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A faulty production line

Diabetes prevention policy is too selective, leading academics warn

Government policymakers are being urged to broaden their strategy on diabetes prevention by leading GP academics, who warn the new national prevention programme is unlikely to cut the incidence of diabetes.

The researchers said the national scheme – which will see GPs screen millions of patients and refer those at high risk of developing diabetes for cooking and exercise classes – is based on very selective evidence that may not apply to populations in England, and underestimates the challenges to implementing lifestyle interventions in practice.

Their criticisms - outlined in a letter published in the British Journal of General Practice - follow similar concerns from diabetes experts who have urged NHS England advisors to ‘refine’ the policy, warning that in its current form the programme risks over-medicalising the population while ignoring the root causes of the diabetes epidemic.

NHS England launched the National Diabetes Prevention Programme - a joint initiative with Public Health England and Diabetes UK - earlier this year, with a view to rolling out the programme in full across England from next April.

Expert advisors on the programme recently wrote an editorial in the British Journal of General Practice describing how the scheme is underpinned by ‘well established’ evidence from five trials that showed 30-60% reductions in the incidence of type 2 diabetes through structured lifestyle change programmes.

However, Professor Trisha Greenhalgh, professor of primary care health sciences at the University of Oxford, and Dr Eleanor Barry, academic trainee at the Barts and the London Medical School, responded that these trials ‘offered expensive, intensive interventions to participants selected on strict and extensive criteria with stringent methods to maintain participant engagement’.

As a result, subsequent trials aimed at putting the evidence into practice have failed to reduce the incidence of diabetes, they said.

Professor Greenhalgh and Dr Barry added that ‘policymakers have underestimated the complexity of sociocultural influences that predispose to diabetes and the barriers that need to be addressed to ensure success of “behaviour change” interventions’.

The called for them to ‘heed the recommendations of experts and initiate a long-term primary prevention strategy applied at multiple levels including population and community components’.

NHS England and Public Health England are due to publish a review of the best evidence on implementing the programme shortly.

Br J Gen Pr 2015; available online 11 July

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Readers' comments (3)

  • Thank you Prof Greenhalgh and Dr Barry.
    The prevention [or reduction] of diabetes epidemic requires a much broader approach. When will policy makers learn that demanding GPs to perform autocratic processes does not lead to behaviour change in an individual.
    These types of policies are attempting to deliver a "packaged product" to a problem, even though the "packaged product " is not appropriate. I can understand the attractiveness of this approach for policy makers, but a little application of what is now common knowledge on behaviour change would not come up with a solution like this.
    Although GPs can deliver public health, a far broader approach is needed than "refer to exercise class" .......after all, what is stopping people going for a walk, and buying food that is not packaged, processed crap food? Perhaps address this problem and the reduction in obesity and diabetes will quietly follow.
    Maybe some serious investment in psychological wellbeing for the nation may help?? Just a thought!

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  • Or just prescribe metformin.......

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  • Steve Martins answer probably would benefit from expansion for the general reader.
    The HPS and DPP both showed exercise and diet worked at reducing diabetes in those with prediabetes, but the patients were highly selected and particularly self selected for a weight and exercise program to prevent diabetes.
    Overall the programme did better, but in the young and obese metformin did just as well.
    In my deprived population am I really going to manage to persuade patients to do 6-7 hours of exercise/week, or am I going to have more success getting them to take a couple of metformin tablets a day?
    Oh and the exercise/diet programme if done properly like the DPS, cost about £1000/year and metformin £10/year.
    The benefits of exercise faded with time, and no benefit on mortality and metformin in the UKPDS that included patients with IFG showed reduction in mortality.
    .... "Or give them metformin"

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