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Effectiveness of NHS-based multi-tiered lifestyle interventions to achieve type 2 diabetes prevention across glycaemic risk tiers.

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This project is delivered as part of the NIHR ARCs National Priority Consortium for Prevention including Behaviour Change

Visit the Prevention including Behaviour Change Consortium Homepage for more information

Project title: Effectiveness of NHS-based Multi-tiered Lifestyle Interventions to Achieve Type 2 Diabetes Prevention Across Glycaemic Risk Tiers.

Duration (start and end dates): 1 June 2021 – 31 May 2023

Funding total: £ 399,192

Funded by NIHR ARC Health and Care Inequalities National Priority Consortium. Led by ARC Northwest London collaborating with ARC East Midlands.

Other involved partners:  Northwest London NHS Clinical Commissioning Group

What does the project aim to achieve?

The overarching aims of this project are to determine how effective lifestyle interventions programmes for prevention and remission of type 2 diabetes are in the real world and how variation in population risk level influences that effectiveness.

These diversified interventions have considerably broadened the population eligible for diabetes prevention services and raise important questions. First, it is unclear whether real-world implementation i brings a ‘scale-up penalty’ that diminishes intervention effectiveness.

Second, it is unclear whether real-world LSIs are effective across the full diversity of risk groups, including women with prior GDM and adults with varied levels of glycaemic risk.

Third, these LSIs provide the opportunity to understand the barriers and facilitators to effective outcomes in diverse populations, as well as their impact on socioeconomic inequalities.

The specific aims and analytical goals of this project are to: 

1) Quantify the ‘cascade’ of referral, participation, and adherence to community-based LSI programmes and their association with long-term outcomes.

2) Examine the effectiveness of the NW London and Leicester LSI programmes on rates and race/ethnic inequalities in T2DM incidence among adults with intermediate hyperglycaemia.

3)  Among women with a history of GDM, compare the effects of the digital-based BabySteps programme with the NDPP on incidence of T2DM.

Who might this benefit?

This project is relevant to and aims to impact adults with either pre-diabetes, a history of gestational diabetes, or type 2 diabetes.

As Leicestershire and Northwest London are implementing LSIs among some of the most culturally and socio-economically diverse communities of the UK, these LSIs provide the opportunity to understand the barriers and facilitators to effective outcomes in diverse populations, as well as their impact on socioeconomic inequalities.

It is important to understand how effective NHS-driven behavioural prevention programmes are so that the strategies to reduce diabetes can be refined and improved. It is also important to understand how lifestyle interventions can best be designed to reduce health inequaltieis.

This is a crucial opportunity to find out what works best, how, why, and among whom.

Background information

Type 2 diabetes (T2DM) affects 7% of the adult UK population and an additional 10-20% of the population are at elevated T2DM risk, creating a huge need for scalable, cost-effective prevention approaches. Randomised controlled trials indicate that multi-disciplinary lifestyle interventions (LSI) can be effective across a broad spectrum of risk stages, ranging from preventing in persons with intermediate hyperglycemia or a history of gestational diabetes to achieving remission from diabetes.

The UK is on the forefront of lifestyle-based prevention, leading to increasingly diverse offerings across different settings and risk strata. The National Diabetes Prevention Programme (NDPP), uses behavioural support to improve diet quality, reduce dietary intake, and increase physical activity to prevent diabetes in high-risk adults. REduction in Weight with INtensive Dietary service (REWIND) uses portion-controlled diet and intensive dietary change with removal of diabetes medications. In Leicestershire, Babysteps uses health trackers, personalized goal setting and peer support for long-term behaviour change.

Approach

There is ongoing referral into NDPP and REWIND in NW London and NDPP and BabySteps in Leicestershire. These interventions have undergone extensive stakeholder engagement amongst NHS leaders and health care providers, and the public.  We will leverage new primary care-based, population-based data systems (SystmOne in Leicestershire and Discover-Now Whole Systems Integrated Care (Discover – WSIC) in NW London) to build a harmonized dual-site longitudinal dataset for ongoing comparative effectiveness of LSIs. Discover – WSIC contains records derived from electronic medical record data from primary care visits, laboratory, pharmacy, acute care, and hospitalisation visits on 2.4 million registered patients.  To apply further context, we will recruit and interview a sample of participants and eligible non-participants to examine perceptions of appropriateness, needs for cultural adaptation, and acceptability of the programmes as delivered.

Lead contact for the project: Professor Edward Gregg  – e.gregg@imperial.ac.uk

Co-investigators

  • Dr Eszter Vamos, Senior Clinical Lecturer, Imperial College London
  • Shivani Misra, Imperial College London
  • Salma Mehar | Diabetes Project Delivery Manager | Consultant Dietitian
  • Dr Anthony Laverty, Lecturer, Imperial College London
  • Ben Griffiths, Imperial College London
  • Dr Emma Redman, Senior Clinical Research Dietitian, University Hospitals of Leicester NHS Trust, Operations Manager NIHR Diet and Activity Research Translation Collaboration
  • Prof Melanie Davies, Professor of Diabetes Medicine, University of Leicester, Director Leicester Biomedical Research Centre
  • Prof Kamlesh Khunti, Director, East Midlands ARC and University of Leicester Centre for Ethnic Health Research
  • Alison Northern, Implementation Manager, Leicester Diabetes Research Centre, University Hospitals of Leicester NHS Trust

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