Type 2 diabetes prevention in high-risk individuals :how might effective, equitable and sustainable service provison be achieved?

Abstract

Background: Prevalence of type 2 diabetes (T2D) is rapidly increasing worldwide, linked to the obesity epidemic. There is substantial research evidence for T2D prevention by lifestyle interventions in high-risk individuals. The span of this research provides a unique case study with which to critically examine general guidance for development and evaluation of interventions to improve health. My research question is how might can effective, equitable and sustainable service provision for T2D prevention in high-risk individuals be achieved? Methods: Five papers reporting my empirical T2D prevention research form the core of my thesis. This research extends from the European Diabetes Prevention Study (EDIPS) RCT to the ‘New life, New you’ (NLNY) feasibility study. NLNY is a community based lifestyle intervention to reduce T2D incidence that is delivered by fitness trainers in North East England. To inform my research question I have reviewed intervention guidance history. I have then used T2D prevention as a case study, supported by my empirical research experience, to analyse this guidance Findings: Development of the NLNY intervention built on the EDIPS RCT evidence and experience. Pilot evaluation of NLNY suggests a feasible and acceptable intervention that is likely to be effective in preventing T2D. Prevention of T2D provided a useful exemplar for analysis of intervention guidance and highlighted strengths and limitations of existing guidance models. This analysis led to a proposed new guidance framework. Conclusions: The NLNY intervention provides a potential service provision model for T2D prevention in high-risk individuals. Well planned effectiveness and cost-effectiveness evaluation of the NLNY intervention is now needed. The analysis of intervention guidance and the proposed new framework will contribute to developing a robust study design. If effectiveness of the NLNY intervention is demonstrated there is potential for this community based intervention model to be further developed and adapted.