Prevention is key to tackling threat of diabetes explosion

With it being Diabetes Week, this is a good opportunity to mention the new NHS Diabetes Prevention Programme (NDPP).

The NDPP is borne from the NHS Five Year Forward View and its commitment to help us halt or delay conditions and diseases developing. The push for prevention calls for a radical upgrade within the NHS. The NHS Diabetes Prevention Programme is a good start and will be very welcome in primary care.

In developing our capacity for prevention it makes a lot of sense to start with diabetes. It is a major cause of premature death and disability, particularly from heart attack and stroke, but also from blindness, kidney failure and amputations.

Diabetes accounts for a large proportion of our workload as GPs and nurses, and is very expensive for the NHS, currently accounting for around 10 percent of the health service budget. And this figure is predicted to rise substantially in the coming years as the prevalence of diabetes grows.

We understand the risks of diabetes very well in primary care. Every day we see the evidence that overweight and obesity is becoming the norm among our adult and child patient. The inevitability is that this will lead to an increase in diabetes and its complications, and the increasing risk that younger people will not outlive their parents.

At the same time we know that diabetes is very preventable. There is robust evidence from international studies that identifying people at high risk of diabetes and offering them intensive behaviour change support can significantly reduce the risk of diabetes developing.

Reflecting this, NICE guidance recommends that all our patients with HbA1c between 42 and 47 mmol/mol are offered intensive interventions to reduce weight, improve diet and increase physical activity.

Despite the clear guidance, however, most of us in general practice do not have access to this kind of service.

We may compile registers of patients at high risk of diabetes, identified opportunistically or through the NHS Health Check. But in general, the best we have to offer is a brief intervention from ourselves and perhaps an annual follow up by the health care assistant who will do her best in a single consultation to encourage weight loss and increased physical activity.

But as the NHS Diabetes Prevention Programme rolls out across the country over the next year or so we will have a high quality local service to refer our high risk patients into. This will provide them with comprehensive and intensive support to modify their behavioural risks, based on evidence of what works. And the evidence is impressive with a 30 to 60 percent reduction in incidence of diabetes being achieved.

So, at a time of burgeoning workload in general practice, this will be a very welcome new resource to support us in managing our patients at high risk of developing diabetes, and will help us to make prevention in the NHS a reality.

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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  1. Sandy Evans, Consultant Dietitian says:

    We would love to be involved in this dynamic programme. We have over 10 years of well audited NHS adult weight management outcome data in primary care and the community. Over 60 GP practice staff (including fitness instructors working in GP practices) in Hertfordshire and Cambridge have produced clinically significant weight loss outcomes including practices in the 20% most deprived areas.

    ProHealthClinical, the computer toolbox demonstrated that patients/clients receiving the personalised tools and guidance lost over three times the weight of control patients. (RCT Pilot was independently funded by BHF). It is being used successfully by a range of practitioners including health trainers, fitness instructors, health care assistants, nurses, dietitians, GPs and Specialist Obesity Consultants.

    I have won, ASO, NOF and RCGP awards for an adult primary care group community programme.

    We would greatly appreciate an opportunity to meet and discuss if we may be involved in any of the pilots.