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Case study: DIPLOMA impact case study

Findings from the DIPLOMA programme have been shared with NHS England, to inform the next wave of Healthier You programmes.

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DIPLOMA: Diabetes Prevention - Long term Multimethod Assessment

Key features

  • 2017 - 2021
  • Funded by NIHR (Health Services and Delivery Research, 16/48/07 – Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the DIPLOMA research programme (Diabetes Prevention – Long Term Multimethod Assessment))
  • More than 500 patients and professionals recruited, with support from the NIHR Clinical Research Network
  • Project management support from the NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester

Diabetes is a major problem in England, and reducing the numbers of people with Type 2 diabetes is a priority for the NHS. The NHS Healthier You: NHS Diabetes Prevention Programme (NHS DPP) aims to identify those at high risk and refer them onto a behaviour change programme.

The NHS DPP started in 2016 with a first wave of 27 areas in England. During the first year over 40,000 places were made available for people to receive personalised help to reduce their risk of Type 2 diabetes. Subsequent annual waves followed and in 2018-2019 all areas of the country were covered. It is now expected the DPP will offer 100,000 places each year. The NHS DPP is being delivered by four provider organisations who provide the NHS DPP course with some flexibility to meet local needs. In 2019, the NHS Long Term Plan committed to fund a doubling of the NHS Diabetes Prevention Programme over the next five years, including a new digital option.

Due to the importance placed on the NHS DPP and the lessons that may be learnt for other large scale health programmes, an independent evaluation was commissioned by the NIHR. DIPLOMA is a four year programme of work comprising seven distinct work packages that make use of quantitative and qualitative methods to assess the success of the NHS DPP in meeting the aim of reducing Type 2 diabetes incidence in a way that is cost-effective and sustainable. It will provide evidence to inform the ongoing development and quality of the programme.

It will investigate implementation of the NHS DPP across the country, looking at access and equality, service delivery and fidelity, and the long-term effectiveness of the NHS DPP. The NIHR Clinical Research Network (CRN) is helping to deliver the study, by identifying sites around the country.

The study will complete in March 2021 with a final report but ongoing feedback is provided to NHS DPP stakeholders as research findings emerge with the aim to support ongoing development and quality improvement.

Outcomes and findings

As of July 2019, NIHR CRN has supported the recruitment of more than 500 patients and professionals.

Early data suggest that the courses generally included the right ingredients, delivered in the right way.

However, the different courses varied in the degree to which their strategies for helping people change their lifestyles (i.e. behaviour change techniques) matched the specification. Every provider organisation included some techniques that were not specified, and no provider included every technique that was specified. Fidelity was generally very good, but there was still some room for improvement.

Value to the NHS

Having identified these differences, we communicated our findings to NHS England, who are working to make sure these findings inform the next wave of Healthier You programmes.

This means that future courses will be even better, meaning that many thousands of patients will receive the best support to help them prevent diabetes.

Professor Matt Sutton, Chair in Health Economics at the University of Manchester and Chief Investigator of the study:

“Preventing long-term conditions is crucial to keep our populations healthy, and the DPP has been introduced to support prevention across the country.

“Given the scale of the DPP, it is really important that delivery of the course is of high quality.

“We are delighted that our DIPLOMA study has been able to support delivery, by taking a detailed look at the programme and highlighting ways in which it can be made as effective as possible.”