Identifying risk to help prevent type 2 diabetes is everyone's business

Published on Thursday, 12 July 2012 15:03
Posted by Scott Buckler

NICE has today published new guidance on identifying people at high risk of developing type 2 diabetes and the provision of clinically and cost effective interventions to help reduce the risk or delay the onset of the condition

Type 2 diabetes is a long-term (chronic) condition that occurs when the body does not produce enough insulini for it to function properly, or when the body's cells do not use insulin properly. Diabetes currently affects almost 3 million people in the UKii, of which about 90% will have type 2 diabetes. This is estimated to rise to 5 million - that is, nearly 10% of the population - by 2025. The cost of treatment and long term care for diabetes is estimated to account for a tenth of the NHS budget each yeariii.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: "Almost three million people are currently affected by diabetes, and it is likely to affect many more in the future. 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.

"Type 2 diabetes is a very large-scale problem and it is important for people to know that it is preventable, and there are simple steps that can be taken to help reduce the risk of developing the disease. 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 new NICE guidance outlines the best ways of identifying people at high risk of developing type 2 diabetes, encouraging them to take steps to reduce their risk and maintain a healthier lifestyle. Consistent good quality 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 guidance recommends that the following groups should be encouraged to have a risk assessment for diabetes, 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 and minority ethnic (BME) groupsvi (except pregnant women), and
  • adults with conditions that increase the risk of type 2 diabetes.

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 get advice about reducing it.

The new recommendations focus on two major activities:

  • Identifying people at risk of developing type 2 diabetes using a staged (or stepped) approach. This involves a validated risk-assessment score and a blood test - either the fasting blood glucose or, importantly, the HbA1c test to confirm high risk.
  • Providing those at high risk with a quality-assured, evidence-based, intensive lifestyle-change programme to prevent or delay the onset of type 2 diabetes.

Recommendations include encouraging adults to:

  • assess their risk of type 2 diabetes using a validated self-assessment questionnaire (paper based or online)ix ,or GP practices can use a computerised risk score based on information contained in patient records.
  • if they are assessed as high risk, to contact their GP or practice nurse for a blood test, either the fasting blood glucose or the HbA1c test to confirm their level of risk and discuss how to reduce it, or whether they already have type 2 diabetes.

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 programmex 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 type 2 diabetes 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 type 2 diabetes. 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.

Professor Kamlesh Khunti, Professor of Primary Care, Diabetes and Vascular Medicine, Department of Health Sciences, University of Leicester, and chair of the programme development group 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."

Christine Cottrell, Clinical Lead for Diabetes at Education for Health, Warwick, and member of the programme development group said: "This new NICE guidance sets out a practical, sensible approach to help stem the rising tide of diabetes in this country. Evidence shows us that changes in exercise and diet work, and can prevent the development of type 2 diabetes."

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."

Barry Cassidy, community member of the programme development group said: "I was diagnosed with diabetes 15 years ago, and in that time I have had to make important changes to my lifestyle. I've improved my eating habits and increased the amount of exercise I do. I would urge anyone who is worried about developing this condition to act now. Diabetes is preventable; people just need to be better informed about the simple steps they can take to halt the onset of this serious condition."

Source: ©NICE

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