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

Dr Matt Kearney is a general practitioner and National Clinical Director for Cardiovascular Disease Prevention in England. He has been working for both NHS England and Public Health England since 2013, building a national programme to improve prevention of cardiovascular disease. In particular, he has focused on mobilising the wider primary care system to support earlier detection and improved management of conditions such as hypertension, atrial fibrillation, and raised cholesterol.

From 2009 to 2014, Matt worked as an advisor to the Department of Health helping develop a national respiratory strategy, and from 2005 to 2013, was a member of Public Health Interventions Advisory Committee at the National Institute for Health and Care Excellence. He graduated in Medicine from the University of Birmingham and obtained a Master’s Degree in Public Health from the University of Liverpool in 2003. He is a Fellow of the Royal College of Physicians and a Fellow of the Royal College of General Practitioners.

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