As part of the NHS Diabetes Prevention Programme launched in March – the first at-scale national evidence-based programme to stop people developing Type 2 diabetes – seven areas of the country began testing different approaches to tackling the issue. Stewart Doyle outlines the work of the Durham demonstrator site:
We decided to apply as a demonstrator site in Durham because it was an excellent opportunity to share our experiences of tackling diabetes locally and to provide examples of what worked well and what hasn’t.
It has also enabled us to learn about different programmes across the country and identify other areas of good practice. But, above all, it is exciting to be part of a national drive to prevent Type 2 Diabetes – the first of its kind in the world.
We have been working on trying to reduce diabetes locally since February 2014, when we launched an initial six month pilot to test the concept called ‘Just Beat It!’ It has been developed by taking the best elements from a wide range of evidence and NICE guidelines, as well as the experiences of staff working in lifestyle interventions.
‘Just Beat It!’ consists of an intensive lifestyle quality assured programme, that includes:
- Initial six months programme
- Education and exercise sessions
- Weekly sessions
- Support resources
- Follow-up support for 18 months
12 month data has recently been collected from those patients taking part in the programme – which shows:
- 46 percent adhered to the programme at 12 months
- 67 percent of patients reduced their Diabetes Risk – 50 percent reducing a risk level (using Diabetes UK Risk Assessment Tool)
- 100 percent of patients increased their physical activity levels – with all achieving CMO recommendations of 150 minutes of moderate physical activity per week
- 100 percent of patients lost weight – with 31 percent achieving weight loss of 5-10kg or 5 percent of their baseline weight.
It must be noted that the sample size was not significant – just 13 patients – however initial findings from the further roll out of the programme indicates these results will be replicated with a larger sample size.
At Just Beat It!, it makes sense to us that lifestyle interventions should be the first-line treatment for people on the verge of developing Type 2 Diabetes – but still have an opportunity to prevent it.
The Diabetes Prevention Programme in the US showed that lifestyle was twice as effective as the drug metformin in preventing diabetes in high-risk individuals, reducing its occurrence by 58 percent.
Throughout the development and implementation of the Just Beat It! programme, there have been a number of key lessons learnt, including:
- Maximise patient contact – it is important to make the patient feel there is always someone there to turn to for support. Each one starting the programme is assigned an individual mentor who is there to provide support as and when required.
- Longer, intensive programmes – our experience has told us that people at risk of developing Type 2 Diabetes (or other Cardio Vascular Disease (CVD) conditions) have generally led unhealthy lifestyles for a number of years. To expect, therefore, a sustainable lifestyle change in an 8-12 week intervention is unrealistic. A long-term approach is required – providing support during the maintenance phase of behaviour change.
- Creating the right environment – humour and camaraderie are important in keeping participants engaged and in developing mutual support. In addition, making it an environment that participants don’t feel as if they are going to ‘told off’ for having a bad week or relapsing.
- Share responsibility with patients – developed an environment where diabetes is a personal issue and that it requires individual action to tackle it. Participants appreciated having an individual plan and enjoyed taking personal responsibility for monitoring, and making changes in their food intake and activity level.
We are excited to take our work on diabetes prevention to the next level by working with our partners in NHS England, Public Health England and Diabetes UK to help inform the development of the national programme.
- Read more about the NHS DPP.
- Stewart Doyle is a Health Improvement Specialist (Just Beat It!) with County Durham and Darlington NHS Foundation Trust.