Overview

What is DP-Next?

DP-Next is a project aimed at developing a sustainably effective strategy for prevention of Type 2 Diabetes in Denmark, Greenland and the Faroe Islands. The project has been funded by a Steno National Collaborative Grant from the Novo Nordisk Foundation and will officially start on the 1st of September 2025. The full name of the project is: Sustainable Type 2 Diabetes Prevention for the 21st Century. We call it DP-Next because we intend to develop the next generation of Diabetes Prevention strategies.

Why is a new strategy for diabetes prevention necessary?

We have known for over two decades that it is possible -in principle- to prevent Type 2 Diabetes in people at very high risk by encouraging them to participate in a very intensive lifestyle modification program.

The original Diabetes Prevention Studies were conducted around the turn of the century.

• The Diabetes Prevention Program (USA)
• The Diabetes Prevention Study (Finland)
• The Da Qing Study (China)

Unfortunately, subsequent efforts to translate the benefits from these efficacy trials into sustainable day to day practice have largely failed. The first main issue is that the resources and intensity of the trial interventions are not practically achievable at large scale. Studies that have applied less intensive lifestyle interventions have generally shown only temporary impacts on weight, but no long-term impact on diabetes incidence. The second main issue is that the particular subgroup of pre-diabetes recruited into the trials (IGT) is the group at highest diabetes risk, but is rarely identified in daily practice especially since HbA1c has replaced the oral glucose tolerance test (OGTT) as the main diagnostic tool in Europe and the US since 2014. A third issue is that the proportion of people who respond to an invitation to participate in health-related programs has fallen substantially. Unfortunately the people with the highest risk profile are generally the least likely to respond.

In other words:

• The population with high diabetes risk today is much more heterogeneous compared to the participants in the original prevention trials
• The intensity of intervention applied in the efficacy trials is not pragmatically or sustainably achievable
• Participation in health initiatives is low and selected

What has changed since?

The past decades have brought a lot of new opportunities for diabetes prevention, which are currently often underutilised:

• Extensive, linkable health registers with population-wide coverage
• Advanced statistical and machine learning methods
• Deeper insight into psychosocial barriers for sustainable health behaviour change
• Stronger experience with methods for development of complex interventions
• Expanding evidence for substantial heterogeneity in (pre)diabetes and diabetes risk
• Advanced technology for real time measurements (CGM, sleep, physical activity)
• Widespread adoption of communication via smartphones and use of apps

What will DP-Next do?

We aim to use these developments to design and deliver a sustainably effective strategy for prevention of T2D in Denmark, Greenland and the Faroe Islands.

We will work towards this aim in four Work Packages (WP) across all seven Steno Diabetes Centres:

Figure 1: There are 5 Steno Diabetes Centers in Denmark, one in Greenland and one on the Faroe Islands.

• WP1 (Management and Collaboration) will manage the project and foster deep collaboration between all partners.
• WP2 (Risk Prediction) will develop an exclusively register-based diabetes risk prediction model for the entire Danish, Greenlandic and Faroese populations, applying advanced statistical and machine learning approaches on a wide set of risk indicators. It will map out meaningful subgroups and validate internally and in external populations.
• WP3 (Heterogeneity) will map out heterogeneity in T2D risk in a new deeply phenotyped cohort of 1000 participants with HbA1c-based pre-diabetes with a core protocol focused on regional fat distribution, hepatic steatosis, beta cell function and insulin resistance plus the creation of an extensive biobank and the ambition for an extended protocol.
• WP4 (Intervention Development) will develop an intervention for sustainable primary diabetes prevention based on co-creation, a “Participatory System Dynamics Approach” and the “Complex Interventions” framework and evaluate the pragmatic feasibility of intervention components in specific risk subgroups in real life practical settings.