index.qmd

---
title: "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](https://novonordiskfonden.dk/en/) and officially started 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.

<details>

<summary>The original Diabetes Prevention Studies were conducted around
the turn of the century.</summary>

<ul>

<li>The <a href="https://doi.org/10.1056/nejmoa012512">Diabetes
Prevention Program</a> (USA)</li>

<li>The <a href="https://doi.org/10.1056/nejm200105033441801">Diabetes
Prevention Study</a> (Finland)</li>

<li>The <a href="https://doi.org/10.2337/diacare.20.4.537">Da Qing
Study</a> (China)</li>

</ul>

</details>

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:

![There are 5 Steno Diabetes Centers in Denmark, one in Greenland and
one on the Faroe
Islands.](images/map-steno-centers.jpg){#fig-map-steno-centers}

- **[WP1 – Management and Collaboration](wp1/index.qmd)** will manage the project and
    foster deep collaboration between all partners.
- **[WP2 – Risk Prediction](wp2.qmd)** 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](wp3.qmd)** 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](wp4.qmd)** 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.