All Wales Diabetes Prevention programme
The All Wales Diabetes Prevention programme (AWDPP), led by Public Health Wales, offers targeted support to people who are at an increased risk of type 2 diabetes, with the aim of preventing them from developing this condition.
The programme sees dedicated, trained healthcare support workers, with oversight from dieticians, deliver a brief intervention to people who have had a blood test that shows that they are at an increased risk of type 2 diabetes. Drawing on approaches piloted by GPs at a local level, the programme delivers a standardised approach to the prevention of type 2 diabetes in high risk individuals for the whole of Wales.
Background
More than 200,000 people in Wales are living with diabetes, and nine in 10 of them have type 2 diabetes. This is a serious, sometimes lifelong condition. It is a leading cause of sight loss and a major contributor to kidney failure, heart attack and stroke. Type 2 diabetes has a severe impact on individuals and their families. There is also a financial cost: the treatment of type 2 diabetes accounts for around 10% of the annual NHS budget.
Unlike type 1 diabetes, type 2 diabetes can be prevented. Evidence suggests that, by supporting people to make lifestyle changes, over half of type 2 diabetes cases could be prevented. Developed nationally by Public Health Wales and delivered locally by dedicated healthcare support workers and dietetic leads working in primary care, the AWDPP supports people who are at an increased risk of type 2 diabetes to make changes to their diet and to be more physically active.
In the first phase of its delivery, the AWDPP will be rolled out in at least two primary care clusters in each of Wales’ seven health board areas. The programme will be subject to an ongoing evaluation, and learning from this first phase of the rollout will be used to inform its design and delivery going forwards.
Why do we need an All Wales Diabetes Prevention programme?
Wales has the highest prevalence of diabetes in the UK and, with excess weight and obesity becoming more common, the number of people at an increased risk of type 2 diabetes is rising. The impact of type 2 diabetes on the health and wellbeing of individuals and their families is severe. There is a financial cost as well: treatment of type 2 diabetes accounts for around 10% of the NHS budget.
Evidence suggests that, by supporting people to make key changes to their diet and level of physical activity, over half of type 2 diabetes cases could be prevented. There is therefore a clear need and opportunity for a national programme that supports people to make changes to their lifestyle that can delay or prevent the onset of type 2 diabetes.
What is the intervention?
In areas where the programme is being rolled out, people who have had a blood test that shows that they are at an increased risk of type 2 diabetes (HbA1c between 42-47mmol/mol) will be invited to attend a 30-minute consultation with a trained healthcare support worker. The healthcare support worker will talk to people about their risk of developing type 2 diabetes and what they can do to reduce it. They may also refer them to additional sources of support from which they could benefit. A follow-up appointment will take place 12 months later.
Why was the intervention designed like this?
The All Wales Diabetes Prevention programme builds on approaches that were piloted and evaluated in two separate primary care clusters: Afan Valley and North Ceredigion. These two pilots demonstrated promise in using a brief intervention to reduce blood sugar (glucose) levels in people at risk of type 2 diabetes.
Public Health Wales has worked with professionals from across disciplines to review and refine each element of the intervention design. As a result, the programme is aligned with NICE guidance, the All Wales Weight Management Pathway, Prudent healthcare principles and insights from behavioural science.
Is the intervention effective?
The design of the intervention draws on successful pilots carried out in primary care clusters in North Ceredigion and Afan Valley. The evaluation of these pilots showed that there was a decrease in average blood sugar (glucose) levels between people receiving the brief intervention and their follow-up appointment, with a smaller number than expected going on to develop type 2 diabetes. The All Wales Diabetes Prevention programme will be evaluated on an ongoing basis. Learning from the initial phase of the programme’s rollout will be used to optimise the programme as it develops over the coming years.
Who is the All Wales Diabetes Prevention programme for?
The AWDPP is a targeted programme for people at an increased risk of type 2 diabetes. People at an increased risk will be identified through a blood test, called an HbA1c test, which measures a person’s average blood sugar (glucose) levels over the last two to three months. People are at an increased risk of developing type 2 diabetes if their HbA1c is between 42-47mmol/mol.
Eligible people in areas where the programme is being rolled out will receive a letter of invitation, together with an information leaflet, requesting them to make an appointment. The appointments are provided in partnership by primary care and local health boards, and delivered as a one-to-one appointment with a healthcare support worker. The appointment will usually last around 30 minutes. This might be in person at a local venue or a virtual appointment via telephone or video, depending on the local service.
Where is the All Wales Diabetes Prevention programme being rolled out?
In its first phase, the All Wales Diabetes Prevention programme is being rolled out in at least two primary care clusters in each of Wales’ seven health board areas. Learning from this first phase of the rollout will be used to inform the development of the programme going forwards.
Why is it being rolled out in these areas first?
The primary care clusters involved in the first phase of the All Wales Diabetes Prevention programme have been identified based on:
- whether there is a high prevalence of type 2 diabetes in their area
- whether there is a clear population health need
- their readiness to deliver the programme
Two primary care clusters from each health board area are involved in the programme, ensuring that the whole of Wales is represented in this first phase of the rollout.
When is the All Wales Diabetes Prevention programme being rolled out?
The primary care clusters involved in the first phase of the rollout began delivering the brief intervention in the Summer/Autumn of 2022. The programme will be rolled out at a different pace in each health board area, depending on delivery arrangements at a local level.
Who was involved in the planning and development of the All Wales Diabetes Prevention programme?
The All Wales Diabetes Prevention programme builds on approaches that were piloted and evaluated in two separate primary care clusters: Afan Valley and North Ceredigion. Healthcare professionals from across disciplines and health board areas have since worked together to review and refine the intervention design and to plan the programme’s delivery. The programme has been developed in consultation with the third sector and people living with type 2 diabetes.
Who is involved in the delivery of the All Wales Diabetes Prevention programme?
The All Wales Diabetes Prevention programme will be delivered by dedicated, trained healthcare support workers, with oversight and supervision from local lead dietitians. The healthcare support workers and dietitians will work in partnership with general practices to identify eligible people and invite them to the brief intervention, which will either take place in GP surgeries or in other venues, depending on local arrangements.
How will the All Wales Diabetes Prevention programme be evaluated?
Evaluation is a key element to the All Wales Diabetes Prevention programme and will be used to measure impact and inform future improvements. PHW’s Research & Evaluation Division are leading the evaluation of the All Wales Diabetes Prevention programme through two separate approaches.
- To evaluate the outcomes of the All Wales Diabetes Prevention programme, a modified stepped wedge approach has been proposed. The outcome evaluation will assess whether the intervention leads to a change in people’s HbA1c levels at their 12-month follow-up, and whether there is a difference in HbA1c for people who receive the intervention compared to those who had received usual care.
- To evaluate the process and value of the All Wales Diabetes Prevention programme, a consortium between Swansea, Aberystwyth and Bangor Universities was chosen to undertake an independent assessment of what works, where and why. This will enable lessons to be learned during the initial programme rollout, in order to inform the scaling of the programme across Wales.
This learning will be achieved through the information gathered via interviews with patients and professionals, observations of intervention delivery, document analysis, and the collection of routine data from GP practices on intervention eligibility, invitation, uptake and follow-up. A value-based assessment will also be undertaken to assess the alignment of the All Wales Diabetes Prevention programme against Welsh prudent health care principles.