Abstract
Introduction
Diabetes prevention programmes are effective, in a pre-diabetic population, in reducing weight, lowering HbA1c and slowing the conversion to diabetes. Little is known about the relationship between participation in diabetes prevention programmes and participant characteristics or service delivery. We investigated uptake and retention in England’s NHS Diabetes Prevention Programme, reporting on variability among patient subgroups, providers, and sites.
Research Design and Methods
This prospective cohort study included 99,473 adults with non-diabetic hyperglycaemia referred to the Diabetes Prevention Programme between 2016 and 2017. The programme, seeks to change health behaviours by offering at least 16 hours of group education and exercise. Multilevel logistic regression models were used to analyse variation in uptake, retention, and completion.
Results
Uptake among 99,473 adults referred to the programme was 56%, (55,275). Among 55,275 who started the programme, 34% (18,562) achieved the required dose and 22% (12,127) completed the full course. After adjustment for variation in case mix, substantial heterogeneity in uptake and retention was seen across four service providers (uptake ORs 1.77 (1.33, 2.34), 4.30 (3.01, 6.15), and 1.45 (1.07, 1.97) compared with the reference provider) and between sites (uptake for typical individuals ranged from 0.32 to 0.78 across the middle 95% of sites, ICC 0.07). Higher levels of retention and completion were seen where some out-of-hours provision was offered (retention (OR 1.32 (1.25, 1.39)).
Conclusions
This study provides the first independent assessment of participation in the English Diabetes Prevention Programme and the first study internationally to examine the impact of diabetes prevention programme service delivery on participation. When implementing a large-scale diabetes prevention programme, heterogeneity in service provision between different providers and sites can result in variable participation beyond that attributable to case mix, with potential consequences for effectiveness and health inequalities. Extending out-of-hours provision may improve participation in prevention programmes.
Diabetes prevention programmes are effective, in a pre-diabetic population, in reducing weight, lowering HbA1c and slowing the conversion to diabetes. Little is known about the relationship between participation in diabetes prevention programmes and participant characteristics or service delivery. We investigated uptake and retention in England’s NHS Diabetes Prevention Programme, reporting on variability among patient subgroups, providers, and sites.
Research Design and Methods
This prospective cohort study included 99,473 adults with non-diabetic hyperglycaemia referred to the Diabetes Prevention Programme between 2016 and 2017. The programme, seeks to change health behaviours by offering at least 16 hours of group education and exercise. Multilevel logistic regression models were used to analyse variation in uptake, retention, and completion.
Results
Uptake among 99,473 adults referred to the programme was 56%, (55,275). Among 55,275 who started the programme, 34% (18,562) achieved the required dose and 22% (12,127) completed the full course. After adjustment for variation in case mix, substantial heterogeneity in uptake and retention was seen across four service providers (uptake ORs 1.77 (1.33, 2.34), 4.30 (3.01, 6.15), and 1.45 (1.07, 1.97) compared with the reference provider) and between sites (uptake for typical individuals ranged from 0.32 to 0.78 across the middle 95% of sites, ICC 0.07). Higher levels of retention and completion were seen where some out-of-hours provision was offered (retention (OR 1.32 (1.25, 1.39)).
Conclusions
This study provides the first independent assessment of participation in the English Diabetes Prevention Programme and the first study internationally to examine the impact of diabetes prevention programme service delivery on participation. When implementing a large-scale diabetes prevention programme, heterogeneity in service provision between different providers and sites can result in variable participation beyond that attributable to case mix, with potential consequences for effectiveness and health inequalities. Extending out-of-hours provision may improve participation in prevention programmes.
| Original language | English |
|---|---|
| Journal | BMJ Open Diabetes Res Care |
| Publication status | Accepted/In press - 21 Oct 2020 |
