By Pam Brown, GP and Editor-in-Chief of Diabetes & Primary Care
In the September 2017 review and update of the NICE PH38 guideline on preventing type 2 diabetes in people at high risk, advice has been added on prioritising those at highest risk of progression. Where the availability of places on quality-assured, intensive lifestyle programmes for reducing diabetes risk is limited, those at highest risk (fasting plasma glucose 6.5–6.9 mmol/L or HbA1c 44–47 mmol/mol [6.2–6.4%]) should receive priority. Although lifestyle change programmes are cost-effective for all people at high risk of diabetes, they are particularly so in people with higher HbA1c or fasting plasma glucose levels.
In addition, the advice on metformin prescribing has been updated. Metformin should be considered in those at high risk whose blood test results deteriorate despite an intensive lifestyle programme and in those who cannot participate. This is particularly recommended if their BMI is greater than 35 kg/m2.
NICE reiterates the importance of communicating with people that they are at high risk of developing type 2 diabetes, but that this progression is not inevitable and can be reduced by changing their lifestyle. Primary healthcare professionals should discuss their personal risk factors and ensure that, if an intensive lifestyle programme is not available, they are signposted to independent advice from health professionals.
To access the guidance, click here.