Ahead of the national roll-out of the Healthier You: NHS Diabetes Prevention Programme (which is being evaluated over four years by our DIPLOMA research programme), NHS England; Public Health England; and Diabetes UK commissioned seven demonstrator sites during 2015 in England. The purpose of these sites was to explore local implementation approaches to identifying patients with increased blood glucose levels and to engage them in intervention programmes to reduce their risk of developing type 2 diabetes mellitus (T2DM). Salford was one of the demonstrator sites, and CLAHRC GM were commissioned to conduct an independent evaluation of their work.
The Salford model was designed to provide routes into lifestyle support programmes through both primary and community care providers. Once diagnosed with non-diabetic hyperglycaemia (NDH), sometimes referred to as ‘pre-diabetes’, patients were given the option of support through a) a nine-month telephone support service (Care Call), b) an eight-week exercise programme with incentivised long-term gym membership (Exercise for IGR), or c) they could access both options. Care Call was an aspect of the Salford model unique amongst the seven demonstrators.
Why was it important?
In 2010, 2.26 million people in England (5.54% of the population) were registered with a diagnosis of diabetes. The prevalence of diabetes in England among adults is predicted to rise to 8.5% by 2020 and 9.5% by 2030. Evidence suggests that in the absence of any lifestyle advice or pharmacological intervention about 50% of people with NDH go on to develop T2DM within five-to-ten years.
The NHS DPP national roll-out is an ambitious programme to identify patients in England at risk of developing T2DM and deliver an evidence-based behavioural change intervention at scale. It is significant because of its potential to impact on the prevalence of T2DM and its associated health risks.
The seven demonstrator sites played an important role in shaping the national roll-out of the NHS DPP by helping the team delivering the programme to learn key lessons before it was rolled out nationally.
The evaluation was conducted using a mixed-methods approach. To facilitate this we initially engaged with stakeholders involved in the delivery of the Salford model, from this starting point, the intervention process was mapped out from start-to-finish and interviewed multiple stakeholders from each point in the intervention. CLAHRC GM then gathered patient-facing materials used as part of the intervention, researched the NHS DPP specification and created evaluation data checklists so that the teams involved could supply us with data from their services. The evaluation was completed as three separate reports to allow the Salford team to make changes to their model based on findings in the reports.
Local and national impact
The evaluation provided key data to inform local and national decision making:
- The Salford DPP Steering Group decommissioned the community referral service based on the results of this evaluation, as CLAHRC GM found that very few of those identified through the community were then referred into the service.
- Salford DPP included the evaluation reports as part of their successful bid to NHS England for continued funding and ‘accredited DPP status’ enabling the service to continue to provide better health outcomes for the NDH population.
- The evaluation was included in the NIHR themed review ‘On the level - Evidence for action for Type 2 diabetes’
The three reports comprised:
- Understanding the Salford IGR Care Call service model (published in July 2016)
- Identifying the roles of community and enhanced GP referral services in the recruitment and retention of people to diabetes prevention programmes in Salford (published in December 2016)
- Retention of people referred to the diabetes prevention programmes in Salford (published in July 2017)
Presentations have been delivered at two key policy level briefings:
- All Party Parliamentary Group for Diabetes - Diabetes & Innovation Summit (Manchester 2016),
- Health Services and Delivery Research (HS&DR) briefing session for ‘Evaluating the NHS Diabetes Prevention Programme’ (London 2016).
The understanding gained from the Salford evaluation enabled Dr Sarah Cotterill (Academic Lead), and Michael Spence (CLAHRC GM Programme Manager) to work with University of Manchester colleagues to win funding from NIHR HS&DR to evaluate the full National Diabetes Prevention Programme.
The 4 year DIPLOMA study (led by Prof. Matthew Sutton and Prof. Peter Bower), the largest NIHR HS&DR funded study to date (approx. £2 million) commenced in April 2017.
For more information about DIPLOMA please see the project page here
Who did CLAHRC GM work with?