The National Diabetes Prevention Programme.

Notwithstanding the human and financial implications of diabetes, we are concerned with the selective use of evidence to support the National Diabetes Prevention Programme. The editorial by Sood et al describes trials, which offered expensive, intensive interventions to participants selected on strict and extensive criteria with stringent methods to maintain participant engagement.1,2 Trials designed to emulate these randomised controlled trials have failed to reproduce the primary outcome of reduced diabetes incidence.3 Many lifestyle intervention trials in the UK and elsewhere have shown improvements in weight4 and blood glucose measurements,5 but have not reduced the incidence of diabetes.6 We hypothesise that policymakers have underestimated the complexity of sociocultural influences that predispose to diabetes and the barriers that need to be addressed to ensure success of ‘behaviour change’ interventions.7 We encourage the National Diabetes Prevention Programme to heed the recommendations of experts8–10 and initiate a long-term primary prevention strategy applied at multiple levels including population and community components.