Diabetes is on the increase due to people’s inactive lifestyles. Currently, there are approximately three million people diagnosed with type 2 diabetes in England, while a further five million people are thought to be at risk of developing the condition. 

Historically, type 2 diabetes would usually appear in the middle-aged or older population, but it is now being diagnosed in overweight children. By 2034, if these trends continue, one in three people will be obese and one in 10 will develop type 2 diabetes. 

Research has demonstrated that behavioural support in maintaining a healthy weight and being more physically active can reduce a person’s risk of developing the condition. 

Diabetes facts

In England:

• 22,000 people with diabetes die early every year
• Type 2 diabetes is a leading cause of preventable sight loss in people of working age
• Type 2 diabetes is a major contributor to kidney failure, heart attack and stroke  
• Type 2 diabetes treatment accounts for just under nine per cent of the annual NHS budget (around £8.8 billion a year).

Aims of the programme

‘Healthier You’ – the NHS Diabetes Prevention Programme (NHS DPP) – aims to identify those at high risk of developing type 2 diabetes and refer them on to a behaviour change programme. It is thought that the NHS DPP should be successful in preventing 26 per cent of people who are at high risk of type 2 diabetes from going on to develop the condition.

The NHS DPP behavioural intervention aims to enable people to achieve a healthy weight, change their diet and achieve the chief medical officer’s physical activity recommendations. Through these interventions, the long-term aims of the NHS DPP can be achieved. These aims are to reduce:

• The incidence of type 2 diabetes 
• The incidence of complications associated with diabetes, such as heart disease, stroke and kidney, eye and foot problems 
• Health inequalities over time associated with the incidence of type 2 diabetes.

Components of the programme

The evidence-based programme is designed to support people through lifestyle change across a nine to 12 month period. The exact model of the programme will vary depending on the local provider, but the service specification stipulates that it must contain 13 sessions, with at least 16 hours of face-to-face contact time spread across a minimum of nine months, with each session lasting between one and two hours. 

People who are referred onto the programme will receive tailored, personalised help to reduce their risk of type 2 diabetes, including education on healthy eating and lifestyle, help to lose weight and bespoke physical exercise programmes.

This behavioural support programme will be provided via a combination of group and one-to-one sessions on weight loss, physical activity and diet. Goals will be set, with support based on achieving those goals to make positive changes to an individual’s lifestyle.

Eligibility and exclusions

The programme will be available to people over 18 years of age who are: 

• Identified as having non-diabetic hyperglycaemia, (i.e. have an HbA1C reading of 42-47mm/mol), or a fasting plasma glucose (FPG) level of 5.5-6.9mmol/l, as well as modifiable risk factors
• Referred onto the programme by a GP or another healthcare professional via the NHS Health Check. An HbA1c or a FPG test must have been undertaken within 12 months prior to referral.

Referral routes into the programme vary, depending on the local case-finding pathways. Other people who could be referred onto the programme include individuals who are identified with non-diabetic hyperglycemia through opportunistic assessment as part of routine clinical care. 

Community pharmacy and the programme

The expertise of community pharmacies in health screening services and their accessibility make them suitable for participating in the NHS DPP. 

The programme was launched in 2016, with the first wave of 27 areas – covering 26 million people – having 20,000 places for referral available. It is due to be rolled out across England by 2020, with approximately 100,000 referrals per year available. A full evaluation of the programme will be supported by the National Institute for Health Research.