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Sixty seconds on . . . diabetes

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1264 (Published 21 March 2018) Cite this as: BMJ 2018;360:k1264
  1. Nigel Hawkes
  1. London

Hooray! The NHS diabetes prevention programme is working

Is it really? That will come as a surprise to its critics, who said when it was launched in 2015 that it was based on speculation and doubtful assumptions.1

But patients who took part have lost a ton of weight

Respectable amounts, certainly: an average of 3.7 kg each if you exclude those who weren’t overweight to start with. NHS England is very pleased2: obesity is the new smoking, says its chief executive, Simon Stevens.

So, diabetes is cured?

Please! You’re jumping the gun. These are people whose glucose is elevated but below the diabetes threshold—sometimes called prediabetes. There’s no evidence of any reduction in progression to diabetes yet but, since overweight is a risk factor, the assumption is that losing weight will have an effect. Early days, says the national clinical director for diabetes and obesity, Jonathan Valabhji.

How early?

The results come from 2277 people who completed at least eight sessions over a nine month period. As each session lasts one to two hours, this isn’t a cheap intervention. Another 66 000 have taken up places.

And how many people in England have prediabetes?

Glad you asked. It’s about 10% of the adult population—let’s say four million.

Bit of a gap, then?

More like a chasm. At current rates it would take over 100 years to enlist them all. Which is one reason why critics believe that an individualised policy of this sort isn’t going to solve the problem.

But good for the individuals?

Maybe, but even that isn’t certain. The many doubts include whether the effects of the sessions will last. The literature finds no evidence of any sustained reduction in deaths or disability from heart disease or diabetes with lifestyle interventions in prediabetes: 17 trials showed no significant effect, while only one was significant—and then only just.

Sounds like we’re trying to move a mountain with a teaspoon

Blindfolded.

References

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