Getting serious about prevention

As the Diabetes Prevention Programme is launched, NHS England’s National Clinical Advisor explains why it is vital to both patients and the sustainability of NHS coffers:

After months of preparation, the world’s first large-scale nationwide programme to prevent type 2 diabetes is about to be launched.

The NHS Diabetes Prevention Programme will start in April with 20,000 places offered in the first year rising to 100,000 places by 2020.

Type 2 diabetes is the fastest growing long-term condition in England, driven largely by the relentless rise in overweight and obesity. A total of 3.2 million people are currently affected by the condition and this is expected to rise to 4 million in the next 10 years, and 6 million – that is 10% of the population – in the next 20 years.

Much of the impact of diabetes results from its serious complications. These include a doubling of the risk of heart attack and stroke, as well as kidney failure, blindness and amputations due to nerve and blood vessel damage.

In addition to the devastating personal and social impact of these complications, the financial cost is a major concern for us all. Currently we spend almost 10% of the NHS budget on diabetes. With the dramatic rise in incidence that we are expecting in the coming years, this level of expenditure will not be sustainable and risks breaking the NHS bank.

But the good news is that type 2 diabetes is often preventable. There is now compelling evidence from studies across the world that intensive individual support to change lifestyle in those who are at high risk does significantly reduce the chances of diabetes developing.

The NHS Diabetes Prevention Programme has drawn on this evidence and, as the service rolls out, individuals who are found to be at high risk of type 2 diabetes by their GP or during the NHS Health Check they can be referred to the new local service.

Over a period of 9 months or more they will be offered regular face-to-face and group sessions with personalised support from experts to lose weight, increase physical activity and improve their diet. The evidence shows that this approach will work for many people, preventing or delaying the onset of diabetes and its complications.

There has been enthusiastic interest from CCGs and Local Authorities across the country, and in each location they will work together with nationally appointed providers to deliver the programme. A total of 27 areas, covering one third of the country, will begin offering places to people at high risk of diabetes over the next few months, and the service will then roll out across the rest of the country over the next couple of years.

I think this new service will be warmly welcomed by GPs because to date most of us have not had access to the sort of intensive support that NICE recommends for our patients who are at high risk of developing type 2 diabetes.

Of course this service has to be part of a wider societal approach to supporting healthier lifestyles, but the launch of the Diabetes Prevention Programme does show that the NHS is getting serious about prevention.

Dr Matt Kearney

Matt Kearney is NHS England’s National Clinical Director for Cardiovascular Disease Prevention and a GP in Shropshire. He has been working for both NHS England and Public Health England since 2013, and has led development of the NHS Long Term Plan CVD Prevention Programme.

In particular, he has focused on driving system change to help the NHS to get serious about prevention of heart attacks, strokes and other vascular conditions – through clinical leadership, better use of data, and new ways of working that support primary care to improve outcomes for patients and communities.

Previously Matt worked as clinical and public health advisor to the Department of Health respiratory programme, and was a member of the NICE Public Health Interventions Advisory Committee from 2005 to 2013. He has a Master’s Degree in Public Health and is a Fellow of both the Royal College of GPs and the Royal College of Physicians.

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  1. David says:

    No detail here as to what the programme regards as a healthy diet to prevent diabetes . Could we have some details ?

  2. John Kapp says:

    Robert Whitaker’s book ‘Anatomy of am epidemic’ 2010, and his sequel ‘Psychiatry under the influence’ 2015 points to mental and physical disorders (such as obesity and diabetes) as being iatrogenically caused by drugs. I believe he is right, so the best way to prevent diabetes is to reduce overprescribing of drugs, by commissioning more NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 week courses, which teach patients how to look after themselves better, and listen to their bodies regarding what and how much to eat. See papers on my website for details.

  3. Phil Hawthorn says:

    As this is not fully rolled out until 2020, what if one is not in the first wave areas? For the worried well / knowledgeable (I was National Sales Manager at Roche Diagnostics – BM Sticks) – and am capable of following advice from a web site. Not everyone will need encounter groups! Or should I just follow dr Michael Mosley’s latest book on preventing insulin resistance progressing?