“Now is the time to act and establish a national service for diabetes prevention,” say academics

The study, entitled ‘Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations. A Systematic Review and Meta-analysis’, has been published in the academic journal Diabetes Care and follows years of research into diabetes prevention by teams at both universities.

The study sought to summarise the current evidence about preventing diabetes through lifestyle change in real world service delivery settings. The authors focused on the effectiveness of pragmatic diabetes prevention programmes which translated evidence from previous large clinical trials.

They additionally considered whether adherence to international guideline recommendations is associated with effectiveness and found that the more closely programmes adhere to the National Institute for Health and Care Excellence (NICE) guidance on programme content, the more effective they are.

Dr Alison Dunkley from the Leicester Diabetes Centre, who led the study, said: “We know that weight loss and physical activity can help prevent or delay the development of Type 2 diabetes in high risk people. The major challenge is how best to achieve healthy behaviour changes in routine clinical care.

“Our findings suggest that improved health outcomes are achievable in practice if current NICE recommendations on diabetes prevention are followed.”

The Leicester Diabetes Centre has a close relationship with NICE. The Leicester Diabetes Centre is an alliance between the University Hospitals of Leicester NHS Trust (Leicester’s Hospitals), the University of Leicester, the local community and Primary Care and is located at Leicester General Hospital.

The NICE guidance on preventing Type 2 diabetes encourages healthcare services to put greater resources into challenging diabetes. Professor Kamlesh Khunti from the University of Leicester, who oversaw the study, chaired the guidance. Study contributors Dr Thomas Yates and Professor Melanie Davies from the University of Leicester and Dr Colin Greaves from the University of Exeter were also on the NICE guidance committee.

The team identified 25 relevant studies from around the world.  They analysed combined data from 22 of those studies which assessed weight loss in participants at 12-months. Overall, the average weight loss was around 2kg per individual – but this was significantly increased where the study closely followed NICE guidelines. The study found that the closer the programme adhered to the guidance, the more weight loss participants achieved.

The findings suggest that pragmatic “real world” diabetes prevention programmes that follow NICE’s guidelines can be effective in supporting people to make the lifestyle changes – such as weight loss - that are needed to prevent Type-2 diabetes.

However, effectiveness varies substantially between programmes, being non-existent in some and strongest in those that stuck closely to the NICE guideline recommendations. In essence, this means that only high quality, evidence based, quality assured programmes, which utilise specific behaviour change techniques are likely to deliver an effective response to the growing diabetes epidemic.

Dr Greaves said: "Now is the time to act and establish a national service for diabetes prevention. If we want to prevent being swamped by a tidal wave of diabetes in the next 20 to 30 years, then we need to start investing heavily in diabetes prevention services. This will require a national effort, co-ordinated by government and public health and NHS bodies. As existing services are under immense financial strain, this will require new money and a new workforce focused on lifestyle change."

The study concludes by suggesting that investing in high quality lifestyle programmes would not only reduce the risk of diabetes, but also heart disease, stroke and other long terms illnesses.

Further research is needed to establish optimal strategies for maximising both cost-effectiveness, and longer-term maintenance of weight loss and diabetes prevention effects.

Diabetes Care is a journal for the health care practitioner that is intended to increase knowledge, stimulate research, and promote better management of people with diabetes.

The article was published in the April issue of Diabetes Care and is available online here: http://care.diabetesjournals.org/content/37/4/922.abstract

It is also part of a special collection in the April issue, available here: http://care.diabetesjournals.org/site/misc/prevention.xhtml

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