Diabetes high impact interventions 

  1. Structured education
  2. NHS Diabetes Prevention Programme
  3. Delivery of 9 diabetes care processes / achievement of treatment targets

Download these high impact interventions as a PDF.

Structured education

An evidence based and quality assured programme that aims to support the person and their family members and carers in developing attitudes, beliefs, knowledge and skills to self-manage diabetes and reduce their chances of deterioration or exacerbation.

It may be focused on either Type 1 diabetes, for example dose adjustment for normal eating (DAFNE), or Type 2 diabetes, for example expert education versus routine treatment (X-PERT). Other structured educational programmes are available.

Cost of intervention / return on investment

  • DAFNE is estimated to save around £2,200 per patient treated discounted over 10 years and 64% lower emergency treatment costs for ketoacidosis and severe hypoglycaemia.
  • X-PERT is cost effective and estimated to be cost saving.
  • Both DAFNE and X-PERT have shown significant improvement in HbA1c/12-month period, providing financial benefits in the short and long term.

Impact on demand:

  • reducing risk, and subsequently incidence, of diabetes complications
  • reducing the number of hospital admissions for diabetes patients
  • reducing the need to refer type 2 diabetes patients to specialist services (does not include type 1 diabetes patients).

Expected outcomes:

  • improved glycaemic control and psychosocial wellbeing
  • reduced risk of complications
  • improved quality of life.


  • APPG report on structured education (March 2015).
  • NHS England digital innovations webpage.
  • Diabetes UK self-management education – information and options.


NHS Diabetes Prevention Programme

The NHS Diabetes Prevention Programme identifies people at risk of developing Type 2 diabetes and refers them onto a nine-month, evidence-based lifestyle change programme.

Evidence shows that it is effective in reducing population incidence of Type 2 diabetes.

Cost of intervention / return on investment

  • Between £200 – £250 per participant, which is funded centrally by NHSE.

Impact on demand

  • An independent evaluation shows 37% relative reduction in incidence in completers and a 7% reduction in population level incidence of diabetes.

Expected outcomes

  • Reduced incidence of diabetes.

Delivery of 9 Diabetes care processes / achievement of treatment targets

Evidence shows that many of the complications associated with diabetes can be prevented or delayed through a combination of foot and eye screening, attending appointments with your health care professional, condition self-management and the appropriate use of medicines and technology.

All people with diabetes aged 12 years and over should receive all of the nine NICE recommended care processes on an annual basis.

The 9 key processes of care measurements are:

  1. Weight and BMI
  2. Blood pressure
  3. HbA1c
  4. Retinopathy screening
  5. Foot risk stratification
  6. Urinary albumin test
  7. Serum creatinine
  8. Smoking status
  9. Cholesterol level

Evidence from the pandemic has found that the risk of mortality increased in those who do not receive all care processes in one or both previous years.

Cost of intervention / return on investment

Impact on demand

  • All-cause hospital admission rates were lower among those who met HbA1c and cholesterol indicators.
  • Patients who achieved the QOF Blood Pressure target had lower cardiovascular admission rates.
  • Meeting all nine care processes had significant associations with reductions in all types of emergency admissions by 22% to 26%.
  • HbA1c and cholesterol indicator attainment associated with considerably lower risks of minor or major amputation. Substantially lower amputation rates were observed among those completing a greater number of care processes.
  • Incentivisation of primary care diabetes indicators such as cholesterol and HbA1c was associated with enhanced survival.

Expected outcomes

  • Lower mortality rates.
  • Reduced admission rates (all-cause & emergency).
  • Reduced amputation rates.
  • Reduced diabetic retinopathy.


Population Health Management (and contained links, including risk stratification tools).

NHS England » Five areas NHS integrated care boards can improve diabetes care for people – See Item 1.