Intended for healthcare professionals

Letters Response

Rachel Clark and colleagues reply to Eleanor Barry and colleagues

BMJ 2015; 351 doi: (Published 08 October 2015) Cite this as: BMJ 2015;351:h5301
  1. Rachel Clark, evidence lead, NHS Diabetes Prevention Programme1,
  2. Jonathan Valabhji, national clinical director for obesity and diabetes2,
  3. Alison Tedstone, national lead diet and obesity and chef nutritionist1,
  4. Louise Ansari, director of prevention of type 2 diabetes3,
  5. Jim O’Brien, national programme director, NHS Diabetes Prevention Programme1
  1. 1Public Health England, London SE1 8UG, UK
  2. 2NHS England, Leeds, UK
  3. 3Diabetes UK, London, UK
  1. jim.obrien{at}

Eleanor Barry and colleagues’ editorial relays their concerns about the NHS Diabetes Prevention Programme (DPP).1 Key concerns are dealt with here. The NHS DPP will offer people already identified as being at high risk of developing type 2 diabetes an opportunity to lower their risk through provision of an evidence based behavioural intervention. By failing to implement such a programme, people with known non-diabetic hyperglycaemia are deprived of consistent and evidence based support that would empower them to reduce their risk of type 2 diabetes, questioning our commitment to the public’s health and wellbeing.

We agree that there is a need for multi-level action. Both NHS England and Public Health England (PHE) published plans last year with a focus on improving diet, increasing levels of physical activity, and obesity prevention and treatment.2 3 We are looking forward to seeing the government’s promised strategy for tackling childhood obesity. The NHS DPP provides an opportunity to target people at high risk of diabetes as part of a population level approach to prevention. We recognise that the programme alone will not provide an answer to the growing incidence of diabetes, but it should make an important contribution.

Concerns raised about our intervention and our “five doubtful assumptions” are speculative: people at high risk of diabetes are already being identified through blood tests based on guidelines set by the National Institute for Health and Care Excellence (NICE) in 20124; we anticipate that there will be lessons to learn on recruitment and retention of participants and will work to optimise these areas; we will look at how best to support maintenance of challenging lifestyle changes; and our economic modelling for the programme suggests it will be both affordable and cost effective.

Claims about how PHE “justifies its proposed policy” are inaccurate. PHE’s meta-analysis supporting the development of the NHS DPP was peer reviewed before publication.5 Its methods were largely derived from a previous meta-analysis, which was published in a peer reviewed journal6 and used to inform NICE guidelines.4 The review provides the most up to date evidence available regarding the effectiveness of DPPs targeting high risk groups and supports the proposition from controlled clinical trials that such interventions can be effective.7 8 9

Meta-analysis findings were scrutinised and used alongside NICE guidelines,4 in close consultation with a group of external experts, to develop the first draft of a service specification. Evidence from implementation of DPPs was also drawn upon.10 11 We are consulting on this draft specification with the public, health professionals, and potential providers,12 and we are working with seven demonstrator sites to generate local evidence on practicalities associated with programme implementation through independent formative evaluation.

Implementation of the programme will be iterative, with integrated evaluation and ongoing adaptation to ensure that the programme reaches those who need it most and to maximise effectiveness. We will work with researchers to generate new evidence and fill gaps in the existing evidence base. Design of the NHS DPP will evolve in parallel, ensuring it is as robust as possible

The commitment of the NHS to the DPP is a pivotal moment in public health. It is the first national behaviour change programme in England and could lead to broader investment in prevention in the longer term. In prioritising the NHS DPP, the NHS—in partnership with Diabetes UK and PHE—has prioritised prevention. PHE has responded accordingly through supporting NHS England in developing an evidence informed intervention that will be continuously improved and evaluated appropriately over coming years.

For anyone interested in contributing to the NHS DPP we encourage you to get in touch by emailing


Cite this as: BMJ 2015;351:h5301


  • Competing interests: RC, Public Health England; JV, NHS England; AT, Public Health England, Nutrition Society, Association for Nutrition; LA, Diabetes UK.

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