The NHS Diabetes Prevention Programme, delivered nationally as Healthier You, is one of the clearest examples of prevention policy translated into a repeatable clinical service. It targets people with non-diabetic hyperglycaemia — raised blood glucose that has not yet crossed into a type 2 diabetes diagnosis — and offers a structured, nine-month course of support before that threshold is reached. For a prevention agenda that traces back to the 2014 case for shifting London’s health system upstream, the NHS Diabetes Prevention Programme is a useful test case: it shows what "prevention" looks like once it moves from a policy recommendation into an appointment a GP can actually make.
What Counts as Non-Diabetic Hyperglycaemia
Eligibility is defined by a blood test, not a symptom. Adults aged 18 and over with an HbA1c reading in the region of 42–47 mmol/mol within the previous 12 months — elevated, but below the diagnostic threshold for type 2 diabetes — are eligible for referral. The programme also makes a specific allowance for women with a history of gestational diabetes, who can self-refer without needing a fresh glycaemic test, including women currently pregnant who can be signposted by maternity services to refer themselves after pregnancy. Participants need to be free of a confirmed type 2 diabetes diagnosis and, in practice, motivated to commit to a nine-month course of behaviour change — the programme is a support structure, not a prescription.
What the Nine Months Actually Involve
Once referred, participants choose (or are offered, depending on local provider) between a small number of delivery formats built around the same core content: healthy eating, building physical activity into daily routines, and skills for sustaining change once the formal course ends. A typical face-to-face pathway runs to around 13 group sessions over nine months with a trained health coach. A digital service delivers broadly the same support through apps, wearable activity tracking, online peer groups and electronic goal-setting for people who prefer not to attend in person. Some providers also run a remote video-session option aimed at people who need additional accessibility support — visual or hearing impairment, specific language needs, or the gestational diabetes cohort described above. The format changes; the underlying content — diet, activity, and relapse-proofing — does not.
The Evidence Behind the Model
The programme’s case rests on outcomes that have been tracked since national rollout, and they are worth stating plainly because they explain why this is treated as core prevention infrastructure rather than a wellness add-on. Completing the course is associated with a reduction of more than a third (37%) in the risk of progressing to type 2 diabetes. Participants who complete the intervention lose an average of 3.3 kg, and one evaluation recorded an average HbA1c reduction of 2.04 mmol/mol (0.19%) among completers. None of these figures describe a cure — non-diabetic hyperglycaemia is a risk state, not a diagnosis reversed by a course — but they describe a measurable shift in trajectory for people who would otherwise have a meaningful chance of a type 2 diabetes diagnosis within a few years.
Referral Routes, and Why They Matter Locally
Three referral pathways feed the programme. GPs and their practice teams can refer any eligible adult with a qualifying HbA1c result. Anyone aged 40–74 can request a free NHS Health Check, which screens for type 2 diabetes risk alongside cardiovascular risk factors and can itself lead to a referral if the result warrants one. And patients who already know their HbA1c or blood sugar reading — through a health check, a workplace screening, or Diabetes UK’s "Know Your Risk" self-assessment tool — can self-refer directly.
Delivery in London runs through Integrated Care Boards rather than a single citywide provider, which means the practical experience of the programme differs by area even though the eligibility criteria and evidence base are the same everywhere. North East London, North West London, South East London and South West London Integrated Care Boards all commission the service; in South East London it is delivered by Thrive Tribe, and in North Central London by Liva Healthcare. For a prevention agenda built on the argument that outcomes vary sharply by borough, that provider-by-area structure is exactly the kind of implementation detail worth tracking — a resident’s actual pathway into prevention support depends on where their GP practice sits on the ICB map, not just on whether they qualify.
Referral Pathways at a Glance
| Route | Who it’s for | What triggers it |
|---|---|---|
| GP referral | Adults 18+ with a qualifying HbA1c result on record | A blood test result identified during routine care |
| NHS Health Check | Adults aged 40–74 | A free periodic check that screens for diabetes and cardiovascular risk together |
| Self-referral | Anyone with a known qualifying blood glucose or HbA1c reading, including women with a history of gestational diabetes | The individual’s own test result or risk-tool outcome |
Where This Sits in the Prevention Picture
The NHS Diabetes Prevention Programme is deliberately narrow: it addresses one risk state, with one defined intervention, delivered at scale. That narrowness is its strength — a service this specific can be evaluated, replicated across ICBs, and refined against real outcome data in a way that broader "improve population health" ambitions cannot. It is also a reminder of what the prevention agenda actually requires on the ground: not just funding commitments, but a referral pathway a GP can use in a ten-minute appointment, a provider with capacity to run group sessions or maintain a digital platform, and a system that tracks whether people who start the course actually finish it. Tracking how that infrastructure holds up borough by borough is precisely the kind of implementation detail an independent record of London’s health system is well placed to follow.