Type 2 diabetes is a serious, expensive and growing public health challenge. In England, national guidance recommends intensive lifestyle interventions promoting weight loss for people at risk of diabetes, and programmes of individualised care, information and advice for those recently diagnosed with type 2 diabetes (NICE, 2012; NICE, 2015). As NHS England rolls out an ambitious National Diabetes Prevention Programme (NDPP), it is essential that areas develop the staff skills, organisational capacity and local insight to make the most of this initiative. The South Gloucestershire Diabetes Prevention (pilot) Project (SGDPP) reflects priorities identified in Bristol North Somerset and South Gloucestershire (BNSSG)’s Sustainability and Transformation Plan (STP) on the urgent need for evidence on the implementation, effectiveness and cost-effectiveness of innovative service models for the prevention of diabetes.
South Gloucestershire Diabetes Prevention Pilot Project
The SGDPP developed from a successful bid to Health Education South West in 2015. It was led by South Gloucestershire Council’s Public Health & Wellbeing Division, in collaboration with NHS South Gloucestershire CCG, Sirona Health, and Leap Valley Surgery. The pilot built upon the X-PERT Prevention of Diabetes (X-POD) programme, which consists of a six-week group education course followed by telephone and email support, with meetings scheduled at three months post-course, and again at six months post-enrolment. The design of the programme is compliant with NICE (2012) guidelines on the prevention of diabetes. The pilot was delivered between January and November 2016 through Leap Valley Surgery, offered to patients aged 35-75 years-old and at risk of diabetes – defined by body mass index (BMI) >30kgm2 recorded in the last five years, plus a key diabetes risk factor such as raised blood glucose (HbA1c; 42-47mmol/mol).
Evaluation research questions and methods
The main evaluation questions were:
1. What were the impacts of the SGDPP on the health and wellbeing of participants at six months post-enrolment?
2. How was the SGDPP implemented, with specific reference to the development of referral pathways, training for delivery staff, and stakeholder perceptions?
3. What were the costs per person associated with the delivery of the pilot?
The evaluation of the SGDPP pilot consisted of a before and after assessment of the biometric (weight, BMI, HbA1c level) and self-reported psychosocial outcomes of participants enrolled on the pilot. This was accompanied by a process evaluation of perceptions of the programme by participants, project staff and wider stakeholders, and a unit cost economic evaluation. SGDPP staff collected biometric and psychosocial questionnaire measures, inputted this data, and collected the financial data. UWE researchers developed the evaluation plan, conducted qualitative data collection, and undertook most aspects of data analysis.
Participation in the project and evaluation
Out of 300 patients invited by letter, 95 (32%) enrolled, and 87 (29%) completed the course to the six-month stage. An additional four partners, who found they also met the inclusion criteria, enrolled and completed the programme to the six-month stage.
Drop out from the project and evaluation was very low – of the 99 individuals who started, only eight (8%) were unable to attend the six-month meeting and provide evaluation data at this point.
Attendance at each group education session and the six-month follow-up meeting did not fall below 84% capacity, with mean attendance for sessions at 90% capacity. Sixty-three (63.6%) participants attended all six group sessions. The mean contact time at group sessions was 10.7 ± 2.4 hours.
Participants provided very positive feedback on the group education sessions – 96% (90) gave a score of 9 or 10 when asked how much they would recommend the course to friends or family (where ‘0’ is extremely unlikely and ‘10’ is extremely likely).
Characteristics of participants at enrolment
Key characteristics of the 99 participants at enrolment were:
• 61.6% (61) female and 99% (98) White British
• 64.6% (64) aged 65 years and above. Mean 64.5 ± 8.2 years. Range 37 to 76 years of age
• 69.7% (68) retired
• 34.4% (34) highest educational attainment was up to 16 years at secondary school
• No participants were resident in an area in the top two national deciles for multiple deprivation; this reflects the demographic characteristics of the GP surgery’s catchment. Nearly half (48.5%, n=48) were resident in an area of lowest deprivation (decile 10 in the Index of Multiple Deprivation, IMD).
• 69.7% (69) were obese, and 22.2% (22) overweight
• 52.5% (52) had a family history of diabetes
• 6.6% (4) of female participants had a history of gestational diabetes
• 70.7% (70) had a comorbidity; 34.3% had high blood pressure and 30.3% had arthritis
• 17.2% (17) reported a disability
• 24.2% (24) were taking part/or recently took part in another healthy lifestyle activity, such as a walking group, sport group or weight management group
Outcomes at six months
There were significant improvements for all measures, apart from those relating to mental wellbeing and mental ill health. The main outcomes relating to weight change for 91 participants at six months can be expressed as follows:
• The mean weight loss was 4.04kg (SD 4.62)
• 52.3% (45) achieved >3% weight loss
• 40.7% (35) achieved >5% weight loss
• 12.8% (11) achieved >10% weight loss
• Excluding participants with normal weight, i.e. BMI
Kok, M., Jones, M., Elvin, R., Cook, C., Bryant, L., Coleborn, S., & Blackmore, S. (2016). South Gloucestershire diabetes prevention pilot project: Full evaluation report