Objectives To determine if a diabetes prevention program (DPP) delivered by a commercial weight management provider using a UK primary care referral pathway could reduce the progression to type 2 diabetes (T2D) in those diagnosed with non-diabetic hyperglycemia (NDH—being at high risk of developing T2D).
Research design This is a quasi-experimental translational research study.
Methods 14 primary care practices identified, recruited and referred patients with NDH (fasting plasma glucose ≥5.5 to ≤6.9 mmol/L and/or glycated hemoglobin (HbA1c) ≥42 to 47 mmol/mol (6.0%–6.4%)) and a body mass index (BMI) ≥30 kg/m2 to a DPP. Eligible patients were asked to contact Weight Watchers to book onto their DPP, an intensive lifestyle intervention which included a 90 min activation session followed by the offer of 48 weekly Weight Watchers community group meetings. Patients’ blood tests were repeated by primary care, weight change plus self-reported data was recorded by Weight Watchers.
Results 166 patients were referred to the program and 149 were eligible. 79% of eligible patients attended an activation session (117 eligible patients) and 77% started the weekly sessions. The study sample was primarily female (75%), white (90%), with 5% living in the most deprived quintile in the UK. Using intention-to-treat analysis, the DPP resulted in a mean reduction in HbA1c of 2.84 mmol/mol at 12 months (from 43.42±1.28 to 40.58±3.41, p<0.01). 38% of patients returned to normoglycemia and 3% developed T2D at 12 months. There was a mean weight reduction in BMI of 3.2 kg/m2 at 12 months (35.5 kg/m2±5.4 to 32.3 kg/m2±5.2, p<0.01).
Conclusion A UK primary care referral route partnered with this commercial weight management provider can deliver an effective DPP. The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact.
- diabetes prevention programme
- non-diabetic hyperglycaemia
- type 2 diabetes
- intensive lifestyle intervention
- weight and blood glucose
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Contributors Carolyn Piper, Agnes Marossy and Zoe Griffiths designed the referral pathway and interface with Weight Watchers, created the data collection tools and undertook data collection. Carolyn Piper and Amanda Adegboye analyzed the data. Zoe Griffiths designed the WWDPP intervention. All authors contributed to the interpretation of data. Carolyn Piper drafted the article and all authors contributed to the critical revision of the article. Carolyn Piper is the guarantor of this work and, as such, takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This study was funded by the London Borough of Bromley Local Authority Public Health Central Government Grant. Funding was received from Weight Watchers® to publish the research article.
Competing interests Zoe Griffiths is a Registered Dietitian for Weight Watchers and was part of the steering group mobilising this project. The Registered Dietitian was responsible for the training of staff and implementation of the Weight Watchers Diabetes Prevention Programme.
Patient consent Obtained.
Ethics approval The study was performed in accordance with the Declaration of Helsinki Protocols, subjects gave informed consent. The study protocol was approved by the ethics committee of the University of Westminster, (ethics number: VRE1516-0978) and permission obtained by the London Borough of Bromley Public Health Department to access non-patient identifiable data.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The full dataset is available from the corresponding author at email@example.com. Participants gave informed consent for annoymised data sharing.