Article Text
Abstract
Introduction Diabetes prevention programs (DPPs) are effective, in a pre-diabetic population, in reducing weight, lowering glycated hemoglobin and slowing the progression to diabetes. Little is known about the relationship between participation in DPPsand participant characteristics or service delivery. We investigated uptake and retention in England’s NHS DPP, reporting on variability among patient subgroups, providers, and sites.
Research design and methods This prospective cohort study included 99 473 adults with non-diabetic hyperglycemia referred to the English DPP between 2016 and 2017. The program seeks to change health behaviors by offering at least 16 hours of group education and exercise. Multilevel logistic regression models were used to analyze variation in uptake, retention, and completion.
Results Uptake among 99 473 adults referred to the program was 56% (55 275). Among 55 275 who started the program, 34% (18 562) achieved the required dose and 22% (12 127) completed the full course. After adjustment for variation in case mix, substantial heterogeneity in uptake and retention was seen across four service providers (uptake OR 1.77 (1.33, 2.34), 4.30 (3.01, 6.15), and 1.45 (1.07, 1.97) compared with the reference provider) and between sites (uptake for typical individuals ranged from 0.32 to 0.78 across the middle 95% of sites, intraclass correlation coefficient (ICC) 0.07). Higher levels of retention and completion were seen where some out-of-hours provision was offered (retention OR 1.32 (1.25, 1.39)).
Conclusions This study provides the first independent assessment of participation in the English DPP and the first study internationally to examine the impact of DPP service delivery on participation. When implementing a large-scale DPP, heterogeneity in service provision between different providers and sites can result in variable participation beyond that attributable to case mix, with potential consequences for effectiveness and health inequalities. Extending out-of-hours provision may improve participation in prevention programs.
- primary prevention
- behavioral medicine
- health services research
- diabetes mellitus
- type 2
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Footnotes
Contributors The study was designed by SC and EH, with comments from the other authors. The overall research study of which this is part was led by PJB. Statistical analysis was done by EH. SC is the guarantor. The first draft of the manuscript was written by EH and SC. All authors contributed to both the initial and final drafts and approved the final submission.
Funding This research was funded by the NIHR Health Services and Delivery Research Programme (16/48/07, Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the DIPLOMA research program (Diabetes Prevention – Long Term Multimethod Assessment)).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The North West Greater Manchester East NHS Research Ethics Committee (reference: 17/NW/0426, August 1, 2017) reviewed and approved the DIPLOMA program of research of which this study is a part. The analysis was undertaken using anonymized routinely collected healthcare data and informed consent from individuals was not necessary.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data were made available to the authors by NHS England under a data processing agreement, and the authors are not permitted to share them beyond the study team.
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