Bower Peter, Soiland-Reyes Claudia, Bennett Carole, Brunton Lisa, Burch Patrick, Cameron Elaine, Chandola Tarani, Chatzi Georgia, Cotterill Sarah, French David P, Gellatly Judith, Hann Mark, Hawkes Rhiannon, Heller Simon, Holland Fiona, Howarth Elizabeth, Howells Kelly, Kontopantelis Evangelos, Lowndes Eric, Marsden Antonia, Mason Thomas, McManus Emma, Meacock Rachel, Miles Lisa, Mistry Manoj, Murray Elizabeth, Parkinson Beth, Ravindrarajah Rathi, Reeves David, Ross Jamie, Sanders Caroline, Stokes Jonathan, Wallworth Helen, Watkinson Ruth, Wattal Vasudha, Whittaker William, Wilson Paul, Woodham Adrine, Sutton Matt
Division of Population Health, Health Services, Research and Primary Care, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
Health Soc Care Deliv Res. 2025 Apr;13(19):1-47. doi: 10.3310/MWKJ5102.
Type 2 diabetes is considered a critical challenge to modern healthcare systems. The National Health Service Diabetes Prevention Programme delivered an evidence-based behaviour change programme at a national scale to reduce the incidence of type 2 diabetes in England.
OBJECTIVE(S): The Diabetes Prevention - Long-term Multimethod Assessment research programme provided a comprehensive assessment of the delivery of the National Health Service Diabetes Prevention Programme and its effectiveness and cost-effectiveness.
Mixed-methods research including qualitative methods, observations, patient surveys and secondary analysis of administrative and survey data using statistical and econometric methods.
Community settings in England delivering the commissioned intervention, supported by general practices responsible for recruitment and referral.
Patients in community settings identified as being at high risk of type 2 diabetes offered and participating in the National Health Service Diabetes Prevention Programme, and staff involved in the organisation and delivery of the service.
The National Health Service Diabetes Prevention Programme, including its evidence-based behaviour change intervention (using both face-to-face and digital platforms) and the associated services for patient recruitment.
Incidence of type 2 diabetes, cost-effectiveness, access to the programme and fidelity of intervention delivery.
Interviews with patients and staff, document analysis and observations of the National Health Service Diabetes Prevention Programme delivery, patient surveys, secondary data (including National Health Service Diabetes Prevention Programme data, national surveys and audits).
The National Health Service Diabetes Prevention Programme was associated with significant reductions in incidence of type 2 diabetes and was highly likely to be cost-effective. Analyses of the delivery of the programme highlighted several aspects which impacted access to the programme and the fidelity with which the behaviour change intervention was delivered. For example, uptake and adherence were influenced by participants' psychosocial beliefs (e.g. chance of getting type 2 diabetes and whether taking part would reduce this). There were large differences between general practices in how many people they referred to the programme, with practices that offered higher-quality care for people with diabetes referring more. Variation in retention and outcomes was associated with differences in providers.
Analysis of administrative data to explore effectiveness and cost-effectiveness may be influenced by confounding. Recruitment of diverse and representative samples for surveys, interviews and observations was likely impacted by selection.
The National Health Service Diabetes Prevention Programme is highly likely to be cost-effective. Data from Diabetes Prevention - Long-term Multimethod Assessment have been used to improve aspects of programme delivery and could suggest further enhancements to improve recruitment, retention and fidelity.
Future research should address the question of whether the National Health Service Diabetes Prevention Programme prevents or delays type 2 diabetes when longer-term follow-up data are available. We identified factors that could be targeted to impact on recruitment, retention and inequalities, and recommend a robust assessment of the link between fidelity and outcomes.
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 16/48/07.
2型糖尿病被认为是现代医疗保健系统面临的一项严峻挑战。英国国民医疗服务体系糖尿病预防计划在全国范围内实施了一项基于证据的行为改变计划，以降低英格兰2型糖尿病的发病率。
糖尿病预防——长期多方法评估研究计划对英国国民医疗服务体系糖尿病预防计划的实施情况及其有效性和成本效益进行了全面评估。
混合方法研究，包括定性方法、观察、患者调查以及使用统计和计量经济学方法对行政和调查数据进行二次分析。
英格兰提供委托干预措施的社区环境，由负责招募和转诊的全科医疗提供支持。
在社区环境中被确定为2型糖尿病高危人群并参与英国国民医疗服务体系糖尿病预防计划的患者，以及参与该服务组织和实施的工作人员。
英国国民医疗服务体系糖尿病预防计划，包括其基于证据的行为改变干预措施（使用面对面和数字平台）以及相关的患者招募服务。
2型糖尿病的发病率、成本效益、参与该计划的机会以及干预措施实施的保真度。
对患者和工作人员的访谈、文件分析以及对英国国民医疗服务体系糖尿病预防计划实施情况的观察、患者调查、二次数据（包括英国国民医疗服务体系糖尿病预防计划数据、全国调查和审计）。
英国国民医疗服务体系糖尿病预防计划与2型糖尿病发病率的显著降低相关，并且极有可能具有成本效益。对该计划实施情况的分析突出了几个影响参与该计划的机会以及行为改变干预措施实施保真度的方面。例如，参与率和依从性受参与者的心理社会信念影响（例如患2型糖尿病的可能性以及参与是否会降低这种可能性）。不同全科医疗转诊到该计划的人数差异很大，为糖尿病患者提供更高质量护理的全科医疗转诊的人数更多。留存率和结局的差异与提供者的差异有关。
用于探索有效性和成本效益的行政数据分析可能受到混杂因素的影响。调查、访谈和观察中多样化且具有代表性样本的招募可能受到选择的影响。
英国国民医疗服务体系糖尿病预防计划极有可能具有成本效益。糖尿病预防——长期多方法评估的数据已用于改进计划实施的各个方面，并可能暗示进一步的改进措施以提高招募率、留存率和保真度。
未来的研究应解决当有长期随访数据时，英国国民医疗服务体系糖尿病预防计划是否能预防或延迟2型糖尿病的问题。我们确定了可以针对影响招募、留存和不平等现象的因素，并建议对保真度与结局之间的联系进行有力评估。
本摘要介绍了由英国国家健康与照护研究所（NIHR）健康与社会照护交付研究计划资助的独立研究，资助编号为16/48/07。
