Risk factors for developing T2DM include diet, lack of physical activity, obesity, genetic factors and deprivation. The costs of treating diabetes and its complications are estimated at 10% of the total National Health Service (NHS budget, or some £10 billion per annum. 2 People with diabetes are at risk of complications including cardiovascular disease, nephropathy, retinopathy and neuropathy. There were an estimated 3.7 million people with diabetes in England in 2016–2017. Globally, it affects over 400 million people or around 9% of the adult population, 1 and of these, over 90% have type 2 diabetes mellitus (T2DM). Qualitative data will be analysed using framework analysis, with data pertaining to implementation mapped onto the CFIR.ĭiabetes is a national and international priority for health services, with a steeply rising prevalence. Quantitative data will be analysed descriptively and using generalised linear models to determine whether changes in outcomes are associated with demographic and intervention factors. Qualitative data will be collected through semistructured interviews with commissioners, providers, healthcare professionals and patients. Quantitative data will be collected at baseline, 6 months and 12 months by the digital intervention providers. Secondary outcomes include use of the intervention, satisfaction, physical activity, patient activation and resources needed for successful implementation. The primary outcomes are reduction in HbA1c and weight (for people with NDH) and reduction in weight (for people who are overweight or obese) at 12 months. In eight pilot areas across England, adults with non-diabetic hyperglycaemia (NDH) (glycated haemoglobin (HbA1c) 42–47 mmol/mol or fasting plasma glucose 5.5–6.9 mmol/L) and adults without NDH who are overweight (body mass index (BMI) >25 kg/m 2) or obese (BMI >30 kg/m 2) will be referred to one of five digitally delivered diabetes prevention interventions. Methods and analysis This study aims to determine whether, and if so, how, should NHSE implement a national DDPP, using a mixed-methods pretest and post-test design, underpinned by two theoretical frameworks: the Coventry, Aberdeen and London - Refined (CALO-RE) taxonomy of behavioural change techniques for the digital interventions and the Consolidated Framework for Implementation Research (CFIR) for implementation processes.
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