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Self-management preventative education and physical activity programme for diabetes prevention

The aim of the project was to develop an integrated care pathway designed around patients to try and avoid the onset on type 2 diabetes for people across South Gloucestershire


The South Gloucestershire CCG Long Term Conditions (LTC) programme group identified self-management and diabetes prevention as one of a number of priorities for 2015/16.

This is an opportunity for Public Health South Gloucestershire, CCG, Primary Care and voluntary sector to work in partnership to develop an integrated care pathway designed around patients to try and avoid the onset on type 2 diabetes and aimed to support a defined group of patients identified as ‘at risk’ of developing Type 2 diabetes to lower their risk of developing the condition, and any associated complications thereafter.

The pilot built upon the X-PERT Prevention of Diabetes (X-POD) programme (http://www.xperthealth.org.uk/), which consists of a six-week group education course followed by telephone and email support, with meetings scheduled at three months post-course, and again at six months post-enrolment. The design of the programme is compliant with NICE (2012) guidelines on the prevention of diabetes. The pilot was delivered between January and November 2016 through Leap Valley Surgery, offered to patients aged 35-75 years-old and at risk of diabetes – defined by body mass index (BMI) >30kgm2 recorded in the last five years, plus a key diabetes risk factor such as raised blood glucose (HbA1c; 42-47mmol/mol).

Outcomes:

  • Courses were delivered to over 100 patients, with 91 completing six month follow up (91 matched pairs). 
  • There were significant improvements in HbA1c (blood glucose), weight, waist circumference and physical activity levels.  Less significant was any change to mental wellbeing.
  • The majority of those taking part valued the chance to learn more about their risk, and felt empowered to make lifestyle changes now, or at some point in the future. 

Whilst the project was being undertaken, Clare Fleming, Public Health Programme Lead Obesity,Nutrition and Physical Activity, Department for Children, Adults and Health, Public Health and Wellbeing Division at South Gloucestershire Council said: 

Within South Gloucestershire we are committed to doing something collaboratively to stem the tide of people becoming patients who are at risk from the complications associated with this serious condition, and other related conditions.  We are aiming for individuals that are at risk of developing type 2 diabetes to be enabled and guided towards greater self-care and informed managers of their health.  The education component is to focus on patient empowerment, encouraging co- design, sharing and appreciating individual experiences.

The programme sessions will be matched to the needs of the target population in terms of availability, accessibility and location, as far as possible.  Sessions can be delivered by health professionals or non-health professionals at the pilot GP Practice.  The sessions will be delivered using predominantly group sessions (ideally between 10 – 15 people) on a weekly basis, including evening sessions.  The sessions will focus on a strong physical activity component as well as nutrition, general health and wellbeing advice.  We are currently recruiting individuals for the X-PERT Diabetes prevention training, this will include lay facilitators, pharmacists, health professionals, physical activity specialists and others.

Excellent relationships have been established with the pilot GP surgery and they are fully supportive to be involved with this innovative scheme.

The application for research governance is now complete and accepted. We are working with The University of West Of England to fully evaluating the pilot over the next year. The aim of the evaluation is to present a robust and transparent account of the impacts of the South Glos Diabetes Prevention Project for participants, to examine the implementation of the project and to assess some delivery costs. Where appropriate, the evaluation will be designed to complement and build upon the project’s performance monitoring plan. 

Following a review of the project, the following benefits and lessons were identified:

Benefit Aims:

  • Completers achieving an individual weight loss of 2kgs or more over a 6 month period and maintaining that for 12 months.
  • All completers reducing their HbA1c levels from base line over 6-12 months
  • An Increase of individual’s daily physical activity over 6- 12 months, measured by using self-report data tool (GPPAQ) and accelerometers.
  • Improvements over 6- 12 months in individuals well-being (physical, emotional &social) measured by using a self-assessment questionnaire (EQ-5D).
  • Qualitative data collection

Actual Aims:

  • Completers achieved a varying amount of weight loss.  Not everyone recorded weight loss, although the majority of those attending did.  A mean weight loss of 4.3kg across all seven groups was recorded 6 moths post course, which exceeded aim of 2kg weight loss. 12 month data is just being collected
  • The majority of completers recorded a reduction in HbA1c with a mean reduction of 3.45mmol
  • Physical activity levels (self-reported) increased.
  • Improvements in individual emotional and social well-being was not demonstrated at six months post course

Since the pilot ended, South Gloucestershire have been part of a successful bid to form part of the ‘second wave’ of sites who will deliver the NHS Diabetes Prevention Programme from April 2017.  Their success was in no small part attributed to the learning taken from the pilot project and applied to further application.  Their ability to show a ‘readiness’ to deliver was pivotal to our application success.

Lessons Learned:

  • The overwhelming message learned from the project was the need to deliver similar projects elsewhere.  The patients who attended were vociferous in their support of the project, and felt it was very important that the messages continued to be disseminated.  The uptake on the course was three times that which we expected – demand exceeded our capacity – which would indicate a current gap in our service provision.
  • The pilot has taught us the importance of relationship building at the very start, and of programme promotion – so everyone involved is aware of the availability of sessions, and how to refer into the service (if eligible)
  • Educators need to be well trained and adept at both delivery and client engagement.  This is key to programme success so QA of all educators / providers would be important. 
  • Ongoing communications with groups have been vital to the continued engagement of patients.  Post course we have emailed groups every month with a light hearted email of ongoing support.  We have also arranged regular ‘reunion’ groups and encouraged groups meet up socially (two groups have done this).  An ongoing form of communication post course will be an important factor in future ventures.

Further information on the project can be found in the full evaluation report at the bottom of this page.

We are delighted to also announce that the pilot won best poster at the Faculty of Public Health annual conference and expo on 21-22 June 2017.  The poster was presented by University of the West of England (UWE Bristol) researchers in collaboration with South Gloucestershire's public health team, and will be displayed at the Faculty of Public Health's office for the next 12 month and is available on the UWE Research Repository

 

For more details, please contact:

  • Clare Fleming, Public Health Programme Lead Obesity, Nutrition and Physical Activity, South Gloucestershire Council  or
  • Lisa Bryant, Project Lead, Department for Children, Adults and Health, South Gloucestershire Council

This Page was last updated on: 20 July 2017

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