Middle aged man with type 2 diabetes using blood sugar measurement device to monitor type 2 diabetes, which can be linked to changes in the gut microbiome.
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A large-scale, community program run by the U.K.’s National Health Service designed to reduce the risk of developing type 2 diabetes is effective, according to a study led by Stanford University.

The ongoing NHS Diabetes Prevention Program (DPP) was set up in 2016 and participants are adults who are at high risk of developing type 2 diabetes who have been referred to join the program by their doctor. The participants are given counselling on losing weight, increasing physical activity and advised on other lifestyle improvements.

There has been uncertainty about how effective the DPP has been so far, but the results of the current study, which is published in Nature and includes over two million people, show consistent improvements in glycemic control, body mass index (BMI), weight, high-density lipoprotein cholesterol and triglycerides.

“Our findings clearly demonstrate the huge benefits of intensive lifestyle counselling for improving the health of patients with prediabetes. The evidence also suggests a promising route for improving population health more broadly,” said co-author Justine Davies, a professor at the University of Birmingham, in a press statement.

“The positive effects observed in the program may also extend to other non-communicable diseases such as cancer, which is increasingly thought to be connected to unhealthy lifestyle habits and environments.”

Over 37 million Americans have diabetes and as many as 95% of these individuals have type 2 diabetes. Although there is a genetic component to type 2 diabetes, unhealthy behaviors such as overeating, smoking, drinking too much alcohol, and a sedentary lifestyle can contribute significantly to the risk of someone developing the condition.

There is significant research showing that individuals who have prediabetes; those with higher-than-normal blood sugar, but not full-blown diabetes, can stop the onset of type 2 diabetes by making significant lifestyle changes.

The NHS DPP was set up to target individuals with prediabetes and try to prevent them progressing to type 2 diabetes. Notably, unlike other similar studies and programs, this is carried out in the community so may better represent the non-clinical trial environment.

People taking part in the study are offered at least 13 counseling sessions over nine months in either an in-person or an online format. Tools such as wearable technology, apps and peer support groups are all used to help participants progress.

This study looked at 2,106,376 participants in the program between 2017 and 2020 who had glycated hemoglobin (HbA1c) measurements at enrollment and during follow up.

They found that participants had a modest improvement in HbA1c after being referred to the program and that active participation in the program would significantly slow progression to diabetes and heart disease.

“There is an urgent need to implement population-based measures that prevent diabetes, enhance its early detection, and address cardiovascular risk factors to prevent or delay its progression to complications,” said first author Julia Lemp, a researcher at the University of Heidelberg.

“Investment in structured, intensive behavior change programs may help prevent development of Type 2 diabetes whilst reducing the risk of complications from diabetes and cardiovascular events.

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