Assessing a National Health Program to Prevent the Onset of Type 2 Diabetes in High-Risk Patients


An analysis on the Diabetes Prevention Program in England found it was effective at improving key cardiovascular risk factors, including glycated hemoglobin and excess body weight.

A national health program that provides lifestyle advice and counseling to patients identified as high-risk for developing type 2 diabetes can be an effective tool to prevent or delay the onset of the disease, according to new research published in Nature.1

Diabetes is currently the leading cause of death and disability worldwide and an estimated 529 million people currently live with the disease.2 With the prevalence of diabetes expected to rise, England implemented the Diabetes Prevention Program in 2015. The program identifies patients at high-risk and refers them to behavioral intervention.

A team of investigators from the US, England, Germany, and South Africa recently conducted an analysis of over 2 million patients from the Diabetes Prevention Program, which is the largest of its kind in the world, to determine how the program has worked so far. Data was gathered from about one-fifth of all primary care practices in England.

“There is an urgent need to implement population-based measures that prevent diabetes, enhance its early detection, and address cardiovascular risk factors to prevent or delay its progression to complications,” Julia Lemp, lead author on the study, said in a release.3

For the study, investigators compared patients who were referred to the program and those who were not. The program, in which patients attend 13 counseling sessions where they are coached on nutrition and how to maintain a healthy weight, determines eligible patients by blood sugar levels. Patients who fall slightly below the required threshold are not referred to the program, even though they are very similar to those who are referred.

Investigators found that the program was effective at improving key cardiovascular risk factors, including glycated hemoglobin, excess body weight, and serum lipid levels. Patients referred to the program were able to improve their glycemic control and reduce their body mass index, all risk factors that contribute to the development of type 2 diabetes.

The researchers noted that the success of the program in England may have relevance to help fight the diabetes epidemic globally. However, they also said the program may widen health disparities, because many members of minority and ethnic communities do not participate in the program.

“Our results show beyond reasonable doubt that investments in programs such as this should continue,” said Lemp. “At the same time, there are many people at risk for diabetes who remain underserved by existing care pathways and for whom targeted prevention strategies should be further explored.”

1. Lemp JM, Bommer C, Xie M, et al. Quasi-experimental evaluation of a nationwide diabetes prevention programme. Nature (2023).
2. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-281. doi:10.1016/j.diabres.2018.02.023
3. UK diabetes prevention programme may have global impact. News Release. University of Birmingham. November 15, 2023. Accessed November 16, 2023.
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