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). There has been little formal evaluation of ‘real-world’ type 2 diabetes prevention and management programmes in the UK, particularly those delivered by community and voluntary agencies. To inform options for action on type 2 diabetes, there is an urgent need for evidence on the implementation and effectiveness of innovative service models.
Living Well, Taking Control
Living Well, Taking Control (LWTC) is a programme designed to prevent and manage type 2 diabetes in non-clinical, community settings. Between July 2013 and October 2015, LWTC was led by Westbank Community Health and Care, and funded as part of the Big Lottery Fund’s (BLF) Wellbeing Programme. LWTC was delivered through third-sector agencies Westbank based in Devon, and Health Exchange in the West Midlands. The programme is compliant with NICE guidance.
The evaluation sought to address the following research questions:
1. What are the characteristics of the population that the programme attracts?
2. What are the patterns of participation in the programme?
3. How well does the programme perform in terms of the main outcomes of weight loss and change in glycated haemoglobin (HbA1c), and secondary outcomes (e.g. physical activity, diet, mental wellbeing)?
4. What is the association between programme exposure and outcomes?
5. What is the association between practice effects (changes in delivery over time) and outcomes?
The evaluation is based upon a pre-post assessment of the experiences of programme participants, with additional data derived from programme delivery records. All individuals taking part in LWTC were asked to complete questionnaires and provide biometric measures at the point of enrolment between November 2013 and April 2015. Participants provided follow-up data for a minimum of six months post-enrolment up to the end of October 2015. In addition, all participants who had reached the point of 12 months post-enrolment were asked to provide further follow-up data.
Participants enrolled in LWTC achieved statistically significant improvements in weight and most associated measures (BMI, waist circumference), for those with pre-diabetes and diabetes, at six-month and 12-month measurement points.
Of those participants who provided data, 2kg weight loss was achieved by 41.9% (n=156/372) at Month 6 and 44.2% (n=73/165) at Month 12. The 2kg weight loss was achieved by more participants with pre-diabetes than those with diabetes, with 42.9% (n=115/268) and 39.4% (n=41/104), respectively at Month 6.
Weight loss and HbA1c were, in the main, closely paralleled by changes in the secondary outcome measures. Overall, there were statistically significant positive changes in general health state, overall life satisfaction, mental wellbeing, anxiety and depression, and self-reported diet at both Months 6 and 12. However, changes in self-reported physical activity were not statistically significant at either measurement point.
Further details on the findings are available in the main report.
The evaluation findings suggest potential positive effects of LWTC on diabetes risk and the early stage management of diabetes. The LWTC programme model offers a number of features that are important for scaling up and embedding action on type 2 diabetes. LWTC incorporates key elements of NICE guidance on both the prevention and management of type 2 diabetes. It has developed successful methods for recruitment in partnership with primary care agencies. The programme builds upon the local expertise and capacity of third sector providers, trained community facilitators and local partner agencies.