Prevention of type 2 diabetes: Are we missing the boat?

The prevention of type 2 diabetes is a key aim of both NHS England and Public Health England. The rising cost of type 2 diabetes means that there is a need to minimise the impact of the condition on the NHS by preventing people developing the condition in the first place. One strategy to manage this is the NHS Health Checks (www.healthcheck.nhs.uk). These cardiovascular risk assessments for people aged 40–74 years in England are an important and integral part of type 2 diabetes prevention. The benefits of these checks are described below:

• It is estimated that NHS Health Checks could prevent 4000 people a year from developing diabetes, if fully implemented.
• NHS Health Checks can identify those who are unaware that they have diabetes, which enables them to access care and treatment to reduce their risk of life-threatening complications. 
• The estimated savings to the NHS budget nationally are around £57 million over four years, rising to £176 million over a 15-year period (Diabetes UK, 2014). It is estimated that the programme will pay for itself after 20 years, as well as having delivered substantial health benefits.

NHS Health Check data for each local authority and region is now published by Public Health England (Diabetes UK, 2014). As you will be aware, Directors of Public Health and their teams were transferred from the NHS to local government in April 2013. Local authorities were given a new duty to improve the health of their population and some mandated public health functions. These included providing or commissioning NHS Health Checks for the eligible population and seeking continuous improvement in the percentage of the population participating in those checks.

A Diabetes UK report, NHS Health Checks in Local Authorities, shows that just 6.4% of people aged 40–74 had a check within nine months of the programme being switched from NHS to local government control. This percentage is significantly lower than the 11.25% of people in this age range that Diabetes UK say should be getting the check (Diabetes UK, 2014).

Do you know how well these checks are being carried out in your area? You can find this information in the Diabetes UK report. I was sad to learn that the local authority in my home town of Hull only achieved 2.9% of checks within the eligible population, but it was even more surprising to learn that the local authority of Surrey only achieved 0.3% of their eligible population. How can this be so? 

In Enfield, we only achieved 6.0%, which is in the mid-range for the boroughs of London (the range is 13.3–1.6%). Currently these health checks are not included in the Quality and Outcomes Framework (Health and Social Care Information Centre, 2013), so this may account for the poor results.

One initiative soon to be launched in Enfield is the “Prevention of Type 2 Diabetes Pathway”. This pathway stratifies risk for those individuals  with a high risk of type 2 diabetes according to the NICE document, Prevention of type 2 diabetes – risk identification and interventions for individuals at high risk (NICE, 2012). Those at high risk will be entered into a register and offered lifestyle modification education in a group setting using the “Healthy eating and physical activity conversation map tool” (created by US company, Healthy Interactions). These people will be reviewed on an annual basis with the aim of preventing the condition for as long as possible. What are you doing in your area to identify those at risk of developing type 2 diabetes?