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?
The increasing number of people being diagnosed with Type 2 Diabetes Mellitus (T2DM) and at risk of complications has made the disease a major public health concern. Increased levels of blood glucose, known as non-diabetic hyperglycaemia (NDH) and detected by a simple blood test, can provide an early warning sign that people are at risk of developing T2DM. Blood glucose levels, along with associated risk of developing T2DM, can be reduced by addressing lifestyle choices.
In 2015, NHS England; Public Health England; and Diabetes UK initiated a nationwide pilot of a T2DM prevention programme. This consisted of seven demonstrator sites, including one in Salford. These sites were used to test new approaches to identifying patients with NDH; and recruiting and engaging them in intervention options, so that learning would shape roll-out of the full programme.
The NHS Diabetes Prevention Programme (NHS DPP) commenced during 2016 with a first wave of 27 areas, covering 26 million people – half the population of England. This coverage made up to 20,000 places available for people to receive personalised help to reduce their risk of T2DM, including education on healthy eating and lifestyle; help to lose weight; and tailored exercise programmes. A second wave of the roll-out will spread the NHS DPP to the whole country by 2020 with a target of making 100,000 places available in the NHS DPP annually.
The NHS DPP is being delivered by four provider organisations – Ingeus UK , Reed Momenta, ICS Health & Wellbeing and Living Well Taking Control (LWTC) – who provide the NHS DPP course with some flexibility to meet local needs.
What are we trying to do?
Funded by the NIHR Health Services and Delivery Research programme (HS&DR), the NHS DPP has commissioned a team of researchers from the University of Manchester (UoM) to evaluate the nationwide NHS DPP roll-out, with project management support provided by NHS staff from NIHR CLAHRC Greater Manchester.
The DIPLOMA research programme is a four-year mixed methods study, which started in April 2017 and is being delivered by an experienced multidisciplinary team. It is designed to provide:
- feedback to NHS DPP stakeholders on the delivery and outcomes of the programme to support ongoing development and quality improvement;
- a rigorous longer-term assessment of the success of the NHS DPP in meeting the aim of reducing diabetes prevalence in a way that is cost-effective and sustainable.
Some members of the DIPLOMA team were also involved in evaluating the local demonstrator model in Salford, providing us with helpful contextual experience of the NHS DPP. The evaluation in Salford was conducted in three parts to report the findings to the local steering committee as the pilot was being delivered. The reports are available here.
Why is the NHS DPP important?
The phased nationwide roll-out of the NHS DPP is a significant and ambitious programme to deliver an evidence-based behavioural change intervention at scale to reduce a major public health risk.
Our assessment will inform the long-term commissioning and delivery of the NHS DPP, by providing evidence on:
- 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 what could be done to achieve long-term sustainability nationwide.
How will we do it?
DIPLOMA is made up of inter-connected work packages. These packages will investigate:
- Access and equality – whether the programme provides fair access for all patients;
- Implementation of the NHS DPP – exploring how implementation differs across the country;
- Service delivery and fidelity – checking what is being delivered and how it compares to expectations;
- Outcomes and variation – assessing outcomes for patients engaged in the programme;
- 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.
Each work package will provide complementary evidence for the reporting of other work packages. The study will complete in March 2021 with a final report.
Who are we working with?