Delivering the mahi program in the NHS
A report for service providers and health professionals
Summary report
This report is a summary of the full analysis which includes a literature review understanding the evidence base of lifestyle interventions and outcome results.
Background
Diet and lifestyle-related programmes for pre-diabetes and type 2 diabetes have been developed and delivered with varying results across the globe. In the UK there is a national diabetes prevention programme for pre-diabetes and regional options including low-calorie, weight-focused and exercise related that are nationally endorsed.
​
On a small-scale there are programmes being delivered taking a lifestyle-based approach. We seek to create an up-to-date programme that can deliver excellent results in pre-diabetes and type 2 diabetes that has ability to be delivered cross-community and scaled.
Program, Results & Analysis
The program was created over 6 months and informed by a full literature review. Recruitment of patients from one GP surgery in North London was undertaken. 22 patients enrolled with 17 patients completing >75% of the programme.
​
N=12 patients had pre and post Hba1c results and included in the analysis. Hba1c fell by mean 9.5 mmol.mol (pre 56.5mmol/mol, post 47.1mmol/mol), weight reduction 6.54kg (pre 91.7kg post, 85.23kg), BMI reduction 2.11, systolic BP drop 2.0 mmHg and diastolic 0.7 mmHg.
Impact across BMI, BP & Hba1c
These results are after the 12 sessions delivered over 6 months.
Qualitative feedback
How has the course improved your health?
“The course has helped improve my mental and physical health. I am sleeping better, doing my best to maintain a good exercise programme and eating less carbohydrates”.
“I have found the weekly sessions have focused me on being more aware of the food I buy, how much I prepare, the names and terms”.
​There were multiple comments on improved sleep, improved weight and improved mental health and well-being.
​
What was most useful to you?
“Hearing other peoples’ experiences”
“Taking part in the group itself, as it helps see others improve and feel normal”, “Most useful was being in a group, not feeling alone with the problems and hearing other people’s situations”
The most frequent answer of what was most useful was being part of a group, and it appears there were significant benefits for many individuals to being part of a group.
​
What was least useful to you?
There were responses that the session on medication was least useful. This could be partly explained by the fact that the medicines may not have been relevant to many people with pre-diabetes and the focus of the program was to reduce medicines.
One person stated one of the sessions with a nutritionist was less useful as this was more of an overview. In consideration of this session there was less coaching involved.
How do you think the programme could be improved?
There was one comment to include the program to anyone that needed to lose weight, and another comment to try and make it even more simple. One person stated face-to-face meetings and including healthy diabetes meals.
Increasing competition or having a league table was also suggested and also long-term creating support groups.
Conclusion
A scientifically informed, evidence-based programme with coaching support, developed and delivered in 2022/2023 can deliver significant outcomes in diabetic, cardiac and metabolic risk markers including Hba1c, weight and BP delivering superior outcomes to incumbent programmes.
​
This programme has ability to be standardised and scaled to deliver ongoing positive outcomes for health systems and patients. There is scope for the programme to be delivered for weight loss as well.