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‘Bradford Beating Diabetes’ helps thousands reduce risk of Type 2 diabetes
More than 2,000 people at high at risk of developing Type 2 diabetes in Bradford have been given a helping hand to change their lifestyles in the first stages of a drive to improve health in the city.
Over the last two years ‘Bradford Beating Diabetes’ (BBD) has contacted 2,300 people they knew to be at high risk of Type 2 diabetes and offered them help to reduce that risk.
After getting good results they put in a successful bid to become one of the National Diabetes Prevention Programme’s pilot schemes which is looking to trial new ways of preventing the disease in high risk patients across the country.
As part of their bid they had to show how they had already mapped out a plan for their area.
Their £1m scheme, being run by Bradford City Clinical Commissioning Group (CCG) aims to reduce the prevalence of Type 2 diabetes but also to make sure those who have it are managing it well.
The CCG has a population which is 75 per cent south Asian and, before the scheme started, 7.5 per cent had diabetes; this was lower than expected, suggesting many people with diabetes had not been identified and were not getting treatment.
In November 2013 they launched a two phased approach: commissioned through a Local Improvement Scheme (LIS) to which all the 27 GP practices signed up.
First they invited 2,300 patients already known to be high risk into their GP practice for blood tests with health care assistants. If they were still at high risk they were invited to join an intensive lifestyle change programme (ILCP).
Secondly, in line with NICE guidance, they are looking to identify the wider population who could be at risk of diabetes – including white population over 40 and the south Asian community over 25 – approximately 38,000 people. Already, more than 14,000 of these people have been asked to attend their GP practice for a diabetes risk assessment, with thousands more expected to attend over coming months.
From the 38,000 people approached, to date 14,000 have attended for a check and 1,000 previously undiagnosed patients have been identified as being Type 2 diabetic. They are now getting treatment and care to reduce future risks of complication.
Around 6,000 were deemed to be at medium or high risk of Type 2. Those at high risk had a brief intervention, were added to a one year recall register and offered a place on an ILCP.
Those at medium risk had a brief intervention and were added to a three year recall register, and low risk patients received brief advice and were put on a five year recall register.
Dr Sohail Abbas, GP Clinical Board Member from Bradford City CCG said: “Nearly half of the people seen to date had either a high or medium risk of diabetes. We were quite surprised it was so high but very pleased we made contact with so many people.
“Overall we think it was a great success but there have been difficulties, for example getting people to attend the ILCP programme. Many of the areas we work in are very deprived and engagement with the public can be hard.
“However, we have been working with communities and faith leaders to make it work and have been trying to make it flexible to help understand issues about time, gender, language and other barriers including understanding nuances in being from certain parts of Bradford.”
The ILCPs are delivered by BBD Champions and are hosted by Bradford District Care NHS Foundation Trust. They are recruited from the community and do an intensive course on the criteria specified by NICE and accredited by the Royal Society for Public Health, administered through Leeds Beckett University.
Each ILCP consists of nine group sessions over a year and supports people to make healthy lifestyle choices including advice on activity, healthy eating, stopping smoking, the risk of not making changes and personal goal setting.
Around 200 people are currently on an ILCP. Leeds Beckett University is evaluating the ILCPs and has monitored its first ‘graduates’ who have all improved their lifestyle indicators, including reducing blood sugar levels. York Health Economics Consortium is producing an economic model with a cost-benefit analysis of the project.
As part of the National Diabetes Prevention Programme the Bradford scheme applied for £890,000. This will expand the work to Bradford Districts CCG to enable all patients in Bradford to have access to the programme. It will also focus on different methods to engage patients in the ILCP programme, increasing the completion rate of the programme.
And they want to link into the wider public health prevention work, for example in schools and local authorities to embed diabetes prevention messages into everyday life.
They forecast that there are at least an additional 10,000 people at a high risk of diabetes in Bradford who could benefit from the expansion of BBD.
Type 2 diabetes is due to a failure of secretion of glucagon like peptide-1 (GLP-1) because glucose is absorbed before it reaches the L cells located in the distal small bowel and rectum. Insulin should not be used since the plasma insulin level is too high due to the high plasma glucose level. Insulin is a growth hormone and high levels cause cancer and other complications often blamed upon the diabetes but actually due to use of insulin. Type-2 diabetes is GLP-1 dependent and not insulin dependent. You do not describe the treatment you use but it should not be any use of insulin. Reduction of insulin will appear to be of benefit but that is because less insulin is given when intensive regulation is used. Over eating causes lengthening of the jejunal villi which increases the absorptive surface resulting in no glucose reaching the L cells.and no secretion of GLP-1 which is required for prevention and treatment of type-2 diabetes. Insulin treatment should only be used is type-1 diabetes is present.