The new NICE guidance outlines the best ways of identifying people at high risk of developing type 2 diabetes (T2D), encouraging them to take steps to reduce their risk and maintain a healthier lifestyle. Evidence shows that individual risk can be reduced by nearly 60%. The recommendations can be used alongside the NHS Health Check programme, the national vascular risk assessment and management programme for people aged 40–74 years.
The guideline group was chaired by Primary Care Diabetes Society committee member Professor Kamlesh Khunti, Professor of Primary Care, Diabetes and Vascular Medicine, Department of Health Sciences, University of Leicester. He said: “Type 2 diabetes is a serious problem in England, and it can be devastating for those affected. I was pleased to chair the group which developed this guidance, which sets out clear, evidence-based recommendations that, if implemented, can help prevent the onset of this condition.”
The guidance recommends that the following groups should be encouraged to have a risk assessment for T2D, so they can be offered advice to help them prevent or delay the condition:
- All adults aged 40 and above (except pregnant women)
- Those aged 25-39 and of South Asian, Chinese, African-Caribbean or black African descent, and other high risk black and minority ethnic groups (except pregnant women).
- Adults with conditions that increase the risk of T2D.
Health and community services, workplaces, job centres, community pharmacies, faith centres, libraries and shops are encouraged to offer risk assessments so that everyone can understand their level of risk and obtain advice about risk reduction.
The new recommendations focus on:
- Identifying people at risk of developing type 2 diabetes using a validated risk-assessment score and a blood test – either fasting blood glucose or HbA1c test – to confirm which individuals are high risk.
- Providing those at high risk with a quality-assured, evidence-based, intensive lifestyle-change programme to prevent or delay the onset of T2D.
Recommendations include encouraging adults to:
- Assess their risk of T2D using a validated self-assessment questionnaire. GP practices can use a computerised risk score based on information contained in patient records.
- if they are assessed as high risk, they are encouraged to contact their GP or practice nurse for a blood test to confirm their level of risk and discuss how to reduce it, or whether they already have T2D.
Measuring HbA1c levels has been used for diabetes management for a number of years, but it has not been used for the identification of people who are at high risk of developing diabetes.
People who have been assessed as high risk and have had their risk confirmed by a blood test should be offered a referral to a local, evidence-based, quality-assured intensive lifestyle-change programme which provides ongoing, practical, tailored advice, support and encouragement to help people be more physically active, achieve and maintain a healthy weight and eat a healthier diet. Providers of risk assessments should explain to those attending the implications of being at high risk and the consequences of developing the condition, and that it can be prevented or delayed by making long term lifestyle changes. It is also important to explain to people why, even though they feel healthy, they can still be at risk of developing T2D. The guidance also recommends that providers of intensive lifestyle change programmes should use a tailored approach, which is sensitive and flexible to the needs, ability, and cultural and religious norms of black and minority ethnic and vulnerable groups.
Jill Hill, Diabetes Nurse Consultant, Birmingham Community Healthcare Trust and member of the programme development group said: “As a diabetes nurse, I have seen first-hand how the condition can affect a person’s life. People may not be aware that diabetes is the most common cause of visual impairment and blindness, kidney failure and non-traumatic lower limb amputations. This guidance focuses on risk assessment and providing those at high risk with evidence-based, effective interventions that can delay or prevent this condition.”
Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE, said: “ Our new guidance includes some large-scale recommendations, such as the setting up of a new accreditation body to oversee effective practice in type 2 diabetes prevention. We also want health and wellbeing boards and public health commissioners to work with clinical commissioning groups to ensure that type 2 diabetes prevention is central to their health improvement strategies. This guidance will help people to identify their own personal risk and highlights that by losing weight, being more active and improving their diet, they can prevent or delay type 2 diabetes.”
The guidance Preventing type 2 diabetes – risk identification and interventions for individuals at high risk is available at www.nice.org.uk/ph38.
