Impact case study database

Changing Clinical Policy, Guidelines and Practice

In 2015, Public Health England commissioned DRC researchers to conduct a systematic review of the evidence for diabetes prevention. Their report identified the key intervention requirements for maximum effectiveness, and highlighted the importance of physical activity. [E1] This review began a step-change in the UK regarding diabetes prevention programmes and was followed in 2016 by the NHS Diabetes Prevention Programme Healthier You, the first ever nationally commissioned NHS-delivered diabetes prevention service. [E2]

In establishing Healthier You, the NHS drew heavily on DRC research and individual expertise, using the PHE Report, [E1] invited DRC expert guidance and the NICE Guideline ‘Type 2 Diabetes: Prevention in People at High Risk’ guideline (underpinned and guided by DRC research and staff) [E3] to set the key criteria for the programme’s service specifications. [E4] This service specification included physical activity as one of the core components that had to be included by providers commissioned to deliver the programme.

Internationally, DRC research demonstrating both the importance of increased physical activity and how it can be accomplished, has underpinned significant changes to clinical practice guidelines including the 2018 Diabetes Canada ‘Physical Activity and Diabetes’ guideline recommendations covering step count levels and recording, the 2019 American Diabetes Association’s ‘Standards of Care in Diabetes’ guidance on recommended types of physical activity and the 2020 joint Research Society for the Study of Diabetes in India and Endocrine Society of India practice recommendations for T2DM management relating to the benefits of physical activity. [E5]

Local Impact

Walking Away was successfully piloted by DRC in 4 sites; Brighton and Hove, Leicester, Cumbria and County Cork between 2011 and 2014. This success led to the programme being actively commissioned by participating centres into 2014 as part of their routine clinical care with additional sites in Gibraltar, London, Northamptonshire and Leicestershire added. Audit data from Leicestershire demonstrated increased levels of physical activity amongst participants of 1000 steps/day. By February 2018, a total of 4573 high-risk patients were referred to Walking Away in Southwark, London. [E6]

In 2015, the Northern Ireland Department for Public Health initiated the Each Step Counts programme to promote increased physical activity for diabetes prevention. Unveiled in the 2014 DPH Annual Report, it is stated that the programme ‘has been developed to complement the existing community-based group intervention based on the Walking Away From Diabetes programme.’ [E7]

National Impact and NHS Healthier You

Following their vital role in establishing the Healthier You programme, DRC researchers collaborated with Ingeus UK (a leading service design and delivery company) to tailor the Let’s Prevent programme to meet the Healthier You service specification. This included the inclusion of core sessions dedicated to promoting and increasing physical activity via the provision of pedometers and personalised step-per-day goals founded on key DRC research findings. The application was successful and Let’s Prevent became the only joint NHS-Industry provider among the original four approved suppliers.

In 2016, Let’s Prevent was implemented and delivered in the first wave of implementation (27 areas serving a total of 26million people with 20,000 places available), and rolled out nationally the following year. As of June 2020, the programme is being delivered in Northumberland, Tyne and Wear, North Durham, Durham, Darlington, Teesside, Hambleton, Richmondshire, Whitby, Lancashire, South Cumbria, Cheshire, Merseyside; Northamptonshire, Leicestershire, Staffordshire, Shropshire, The Black Country, Hampshire and the Isle of Wight. [E8] The implementation of Let’s Prevent in the East Midlands region is projected to have the highest number of referrals into Healthier You nationally, demonstrating the strength of the Ingeus partnership. This rapid national expansion established Let’s Prevent as the most widely delivered programme within the Healthier You framework during the second wave of implementation, resulting in it being the winning entry in the prevention and early diagnosis category for the Quality in Care (QiC) awards 2018. [E9]

Ingeus audit data shows that between 2016 and 2020, over 140,000 patients have been referred to Let’s Prevent. In the first year alone, 21,233 patients were referred, 40% of whom attended.

Attendees consistently achieved significant health benefits including the loss of a clinically meaningful amount of body weight (averaging 4kgs each), substantial reduction in diabetes risk and improved glycaemic control. [E10] Of those with non-diabetic hyperglycaemia, 77% achieved normal glycaemic control by the end of the Let’s Prevent programme. Published case studies further demonstrate the impact of our prevention programme, with people reporting making fundamental changes to their lives after attending the programme [ E11].

This data mirrors that of NHS England who reported that the first 17,000 patients attending Healthier You lost an average of 3.4kg body weight. [E12] NHS England predict that 390,000 will attend Healthier You by 2021, resulting in 4,500 T2DM cases being delayed or prevented. [E13] Long term, Healthier You will thereby lead to an estimated undiscounted economic net benefit to the NHS of £1.2billion due to diabetes prevention and reduced healthcare resource demand. [E13] Let’s Prevent is playing a pivotal role in these substantial improvements. Our work has also directly benefited the local health care economy, where our partnership with Ingeus UK has generated over £1.7 million in health service income into the University Hospitals of Leicester NHS Trust.

National and international impact beyond Healthier You

The success of Let’s Prevent has provided impact beyond Healthier You. In 2019, the programme was commissioned into routine primary care across Scotland with early adopting trusts in Lanarkshire, Dumfries and Galloway and Ayrshire and Arran reporting over 400 referrals within the first 9 months, with other sites joining in 2020 (NHS Lothian Borders, Fife and East, NHS Highlands). In 2018 the programme was commissioned and delivered across Western Australia [E14] with audit data from the Bunbury site showing that 193 patients have completed the programme in the first year achieving an average increase of 3.2 points in the Patient Activation Measure.

This demonstrates the increased confidence and worldwide commitment to engage with diabetes prevention underpinned by DRC research and using the Let’s Prevent model.