A 10,000-person screening programme in Norfolk will identify people at high risk of Type 2 diabetes and test whether a low-cost prevention programme, partly delivered by lay trainers who have the condition themselves, can cut diabetes rates. The problem is stark: landmark trials proved that diet and lifestyle changes slash diabetes risk by more than 50% over three years, but the intensive resources those trials used are far too expensive for the NHS. This programme aims to build a realistic, affordable alternative. It uses existing NHS services for screening, trains people with Type 2 diabetes as "Diabetes Prevention Mentors," and keeps financial pressure off general practices. If the programme works, NHS commissioners could adopt it as an off-the-shelf prevention package. That would mean fewer people progressing to full-blown diabetes, lower long-term healthcare costs, and a new workforce role—patients as peer educators—integrated into routine care. The research also models cost-effectiveness over decades, giving policymakers hard numbers on value for money.
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Aims & Objectives. The main aim of this 5 year programme is to test the hypothesis that our novel Type 2 diabetes (T2DM) prevention programme reduces the risk of T2DM in a high risk Norfolk population. We will use established strategies with limited impact on general practices, in a programme in part delivered by lay trainers with T2DM, and which could be used by NHS commissioners as an ‘off the shelf’ diabetes prevention programme. The programme has been piloted in our NIHR feasibility programme grant (0606-1099) which has provided substantial data on participant recruitment and retention, recruitment of lay trainers, practice engagement, staff training, IT and database creation, study materials, and has Research Ethics and Governance approval. Background. The importance of T2DM is well recognised. Landmark clinical trials have shown diet and lifestyle interventions reduce the risk of developing T2DM by > 50% over 3 years in people with impaired glucose tolerance. Translation of the resources used in these large clinical trials to NHS clinical practice is entirely unaffordable, a point recognised by the researchers. We need a realistic diabetes prevention intervention for a financially constrained NHS, which has limited financial impact on general practices. Cultural changes in the NHS put patients at the centre of health choices and we propose to develop the role of people with T2DM as lay lifestyle trainers (Diabetes Prevention Mentors; DPMs) and will develop and test this new role alongside healthcare professionals known as Diabetes Prevention Facilitators (DPFs).Research Plans: •Project 1: Carry out a high volume (n = 10,000) two year screening programme in participants at higher risk of T2DM, based on age and body mass index (BMI) criteria to identify subjects with impaired fasting glucose (IFG), using piloted recruitment strategies and existing NHS services. •Project 2: A 3 year Randomised Controlled Trial (RCT) of our piloted diabetes intervention programme (UEA–IFG) in 390 participants with screen detected IFG (isolated IFG or with IFG + Impaired Glucose Tolerance) with transition to T2DM as the primary end point compared to 170 standard care controls. •Project 3: Evaluate the additional impact of using DPM in the UEA–IFG intervention in a 3 year RCT in a further 390 IFG subjects, with transition to T2DM as the primary end point, compared to the UEA–IFG intervention alone (n=390), and the potential for the DPM to deliver the intervention independently.•Project 4: Evaluate the UEA–IFG intervention (with or without DPM support), in a three - arm RCT in 240 screen detected T2DM patients with the primary end point of glycaemic control compared to standard care over 3 years. •Project 5: Evaluate cost effectiveness of all programme elements with modelling of longer term health costs. •Project 6: Disseminate the programme’s findings to UK national commissioning bodies and policy makers, and develop a marketing strategy with industry. •Project 7: Examine the integration of the new roles of DPMs and DPFs in NHS and international workforce planning.Research team. The research team is an established group of NHS and academic staff that includes clinical epidemiologists experienced in health service research and diabetes modelling (Harvey/Bachmann/Niessen), NHS diabetes specialists with academic interests in obesity and diabetes (Turner/Dhatariya/Wallace/Sampson), expertise in academic and clinical primary care and qualitative methods (Howe/Hadley–Brown), lay diabetes champion (Rea), clinical chemistry and HbA1c standardisation (John), clinical and health psychology of chronic disease (Hobbis/Smith), economic evaluation (Barton), RCT statistical management (Clark), and service delivery at board level (Sethia). Research environment. A large NHS Clinical Research and Trials unit, satellite locations throughout Norfolk, and substantial research network support.Public involvement. Public involvement is at the core o
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