Preventing Type 2 Diabetes: the size of the prize

A major report published this week shows us the size of the prize for the NHS Diabetes Prevention Programme (NHS DPP).

The report by the National Cardiovascular Intelligence Network has analysed five years of data from the Health Survey for England and estimates that 5million people over the age of 16 in England are at high risk of developing Type 2 diabetes. That is, they have blood sugar levels that are high although not yet in the diabetes range, so-called non-diabetic hyperglycaemia.

It’s helpful for people to know they’re at high risk because they can take steps to reduce that risk and prevent diabetes from developing.

There is robust evidence from a range of international studies which show that intensive support for behaviour change in people without diabetes, who have high blood sugar levels substantially, reduces the risk of conversion to Type 2 diabetes. This preventative approach is the rationale for the NHS Diabetes Prevention Programme which will be rolled out in stages from 2016.

As GPs and nurses, of course, we’re well aware of the need to take action to reduce the risk of Type 2 diabetes. Every year we see the progressive rise of overweight and obesity among our patients, with increasing numbers developing Type 2 diabetes.

As a result of this we see more people developing the serious complications of diabetes at an earlier age – heart attacks and strokes, kidney, eye and foot problems, all increasing the risk of early death or major disability in relatively young people.

As well as these personal disasters for our patients and their families, national spending on Type 2 diabetes currently uses up about 10% of the NHS budget. As this proportion rises with the predicted increase in obesity and Type 2 diabetes, our health service risks becoming unsustainable. Yet despite these immense costs to individuals and the NHS, many people are unaware that diabetes can often be prevented or delayed through changes in personal lifestyle.

In general practice we often discover that people have non-diabetic hyperglycaemia just as part of routine care. The NHS Health Check now supports us in this, with a more systematic approach to identifying people at high risk: when someone is found to have a raised HbA1c or blood sugar as part of the health check they are referred back to the GP for further management.

The challenge for many of us in primary care is that we don’t generally have access to evidence-based diabetes prevention services to refer those patients into. The NHS DPP will help us fill that gap. I think this is an encouraging development.

Once up and running my colleagues and I will be able to refer patients on to the programme, knowing they will be offered intensive professional support to lose weight, improve their diet and increase physical activity – all known to reduce the risk of diabetes. At the moment most of us in primary care do not have access to that sort of service for our patients.

Also published this week is a major review of the evidence for diabetes prevention. The review included 36 original studies and updated a systematic review from 2012. The findings are very encouraging, showing that on average the incidence of Type 2 diabetes was 26% lower, following completion of a diabetes prevention programme. This was accompanied by significant reductions in weight and HbA1c.

Importantly this review also tells us more about the essential components of a successful diabetes prevention programme. For example, better outcomes are seen in programmes that combine physical activity and diet, with sessions that last one to two hours delivered 13 or more times over nine to 18 months. Additional social support alongside the intervention also resulted in better outcomes.

These essential elements have been incorporated into the proposed model for the NHS DPP to ensure that the programme closely reflects the evidence of what works. The draft outline of the programme has just been published for consultation so that clinicians, practitioners, academics and the public can give their views.

From a GP and nursing perspective, this is a great opportunity for us to help shape the NHS Diabetes Prevention Programme as a major new resource for primary care and help to make sure that it reflects the needs of our patients and fits well with general practice.

Dr Matt Kearney

Matt Kearney is NHS England’s National Clinical Director for Cardiovascular Disease Prevention and a GP in Shropshire. He has been working for both NHS England and Public Health England since 2013, and has led development of the NHS Long Term Plan CVD Prevention Programme.

In particular, he has focused on driving system change to help the NHS to get serious about prevention of heart attacks, strokes and other vascular conditions – through clinical leadership, better use of data, and new ways of working that support primary care to improve outcomes for patients and communities.

Previously Matt worked as clinical and public health advisor to the Department of Health respiratory programme, and was a member of the NICE Public Health Interventions Advisory Committee from 2005 to 2013. He has a Master’s Degree in Public Health and is a Fellow of both the Royal College of GPs and the Royal College of Physicians.

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