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Diabetes Prevention – Long term Multimethod Assessment (DIPLOMA) of the implementation, delivery and outcomes of the ‘Healthier You: National Health Service Diabetes Prevention Programme’ (NHS DPP)

What is the Diabetes Prevention Programme?

In 2015, NHS England; Public Health England; and Diabetes UK initiated a nationwide pilot of a Type 2 Diabetes Mellitus (T2DM) prevention programmem; consisting of seven demonstrator sites, including one in Salford. The demonstrator sites were used to test new novel approaches to identify patients who had a higher risk of developing T2DM, to help define and shape the roll-out of a national programme.

The NHS Diabetes Prevention Programme (NHS DPP) was rolled out in 2016 in England. Delivery was commissioned to four private provider organisations - Ingeus UK , Reed Momenta, ICS Health & Wellbeing and Living Well Taking Control.

The first wave covered 26 million people, half the country population, providing lifestyle advice to reduce participants’ risk of developing Type 2 Diabetes. By August 2018 the NHS DPP had been rolled out across all England. In 2019, the NHS Long Term Plan doubled funding for the NHS DPP, increasing capacity from 100,000 to 200,000 places per year by 2023. Having piloted a Digital DPP delivery throughout 2018, in 2019 the NHS DPP introduced a new framework which included a digital programme in addition to the initial face to face programme, this with the aim to increase programme reach.

Why is it important?

The increasing number of people being diagnosed with T2DM and at risk of complications has made the disease a major public health concern. Being diagnosed with NDH can provide an early warning that people are at risk of developing T2DM. Blood glucose levels, along with associated risks of developing T2DM, can be reduced by addressing lifestyle choices.

The NHS DPP is a publicly funded programme. It is the first T2DM prevention intervention delivered at national scale, providing lifestyle behaviour change education with the aim to reduce the major public health risk that T2DM is. Hence it is important to have an independent evaluation of the NHS DPP to assess:

whether the programme is accessing the patient populations at greatest risk,
whether patients receive a high-quality diabetes prevention course from their local provider,
if the programme is delivering value for money, and
to advise what could be done to achieve long-term sustainability nationwide.

How did we do it?

DIPLOMA – Evaluation of the NHS DPP was commissioned by the National Institute of Health Research (HS&DR 16/48/07). Initially, DIPLOMA was funded to evaluate NHS DPP’s Framework 1. Following the introduction of a digital intervention in Framework 2, DIPLOMA received funder approval to extend its scope to include assessment of the digital elements.

DIPLOMA was a comprehensive programme of work, led by researchers from The University of Manchester and University College London. It comprised of nine distinct but complimentary work packages, which made use of both quantitative and qualitative methods to assess the following:

Access and equality - whether the programme provides fair access for all patients;
Implementation - exploring how implementation differs across the country;
Service delivery and fidelity - checking what is being delivered and how it compares to expectations;
Patient decision-making and their experience;
Outcomes and variation - assessing outcomes for patients engaged in the programme;
Comparison of uptake and outcomes between the face-to-face DPP and digital DPP;
Comparative effectiveness - analysing the programme vs. routine care in preventing T2DM;
Validation study - a study to collect data on the potential barriers to access;
Comparative long-term cost-effectiveness - to assess whether the NHS DPP is cost-effective compared to usual care in terms of long-term costs and benefits.

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The study finished in March 2023 and a final report has been provided to the funder. However as research findings emerged from this national evaluation, we have provided feedback to NHS DPP stakeholders to support the ongoing development of the NHS DPP Programme. All of the findings from indivudaul workpackages have been published with open-access in peer-reviewed journals.

What we found?

Behaviour Change Video: Our DIPLOMA Patient and Public Involvement group co-produced this video on behaviour change, summarising the types of behaviour change activities people might be encouraged to try when they join a programme such as the NHS Diabetes Prevention Programme.

(published May 2023)