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• W2768147107 abstract "Abstract Background Prevention of type 2 diabetes is a priority for England driven by the diabetes epidemic. Cost-effective, lifestyle interventions aimed at delaying or preventing the onset of diabetes in individuals at high risk represent the cornerstone of the National Diabetes Prevention Programme (NDPP). Pharmacological interventions (eg, metformin) are also recommended in national clinical guidelines. The UK Government proposes to introduce a sugar tax, a population-wide intervention that can contribute to lowering the prevalence of diabetes. We aimed to model the effect of these three interventions on prevention of diabetes. Methods We developed Markov models estimating the number of diabetic cases prevented in 20 years' time by three interventions (NDPP, metformin, and a sugar tax) that represent current practice or proposed policy in England. The model's assumptions and inputs were retrieved from the grey and published literature (searched on EMBASE, Medline, and National Health Service Economic Evaluation Database, published in English at any time) and were validated in two expert workshops. For each intervention, we developed different scenarios to reflect uncertainty in the inputs and ran sensitivity analyses. Findings For an average English local health economy with a population of 300 000, in 20 years' time the number of cases of diabetes is projected to increase from 22 000 to 30 000. The NDPP is estimated to prevent about 30 cases of diabetes; metformin, if prescribed to half of those at high risk, about 200 cases; and a sugar tax about 600 cases. Interpretation Lifestyle interventions, such as the NDPP, though cost-effective, have negligible impact on the diabetes epidemic because of their limited scale, poor uptake, and declining adherence by participants over time. Metformin and a sugar tax could have a greater impact but together would only prevent about 10% of new cases. We argue for a diabetes prevention strategy based on three components: first, and most effective, national population-based interventions irrespective of individual risk of diabetes (eg, a sugar tax); second, pharmacological treatments for those at high risk who accept, tolerate, and are willing to comply with the medication; and third, locally implemented lifestyle interventions designed to achieve higher rates of uptake and adherence. Funding National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust (CDP, EP), London School of Economics and Political Science (GB, MJK)." @default.
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• W2768147107 date "2017-11-01" @default.
• W2768147107 modified "2023-10-13" @default.
• W2768147107 title "Impact of interventions to prevent diabetes in England: a simulation model" @default.
• W2768147107 doi "https://doi.org/10.1016/s0140-6736(17)32971-9" @default.
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