Diabetes Prevention Programme and socioeconomic inequalities in Type 2 Diabetes in England

Abstract   The National Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing Type 2 Diabetes Mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH, HbA1c 42-47 mmol/mol or 6.0-6.4%). How this programme affects inequalities by age, gender, disability, ethnicity, or deprivation is not known. We used multinomial logistic regression models to compare population characteristics at three stages along the prevention programme pathway: prevalence of NDH [using survey data from UK Household Longitudinal Study (N = 794) and Health Survey for England (N = 1,383)]; identification in primary care and offer of the programme [using administrative data from the National Diabetes Audit (N = 1,267,350)]; and programme participation [using programme provider records (N = 98,024)]). Younger adults (aged under 40) [4% of the NDH population (95% CIs 2%-6%)] and older adults (aged 80 and above) [12% (95%CIs 10%-14%] were both underrepresented amongst DPP participants [2% of DPP participants (95%CIs 1.8%-2.2%) and 8% (95%CIs 7.7%-8.3%) respectively]. People with disabilities were underrepresented in the DPP [15% (95%CIs 14.9%-15.1%) vs 60% (95%CIs 58%-62%)] compared to the general population. People living in more deprived areas were under-represented [14% (95% CIs 13.7%-14.3%) vs 20% (95%CIs 16%-24%) in the general population]. Ethnic minorities were overrepresented [36% (95%CIs 35.8%-36.2%) vs 13% (95%CIs 9%-17%) in the general population] among DPP referrals, though the proportion dropped at programme completion stage [19% (95%CI 18.5%-19.5%)]. The DPP has the potential to reduce ethnic inequalities but may widen socioeconomic, age, and disability-related inequalities in T2DM. Whilst ethnic minority groups are overrepresented at identification and offer stage, efforts are required to support the completion of the programme. Programme providers should target underrepresented groups to ensure equitable access and narrow inequalities in T2DM. Key messages • The DPP intervention may result in a widening of socioeconomic and disability related inequalities amongst people with NDH as the programme had fewer adults in deprived areas and with a disability. • The programme has the potential to reduce ethnic inequalities, but efforts are required to support the completion of the programme by minority ethnic groups.


Key messages:
The DPP intervention may result in a widening of socioeconomic and disability related inequalities amongst people with NDH as the programme had fewer adults in deprived areas and with a disability.The programme has the potential to reduce ethnic inequalities, but efforts are required to support the completion of the programme by minority ethnic groups.
Abstract citation ID: ckac129.160A community-based participatory approach to engaging Congolese migrants in intervention co-design Black and African migrants are known to be at risk of underimmunisation and have lower COVID-19 vaccine uptake rates in high-income countries.This UK study will use communitybased participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake.A community-academic coalition will lead the study.Community members will be trained as peer researchers and financially compensated.The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community.

Preliminary results:
The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants.Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised).

Lessons:
Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study.Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort.This study offers an innovative engagement model and study design that can be adapted to other underserved populations.

Key messages:
Global policy-setting organisations have called urgently for participatory research that engages migrants in the coproduction of tailored initiatives to address vaccination inequalities.This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.
15th European Public Health Conference 2022