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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