September 07, 2015

Just Beat It! Tackling Diabetes in County Durham

In March this year NHS England, Public Health England and Diabetes UK launched the NHS Diabetes Prevention Programme (DPP): the first at-scale national evidence-based programme to stop people developing Type 2 diabetes. .

As part of the programme seven areas of the country are testing different approaches to tackling the issue and, during Diabetes Awareness Week 2015, our demonstrator site in Durham describes their approach.

Here in Durham we decided to apply as a demonstrator site for the NHS Diabetes Prevention Programme because it was an excellent opportunity to share our experiences of tackling diabetes locally and to provide examples of what worked well and what hasn’t. It has also enabled us to learn about different programmes across the country and identify other areas of good practice. But above all it is exciting to be part of a national drive to prevent Type 2 Diabetes – the first of its kind in the world.

We have been working on trying to reduce diabetes locally since February 2014, when we launched an initial six month pilot to test the concept called ‘Just Beat It!’ It has been developed by taking the best elements from a wide range of evidence and NICE guidelines, as well as the experiences of staff working in lifestyle interventions.

‘Just Beat It!’ consists of an intensive lifestyle quality assured programme which includes:

  • Initial six months programme
  • Education & exercise sessions
  • Weekly sessions
  • Support resources
  • Follow-up support for 18 months

12 month data has recently been collected from those patients taking part in the programme which shows that:

  • 46% adhered to the programme at 12 months
  • 67% of patients reduced their Diabetes Risk – 50% reducing a risk level (using Diabetes UK Risk Assessment Tool)
  • 100% of patients increased their physical activity levels – with all achieving CMO recommendations of 150 minutes of moderate physical activity per week
  • 100% of patients lost weight – with 31% achieving weight loss of 5-10kg or 5% of their baseline weight.

It must be noted that the sample size was not significant (13 patients) – however initial findings from the further roll out of the programme indicates that these results will be replicated with a larger sample size.

At Just Beat It!, it makes sense to us that lifestyle interventions should be the first-line treatment for people on the verge of developing Type 2 Diabetes – but still have an opportunity to prevent it. Preventing Type 2 Diabetes should always be preferable to treating it and weight management, proper diet and exercise are key elements in achieving this. The Diabetes Prevention Programme in the US showed that lifestyle was twice as effective as the drug metformin in preventing diabetes in high-risk individuals, reducing its occurrence by 58%.

Throughout the development and implementation of the Just Beat It! programme, there have been a number of key lessons learnt – these include:

  • Maximise patient contact – it is important to make the patient feel there is always someone there to turn to for support. Each one starting the programme is assigned an individual mentor who is there to provide support as and when required.
  • Longer, intensive programmes – our experience has told us that people at risk of developing Type 2 Diabetes (or other Cardio Vascular Disease (CVD) conditions) have generally led unhealthy lifestyles for a number of years. Therefore to expect a sustainable lifestyle change in an 8-12 week intervention is unrealistic. A long-term approach is required – providing support during the maintenance phase of behaviour change.
  • Creating the right environment – humour and camaraderie have been important in keeping participants engaged and in developing mutual support. In addition, making it an environment that participants don’t feel as if they are going to ‘told off’ for having a bad week or relapsing.
  • Share responsibility with patients – developed an environment where diabetes is a personal issue and that it requires individual action to tackle it. Participants appreciated having an individual plan and enjoyed taking personal responsibility for monitoring, and making changes in their food intake and activity level.

We are excited to take our work on diabetes prevention to the next level by working with our partners in NHS England, Public Health England and Diabetes UK to help inform the development of the national programme.

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