Time to question the NHS diabetes prevention programme
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4717 (Published 07 September 2015) Cite this as: BMJ 2015;351:h4717
- Eleanor Barry, NIHR in-practice fellow1,
- Samantha Roberts, DPhil student1,
- Sarah Finer, honorary clinical senior lecturer2,
- Shanti Vijayaraghavan, consultant diabetologist3,
- Trisha Greenhalgh, professor1
- 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
- 2Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 3Department of Diabetes, Newham University Hospital, Barts Health NHS Trust, London, UK
- Correspondence to: T Greenhalgh trish.greenhalgh{at}phc.ox.ac.uk
A new Public Health England report on the rising prevalence of type 2 diabetes proposes targeting people with non-diabetic hyperglycaemia (defined as an HbA1c concentration of 42-47 mmol/mol) with behavioural interventions (diet and exercise). 1 Action for this group (10.7% of the adult population) is to be the cornerstone of the NHS Diabetes Prevention Programme, which will be rolled out nationally from 2016.2
Such individualised policy is divorced from the multilevel, community-wide, and politically engaged prevention plans recommended by the World Health Organization3 and Robert Wood Johnson Foundation.4 In its report on non-communicable disease WHO calls for “multisectoral action that simultaneously addresses different sectors that contribute to the production, distribution and marketing of food, while concurrently shaping an environment that facilitates and promotes adequate levels of physical activity.”3
Targeting individual behaviour as a preventive strategy rests on five doubtful assumptions: that it is possible, on the basis of a risk score and blood test, accurately to identify a population subgroup with the highest risk of developing diabetes; that individuals thus targeted will behave like participants in research studies; that behaviour changes will be sustained indefinitely; that clinically important improvements in patient relevant outcomes will follow; and …
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