Preventing type 2 diabetes on a national scale

The recent publication of the NICE (2011) guidance on the prevention of type 2 diabetes is the first of two documents on the subject. The second, currently in development, looks at interventions to prevent type 2 diabetes among individuals at high risk. This first guideline focuses on large scale interventions, particularly among high-risk groups (lower socioeconomic and black and minority ethnic groups). The formulation of the guidance generated some debate and the programme development group considered several different approaches to reducing the population and community risk of type 2 diabetes. It is important to take into consideration that there is a lack of good-quality evidence in this area and expert testimony as well as existing NICE guidance played a key role in helping shape the recommendations. The key themes are summarised below.

Recognition
Recognition of at-risk groups is important among healthcare professionals. Obesity is the single biggest risk factor for type 2 diabetes and there is separate NICE guidance on this subject (NICE and National Collaborating Centre for Primary Care, 2006).

Service provision and strategy
There needs to be some integration when developing a national strategy on non-communicable diseases such as type 2 diabetes and cardiovascular disease with a major link to diet, physical activity and obesity. Lifestyle messages should be consistent, clear, culturally appropriate and integrated within other health promotion campaigns or interventions. Ideally, successful local interventions, local resources and existing community groups should be identified that could help promote healthy eating, physical activity and weight management, particularly within local communities at high risk of developing type 2 diabetes.

Diet
Healthier food choices should be promoted, in particular those that have less calories and saturated fat. Portion control should also be emphasised. The aim should be to make the healthier food choice the easiest and relatively cheaper choice for people. The retailers targeted may include regional and national supermarkets and convenience store chains, as well as street markets and small independent shops.

Physical activity
The benefits of physical activity and the national recommendations on physical activity need to be made clear. Benefits exist even if there is no significant weight loss, so this fact should not put people off being more active. Much can be done to promote physical activity, which should be a priority when developing the local infrastructure and when dealing with planning applications for new developments.

Training
It is important that all healthcare professionals can provide advice on nutrition, physical activity and weight management to prevent type 2 diabetes. It is also key that training programmes exist for all healthcare professionals (including undergraduate, continuing professional development and, where appropriate, postgraduate training), and where they exist, the use of community links and lay workers from black and minority ethnic communities and from lower socioeconomic groups can be used to help deliver interventions.

The benefits
Implementing this new NICE guidance could result in a reduction in the number of people developing type 2 diabetes, or a delay in onset for a number of years; this could lead to savings for the NHS and other public sector organisations. Reducing the number of people with type 2 diabetes may also reduce the number of people with other non-communicable diseases that share similar risk factors (such as cardiovascular disease). However, any potential savings are not likely to be realised for a number of years after the initial costs are incurred and this may prove a stumbling block if a “quick win” solution is sought to the problems at hand