity and medication can prevent progression to this condition".

This was supported by an NHS England spokesperson, who commented that the latest data showed that "over 1.2 million people have been offered support through the programme".

Reduced Risk of Escalation From Pre-Diabetes to Type 2 Diabetes

Researchers from the University of Manchester set out to investigate whether people who were referred to the programme were less likely to develop type 2 diabetes, compared with those who were not referred to the programme. 

They used a cohort study of patients attending primary care in England using clinical Practice Research Datalink data from 1 April 2016 (NHS Diabetes Prevention Programme introduction) to 31 March 2020. Patients referred to the programme from referring practices were matched to patients in nonreferring practices to minimise confounding. Patients were matched based on age, sex, and date of NDH diagnosis (within 365 days). Analysis was adjusted for age (at index date), sex, time from NDH diagnosis to index date, BMI, HbA1c, total serum cholesterol, systolic blood pressure, diastolic blood pressure, prescription of metformin, smoking status, socioeconomic status, a diagnosis of depression, and comorbidities. 

A total of 18,470 patients referred to the NHS Diabetes Prevention Programme were matched with 51,331 patients not referred to NHS Diabetes Prevention Programme in the main analysis. Mean follow-up from referral was 482.0 and 472.4 days, respectively. Baseline characteristics in the two groups were similar, except those referred to the NHS Diabetes Prevention Programme were more likely to have higher BMI and be ever-smokers. 

The researchers identified that the risk of developing type 2 diabetes was "one fifth lower" (20%) in people with raised blood sugars referred to the programme, compared with people who were not referred and who received usual care. 

"Assuming 1000 referred to the NHS Diabetes Prevention Programme and 1000 not referred to NHS Diabetes Prevention Programme, by 36 months since referral, we would expect 127 conversions to type 2 diabetes in the group referred to the intervention and 154 in the group not referred," the authors explained.

Programme a Powerful Way to Protect Health

The authors cautioned that, although they had observed smaller associations with risk reduction, compared with those observed in randomised controlled trials, this was "unsurprising" as they had examined the impact of referral, rather than attendance or completion of the intervention. 

The authors also pointed out that as an observational study, they could not "establish causality". Other limitations they highlighted included the inclusion of controls from the other three UK countries, and that the data did not allow the evaluation of the association between attendance (rather than referral) and conversion. Further work was needed to examine the long-term effects of the programme and to examine if the programme delays or prevents type 2 diabetes, and whether certain population groups benefitted more from the programme, they pointed out.

However, they emphasised that the findings supported the decision of the "rapid large-scale implementation" of the programme in England, rather than a slower or regional introduction, but also supported the continuation of the programme and the introduction of similar programmes to the rest of the United Kingdom.

"Today's research builds on previous analysis, which found the programme scheme resulted in a 7% reduction in the number of new diagnoses of type 2 diabetes in England between 2018 and 2019, with around 18,000 people saved the consequences of the condition," said NHS England.

"This important study is further evidence that the NHS is preventing type 2 diabetes and helping hundreds of thousands of people across England to lead healthier lives," said Prof Valabhji. "It is fantastic that our world first programme has offered well over one million people support and empowered them to lead healthier lives and prevent type 2 diabetes."

Asked to comment by Medscape News UK, Chris Askew OBE, chief executive of Diabetes UK, said: "The number of people with type 2 diabetes is increasing year-on-year, so it has never been more vital to have effective support available for people at risk of this serious, potentially devastating condition."

Mr Askew said Diabetes UK was "greatly encouraged" by the results of the research. "It’s clear the NHS Diabetes Prevention Programme can be a real turning point for people."

Prof Kontopantelis added: "This study is good news for the Healthier You Diabetes Prevention Programme, which we show beyond doubt is a powerful way to protect your health."