NHS Diabetes Prevention Programme – Fair and Equal Access
Our CLAHRC GM research study of a type 2 diabetes prevention project in Salford is almost complete. Close on its heels, our team from the University of Manchester is just starting out on DIPLOMA a four-year evaluation of the NHS Diabetes Prevention Programme (NHS DPP).
Growing numbers of us in the UK and across the world are at risk of developing Type 2 Diabetes. It is a nasty condition, which can lead to loss of vision, pain, limb amputation, and increased risk of stroke and heart disease. The good news is that people can find out whether they are at risk of type 2 diabetes with a simple risk score followed by a blood test, and can halve their risk of developing the disease by lifestyle changes like losing weight, eating healthy foods and taking more exercise. But we all know how hard it is to maintain changes in diet and exercise.
The NHS DPP aims to provide tailored, personalised help to reduce the risk of Type 2 diabetes including education on healthy eating and lifestyle, help to lose weight and bespoke physical exercise programmes. Of course, a diabetes prevention programme targeted at individuals isn’t the only way to fight diabetes, and it is likely that other population-wide approaches will be needed too.
One of the priorities for us as researchers is to find out whether and how the NHS DPP can successfully identify people who are at risk of diabetes and bring them into the prevention programme. This is harder than it sounds. Often people at risk of diabetes don’t feel unwell or have any symptoms. That means it is easy for people to be at risk and not know it … and also easy for people to ignore the risk and hope it will go away.
Anyone can be at risk of Type 2 Diabetes, but the risk increases with age, and is higher among people with a family history of the disease. In the UK, people from South Asian and Black communities are between two and four times more likely to develop T2DM than people who are White. Deprivation is strongly associated with obesity, physical inactivity, poor diet, smoking and poor blood pressure control, all of which are linked to a high risk of developing T2DM. Ideally, the DPP will be available to all who need it. If it does not engage all the groups of people most at risk, there is a danger of increasing health inequality.
One way of identifying people is through their local GP surgery. GPs can offer tests for diabetes risk within routine health appointments, or as part of an annual health check; or the surgery might look at their health records and target specific people to invite them to come in and be tested. More research is needed to identify suitable ways for GP surgeries to identify people for referral to the diabetes prevention programme, and that is something we will be exploring in the DIPLOMA research programme.
Not everyone attends their GP surgery: other routes to identifying people at risk may be more suitable for some groups of people. Targeting of risk scores to ethnic minority communities and areas with the highest levels of deprivation may be a fruitful way of identifying those at risk. One approach is a local community campaign, where members of the public are approached in the street, outside supermarkets, in community groups and offered the opportunity to take a test for diabetes risk and referral to NHS DPP. We need to know more about how to do this successfully.
Joining the NHS DPP is not a single act, but a series of steps (see diagram below). It involves identification, initial approach, testing, being at risk, referral, sign-up, attendance and completion. Our new DIPLOMA project will study each of those steps, to learn how GPs, local health services, NHS DPP providers and patients navigate them. We will interview patients, observe DPP sessions, read documents and analyse data from many sources. We will be paying particular attention to whether access to diabetes prevention services is fair and equal for all, and how it could be more so.
About the author: Dr Sarah Cotterill is an investigator on the DIPLOMA research team which is funded by the National Institute for Health Research Health (NIHR) Services and Delivery Research.
This blog was also published on the NIHR website on 10th October 2017.