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Diabetes Distilled: Early outcomes from NHS DPP suggest reduction in progression to type 2 diabetes is achievable

Data from the Healthier You: NHS Diabetes Prevention Programme have shown a mean weight loss of 2.3 kg and a mean HbA1c reduction of 1.26 mmol/mol in those who attended at least one intervention session, while completers (those attending at least eight of 13 group sessions) achieved a mean weight loss of 3.3 kg and an HbA1c reduction of 2.04 mmol/mol. These reductions compare well with those in other pragmatic prevention studies and are likely to translate into reductions in progression to type 2 diabetes in this high-risk population with non-diabetic hyperglycaemia. There was a clear dose–response relationship between the number of sessions attended and benefits.

Between June 2016 and December 2018, nearly 325 000 people with non-diabetic hyperglycaemia were referred to the Healthier You: NHS Diabetes Prevention Programme (NHS DPP). Of these, 152 294 (53%) had attended an initial assessment and 96 442 (36%) attended at least one group intervention session. At referral, the mean HbA1c was 43.7 mmol/mol, mean age was 62 years and 46% of patients were male. At initial assessment, the mean weight was 83.9 kg (BMI 30.3 kg/m2).

Data from 32 665 people who attended at least one intervention session and had time to complete the programme by December 2018 were analysed. Of this group, around half (53%) were deemed to have completed (attended at least eight of 13 group sessions). The intention-to-treat analysis showed a mean weight loss of 2.3 kg and an HbA1c reduction of 1.26 mmol/mol, while completers achieved weight loss of 3.3 kg and an HbA1c reduction of 2.04 mmol/mol.

Systematic reviews of pragmatic prevention studies suggest that achieving a weight loss of 2.5 kg would provide a 26–29% reduction in progression to type 2 diabetes amongst high-risk groups.

Younger age, female sex, Asian and black ethnicity, lower socioeconomic status and normal BMI at baseline were associated with less weight loss, while older age, female sex, black ethnicity, lower socioeconomic status and being overweight or obese at baseline were associated with smaller reductions in HbA1c. In the new round of procurement to deliver the NHS DPP, provider payments are designed to increase retention of those from black, Asian and mixed-ethnicity groups and those from more deprived backgrounds. Digital programme delivery previously demonstrated to assist with weight loss will be offered to those who decline or fail to attend face-to-face group programmes.

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