Type 2 diabetes is a major threat to individual health (1), although largely preventable (2). Many cases can be avoided through supporting people to adopt healthier diets and be more physically active (3), with research showing that interventions offered to at-risk populations can significantly reduce the likelihood of type 2 diabetes incidence (4). In response to this evidence, and to similar piloted approaches in Afan Valley (5) and North Ceredigion (6), Welsh Government provided funding to Public Health Wales in 2021 to deliver the All-Wales Diabetes Prevention Program (AWDPP).
The AWDPP was developed in collaboration with a wide range of stakeholders (including general practitioners, diabetes specialists, public health specialists and more) to provide structured, person-centred support for individuals at risk of type 2 diabetes (7). People identified as at risk (based on HbA1c (i.e., blood sugar) of 42-47 mmol/mol) are invited to participate in a 30 minute consultation with a trained Health Care Support Worker. These sessions raise awareness of the increased risk of type 2 diabetes and focus on promoting healthier diets, encouraging physical activity, and supporting goal setting. Where appropriate, participants are also referred into wider weight management and exercise referrals pathways as available (8). The overarching aim of the AWDPP is to reduce blood sugar levels among individuals at an increased risk of developing type 2 diabetes, thereby helping to delay or prevent the onset of the disease.
This short report, published by the Evaluation Team within Public Health Wales, investigates the impact of the AWDPP on blood sugar levels and associated glycaemic categories (normoglycaemia, pre-diabetes, and diabetes). The evaluation used linked service data and routine healthcare records held within the Secure Anonymised Information Linkage (SAIL) databank (9–13). The evaluation employed a stepped wedge design, comparing outcomes for nearly 2,000 individuals offered the AWDPP with close to 1,500 people identified as at risk of 2 diabetes who received care as usual prior to the programme’s introduction.
This evaluation indicates that the AWDPP is effective in reducing blood sugar levels (HbA1c) and preventing progression to levels consistent with type 2 diabetes when compared with usual care. The findings align with a recent report capturing staff and participant perspectives of the service (14) and highlight that a brief, targeted intervention focusing on modest changes to diet and levels of physical activity can deliver significant and measurable improvements in clinical outcomes associated with type 2 diabetes. Overall, these findings suggest that the AWDPP has the potential to make a substantial contribution to reducing the future burden of diabetes across Wales.