Short Report: Epidemiology
Progress of the Healthier You: NHS Diabetes Prevention
Programme: referrals, uptake and participant
, R. Clark
, R. Hewings
, J. Smith
and J. Valabhji
Public Health England,
Diabetes UK and
NHS England, UK
Accepted 7 December 2017
To describe early progress of the Healthier You: NHS Diabetes Prevention Programme, a behavioural
intervention designed to prevent or delay onset of Type 2 diabetes in people in England already identiﬁed to be at high
risk, to assess numbers of referrals received by Programme providers and the proportion that attended the initial
assessment, and to identify the factors associated with attendance rates.
These analyses examine the data for referrals received between June 2016 and March 2017.
There were 43 603 referrals received, 16% higher than expected. Of those referred, 49% attended the initial
assessment, higher than the 40% modelled uptake. Of those referred, there was no signiﬁcant difference in uptake by sex
(P=0.061); however, attendance per 100 000 population varied signiﬁcantly by sex, age group, ethnicity and deprivation;
it was signiﬁcantly lower for men (P<0.001), higher as age increased (P<0.001) and higher for individuals from Asian,
Afro-Caribbean, mixed and other ethnic groups compared with individuals from white European groups (P<0.001).
There was signiﬁcant interaction between attendance rates by ethnicity and deprivation (P<0.001) such that attendance
rates were signiﬁcantly higher in the most deprived quintile vs the least deprived quintile for Asian, Afro-Caribbean,
mixed and other ethnic groups but not signiﬁcantly different for white European ethnic groups.
The analyses show that referral numbers and percentage uptake are in excess of prior modelled values.
Characteristics of attendees suggest that the programme is reaching those who are both at greater risk of developing
Type 2 diabetes and who typically access healthcare less effectively.
Diabet. Med. 35, 513–518 (2018)
The prevalence of diabetes in England has increased from 2.3
million in 2009/2010  to 3.0 million in 2015/2016 .
Over 90% of people with diabetes have Type 2 diabetes .
The associated complication and premature mortality burden
is borne by individuals, their families and carers , and by
the National Health Service (NHS) . Randomized con-
trolled trials in those with impaired glucose tolerance have
shown that onset of Type 2 diabetes can be prevented or
delayed through behavioural interventions [6,7].
A strategy for future healthcare in England, published in
2014, suggested a focus on prevention to manage demand,
and proposed a national Type 2 diabetes prevention
programme . The Healthier You: NHS Diabetes Preven-
tion Programme was therefore developed to prevent or
delay onset of Type 2 diabetes in adults already identiﬁed to
be at high risk, deﬁned as having non-diabetic hypergly-
42–47 mmol/mol (6.0–6.4%) or fasting
plasma glucose 5.5–6.9 mmol/l]. Individuals identiﬁed after
an NHS Health Check , through retrospective searches of
general practice records for qualifying blood tests, or
through routine clinical practice, are offered a place on a
behavioural intervention. This approach is outlined in the
National Institute for Health and Care Excellence (NICE)
Public Health Guideline PH38 , and will be comple-
mented by the population-level interventions to tackle
obesity, the major modiﬁable risk factor for Type 2
Correspondence to: E. Barron. E-mail: Emma.Barron@phe.gov.uk
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ª 2017 Crown copyright.
Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.