Impact case study database

Results from the primary research and systematic reviews conducted by Greaves, Smith, Evans and others have directly informed the main NHS diabetes prevention strategies and services across the UK since 2015,. These programmes are typically delivered in primary care or community settings by approved providers commissioned by NHS England (e.g. voluntary sector, community interest companies). This research has resulted in: the creation of the NHS Diabetes Prevention Programme itself; its ongoing delivery and expanded uptake between 2015 and 2020; preventing or delaying thousands of people from developing diabetes, and the related economic benefits, and; other related developments in service delivery models, widening access and patient education .

4.1 Creation of the NHS Diabetes Prevention Programme

Evidence from University of Exeter research which first led to the 2012 recommendations of the NICE public health guidance (PH38) on diabetes prevention [NB. not claimed as a REF impact here] also directly informed the creation, in 2015, of the NHS Diabetes Prevention Programme (NHS DPP) [5.1]. The programme consists of at least 13 sessions, with 16+ hours of face-to-face contact time (usually in groups), spread across a minimum of 9 months. People are supported to set and achieve goals and make positive changes to their lifestyle to reduce their risk of developing Type 2 diabetes. Referrals to the programme are typically from practice nurses or GPs.

One systematic review in particular [3.1] formed the cited evidence base for NICE Public Health Guidance recommendations on intervention content for the included diabetes prevention programmes [5.2]. This review of the effectiveness of existing prevention programmes was updated (2014) and published in full (2015) by Public Health England (PHE) as a major part of the evidence base underpinning the NHS DPP [5.1].

4.2 Ongoing delivery and expanded uptake of the NHS DPP

Since 2016, the NHS DPP has been a joint programme of NHS England, Public Health England and Diabetes UK, delivering at scale, evidence-based behavioural interventions for individuals identified as being at high risk of developing Type 2 diabetes. The Exeter research has subsequently been reflected in full within both the 2016 and 2019 service specifications of the NHS DPP [5.3; 5.4], which also recommends that delivery is by diverse, suitably trained health professionals, for example those specialising in nutrition or exercise . The programme is now delivered by four providers across 30 counties in England [5.5; 5.6].

To date over 400,000 people have been referred to NHS DPP and in 2018-19 NHS DPP exceeded its mandate and NHS ‘ Five Year Forward View’ target of 100,000 people on the programme each year, by delivering 105,000 places. Due to this success, the NHS Long Term Plan (2019) makes a commitment to doubling capacity on the programme from 100,000 places per year to 200,000 places per year and notes that demand for the programme has ‘ outstripped supply, and it has proven highly effective.’ [5.7]

More recently, findings from the Exeter-led community-based prevention of diabetes (ComPoD) study (ref. **[3.6]**) have directly informed policy reviews of the NHS DPP. As a result, and with an update of the programme in 2019, ‘Living Well, Taking Control’, a partnership between a Birmingham-based social enterprise and an Exeter-based charity ‘Westbank Community Health and Social Care’, became one of the five providers of the ‘Healthier You: NHS DPP’ in 2019 [5.5]. This resulted in the programme reaching a broad spectrum of local populations, including men, those from ethnic minorities and those living in deprived areas. The NHS England National Clinical Director of Diabetes and Obesity marked the success of ‘Living Well, Taking Control’ by publicly saying:

“Around two-thirds of adults and one-third of children are now overweight or obese, driving higher and higher rates of Type 2 diabetes that we are now focusing huge efforts to address, as outlined in the NHS Long Term Plan.

I’m delighted that our work so far in this area has been producing really positive results. This weight loss is promising – and we hope to help many more of those who are at risk of Type 2 diabetes to not get it in the first place.” [5.5]

4.4 Uptake of Exeter-developed WAKEUP pre-diabetes education materials

Exeter’s WAKEUP study [3.4; 3.5] developed and piloted ways of improving practice systems for managing pre-diabetes. In 2015, following revised NICE Guidance, Exeter’s WAKEUP study’s patient and practitioner education materials were revised. The WAKEUP materials have since been sent to all Public Health England leads in the 152 local authorities for the National Diabetes Prevention Programme. From 2015, more than 10,000 copies of the patient information booklet have also distributed via a large-scale diabetes prevention initiative in Wales.

4.3 Estimated prevention of diabetes and economic benefits of the NHS DPP

Based on similar participation assumptions, NHS England’s own impact analysis of the NHS DPP (in 2016) estimated that by the end of the fifth year of the programme (i.e. 2020) 18,000 cases of diabetes would have been prevented or delayed among 390,000 programme participants [5.8]. This impact analysis further estimated that the overall undiscounted economic net benefit would be £1.2bn (£967m discounted) for the five-year cohort (based on cost savings from reduced health expenditure, and the health gains from the reallocation of these savings within the NHS) [5.8].

A health economic model of diabetes prevention (led by SCHaRR, University of Sheffield, but involving Prof Greaves of Exeter) was used as the basis for the PHE/NHS evaluation of the NHS DPP, and for developing the Payment by Results model which has been used to fund the programme since 2018 [5.9]. The study clearly showed that diabetes prevention interventions very similar to those included in the NHS DPP “are likely to be cost-effective and may be cost-saving over a lifetime” in those people defined as high risk for diabetes [5.9].