UK diabetes prevention update underscores importance of program retention
medwireNews: The latest update from the UK’s National Health Service (NHS) Diabetes Prevention Programme shows that persistence pays, and reveals weight loss and a reduction in glycated hemoglobin (HbA1c) levels for people who have so far completed the intervention.
Presenting the latest data at the Diabetes UK Professional Conference in Liverpool, Jonathan Valabhji (National Clinical Director for Obesity and Diabetes at NHS England) reported a clear dose–response relationship between retention on the program and weight loss.
In total, over 300,000 people have now been referred to the program, he said. And of the 32,665 who were referred sufficiently long ago to have had time to complete the entire 9–12-month intervention, 17,252 attended at least 60% of sessions and so are regarded as completers.
The likelihood of completing the program increased with older age and, “one might say not surprisingly,” with less economic deprivation, said Valabhji. But the likelihood was reduced in participants with Asian and mixed ethnicity, and in those who were obese.
“We always said the program would be iterative and that […] we would learn from our experience as the program progresses,” he said.
The program will therefore introduce measures to address inequities in completion, noted Valabhji. One of these is that they will offer digital program delivery to people who refuse in-person delivery or accept but then fail to attend, which should “selectively benefit the younger cohort – those of working age.”
The other new factor is a pay-for-performance element that specifically encourages program providers to focus on retention of specific groups.
The average weight reduction was 3.4 kg for program completers versus 2.3 kg among all people referred early enough to have completed the program, equating to a 4.0% reduction (vs 2.7%), with 36% of completers losing at least 5% of their bodyweight (vs 23%).
And there was a marked linear association with retention on the program, with average weight loss ranging from negligible for those who only attended one session to around 5.5 kg for those who attended 18 sessions.
Similar to retention, weight loss was more likely in older, less economically deprived people, and in some minority ethnic groups (Asian and Black). There was no differences between the sexes, but people who were overweight or obese at referral lost more weight than slimmer people, despite less retention on the program.
The average HbA1c reduction was 2.0 mmol/mol for completers and 1.2 mmol/mol in all patients with time to complete.
Predictors of HbA1c reduction were notably different than for retention and weight loss, with women, older people, Asian and Black participants, and overweight/obese people having smaller reductions than other program attendees, whereas there was no association with economic deprivation, about which Valabhji said that “I’m not sure whether I can completely explain that.”
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