Introduction to the National Diabetes Prevention Programme

Background The National Diabetes Prevention Programme (NDPP) is Commissioned at national level by NHS (England), Public Health (England) and Diabetes UK. By 2020 it is projected to be supporting 190,000 people across England with a high risk of developing diabetes to reduce their risk. It is is a free, voluntary ten month programme consisting of 4 weekly sessions followed by 9 monthly sessions in a local venue, in groups of up to 20 people in daytime and evening sessions. Those referred to the service receive group sessions to reduce their risk of Type 2 diabetes which are designed to support lifestyle interventions. An experienced Educator leads sessions around healthy lifestyle topics encouraging self management and empowering individuals to make successful long term healthy lifestyle behaviour change. Participants receive resources and handouts to help them on their way. Participants also have access to 2 x HbA1C tests; one mid-programme and one on completion (in addition to the one they receive prior to being referred).

Our Partner Leicester Diabetes Centre A leading applied health research unit, committed to improving the lives and care of people with diabetes and other long-term conditions A collaboration between the University of Leicester and University Hospitals of Leicester NHS Trust Already delivers DESMOND and Let’s Prevent services, as well as providing training across the NHS Responsible for developing the NDPP curriculum, training Educators and carrying out quality excellence on the delivery of courses Have spent significant time and effort developing the course and will be critical to delivering the programme over the next three years

Referral routes into the NDPP GP Referral from At Risk Register Opportunistic Referral from Healthcare Professional Annual Review

Eligibility Patients are eligible for NDPP if they meet the following criteria: Are aged 18 years or over Are not currently pregnant Have non diabetic hyperglycaemia - a HbA1c 42-47mmol/mol (6.0%-6.4%) or a FPG 5.5-6.9mmol/l reading within the last 12 months If the blood test result has occurred within 3 months of the date of referral, and lies within the acceptance criteria, the patient is immediately considered suitable to join the programme and is offered a place. If the blood test result has taken place between 3 – 12 months of referral, an Ingeus employed HCA will undertake a new blood test. If the blood test stated on the referral form has taken place over 12 months ago, the patient is not considered eligible for the programme and will be discharged back to the GP.

The Participant Journey Engagement Local NDPP teams engage Clinical Networks, CCG’s, LA’s and GP practices Raise participant awareness Wraparound Support E-learning Contact Centre Automated contact Website Referral Referral via GP or other Health Check provider Multi-channel referrals including: Online form Secure email or fax Post Invitation to participate issued with detailed programme overview Contact centre conduct first part of individual assessment Face to face completion of individual assessment: Blood test, BMI – delivered by Lloyds Pharmacy Session scheduling completed Multi-channel referrals including; Online form, Secure email or fax, Post Individual Assessment and Enrolment Keeping a healthy lifestyle going Mindful living Healthy living for a healthy heart Pushing the Pace Maintenance Sessions Eight sessions over eight months: Healthy eating for a healthy weight Balancing food and activity Choosing healthy snacks and drinks Getting standing and reshaping your day Final Session Progress and motivation Where am I now? Sustaining the change What next Core Sessions Four weekly sessions: Understanding pre-diabetes Weight Management Physical activity benefits and activity goals Risk of large blood vessel disease and management Healthy eating focusing on fibre and dietary fats Discharge Discharge letter/final blood results back to GP Information on NHS Choices On-going access to e-learning for 12 months

Education and Behavioural Change “A structured education program with clear philosophy incorporating behavioral change and psychological support may be best for making sustainable change” Diabetes UK What do we teach? The basics of insulin resistance, blood glucose and raised HbA1c The basics of risk factors for insulin resistance and identifying those that can be changed The basics of cardio vascular disease risk indicators and implications for health (Blood pressure, cholesterol, stroke, atherosclerosis) The basics of a healthy diet (including discussion about fibre, free sugars, the Eatwell guide, reading food labels and portion size guidance) The basics of self management (choice, alternatives, swaps, support, setting SMART goals)

Interactive activities Drink Number of sugar cubes (one cube = 4g) Cocoa Cola (330mls) Diet Cocoa Cola (330mls) Juicy water lemon and lime (420 mls) Orange, mango pineapple, smoothie (180mls) Apple juice (150mls) Chocolate milkshake (400mls) No added sugar chocolate milkshake (400mls) Energy drink (250mls) Blackcurrant squash No added sugar Blackcurrant squash

Sugar cubes - results Drink Number of sugar cubes (one cube = 4g) Cocoa Cola (330mls) 9 Diet Cocoa Cola (330mls) Juicy water lemon and lime (420 mls) 8 Orange, mango pineapple, smoothie (180mls) 5 Apple juice (150mls) 3 Chocolate milkshake (400mls) 10 No added sugar chocolate milkshake (400mls) Energy drink (250mls) 7 Blackcurrant squash No added sugar Blackcurrant squash

Outcome Measures NHS England assess Ingeus’ success in delivering the program by reviewing a range of outcome measures: BMI / Weight reduction HbA1c Reduction WEMWBS/ EQ-5D-5L score improvement Participant satisfaction survey Attendance at sessions (more than 75% attendance) BMI = Body Mass Index WEMWEBS = Wellbeing Scale More than 75% attendance or less than 25% DNA

Case Study Clive Jones Retired church minister Clive had a health scare last summer, blood tests done at the time revealed he had higher than normal blood sugar results and was at risk of developing diabetes. My wife Lynne and I are part-time carers for our young granddaughter Lylah, so it’s hugely important that I stay fit and active,”. “A Ministers life can be quite sedentary and I guess I’d slipped into some bad habits”. “It’s really helpful to have the support of Cathy and the group, there’s a friendly camaraderie and we’re all aiming for the same outcome. “I feel so much better for making just some simple life changes.” A few months on and Clive has lost 18lbs, wears his belt two notches tighter and no longer struggles to keep pace with the church walking group. He and Lynne also regularly swim, garden, cycle and walk. His blood sugar levels are decreasing and he credits the Healthier You group for his new-found lease of life.

South East Healthier You Programme Update Since it’s launch in in September 2016 over 20, 000 referrals have been received into the Healthier You Programme South East. Over 500 Core programmes have completed or are currently underway with an over 80% conversion from Initial Assessment into Core Programme delivery. 17 fully equipped and highly experienced NDPP heath educators are currently deployed and dedicated to the South East. Plans for 2018 To continue to roll out across all areas that are not currently accessing NDPP An improved Customer Relationship Management system (CRM) so we can provide patients with better communication and provide CCG and practices with improved data analysis To work with the diversity of our communities in order for everyone to access our NDPP services

Next Steps Any practice wishing to sign up to the programme and begin referring should contact either: Their NHS Clinical Commissioning Group Or Ingeus NDPP Vaqqas Javaid | Regional Manager for England South | Ingeus vjavaid@ingeus.co.uk Website: www.stopdiabetes.co.uk