NICE has updated its PH38 guidance on preventing type 2 diabetes in people at high risk. The 2012 version of the guideline recommended that intensive lifestyle-change programmes should be offered to people at high risk of type 2 diabetes:
- Fasting plasma glucose 5.5–6.9 mmol/L, or
- HbA1c 42–47 mmol/mol (6.0–6.4%).
However, the guideline committee recognises that providing these programmes to so many people has a large resource impact. Therefore, the committee has determined that, in instances where offering the intervention to all high-risk people is not possible due to capacity constraints, lifestyle-change programmes should be prioritised for people with the following:
- Fasting plasma glucose 6.5–6.9 mmol/L, or
- HbA1c 44–47 mmol/mol (6.2–6.4%).
This has been estimated to prioritise around 1.7 million people. The NHS Diabetes Prevention Programme is currently being implemented throughout England in response to the 2012 recommendations. Implementing the 2017 recommendations will allow this programme to be initially targeted at groups who will benefit most, in a way that is consistent across the UK.
The committee also recognised that people with mental illness or dementia often have worse physical health and would, therefore, benefit from testing and, if needed, intervention to reduce their risk of type 2 diabetes. Therefore, an additional recommendation has been made to ensure that intensive lifestyle-change programmes are designed to help as many people as possible to access and take part in them.
In addition, advice on prescribing metformin has been updated. The committee agreed that:
- Metformin can be used in support of lifestyle change when blood test results have deteriorated despite someone taking part in these programmes or if they cannot take part.
- This is particularly recommended for people whose BMI is over 35 kg/m2.
The updated guidance is available at https://www.nice.org.uk/guidance/ph38
