More than 3m people have been diagnosed with diabetes in England and a further 5m are at high risk of developing the condition due to non-diabetic hyperglycaemia.*
Unless we act, the prevalence of type 2 diabetes and the devastating complications associated with the condition - heart disease, stroke, blindness, kidney disease and amputation - will continue to rise.
The Healthier You: NHS piabetes prevention programme (NHS DPP) is run collaboratively by NHS England, Public Health England and Diabetes UK with the aim of reducing people’s risk of developing type 2 diabetes across England. It will significantly improve the nation’s health while at the same time reducing a major financial burden on the system.
The NHS diabetes prevention programme began to roll out in 2016 to a first wave of 27 areas covering 26m people and making up to 20,000 places available to people with non-diabetic hyperglycaemia. It will be rolled out to the whole country by 2020 with an expected 100,000 referrals available each year.
The programme, delivered by one of four providers from a national framework but commissioned locally, is based on the best evidence. Running for at least nine months, with at least 16 hours face-to-face contact time, each intervention covers weight loss, healthy eating and physical activity with a focus on sustained behaviour change.
An evidence review commissioned by Public Health England highlighted the importance of covering both diet and activity in helping people delay or prevent type 2 diabetes.
Who is eligible for the programme
The programme will be available to over-18s with non-diabetic hyperglycaemia. It is not a screening programme – patients will be identified through routine clinical practice through:
- Those who have already been identified as being at high risk of type 2 diabetes within primary care. Routine primary care appointments can provide openings or opportunities to identify those at high risk of type 2 diabetes and most practices will have already identified individuals who are at high risk and will have information on their systems, or a register of patients with non-diabetic hyperglycaemia enabling them to refer into the NHS DPP.
- The NHS Health Check programme, commissioned by all local authorities in England systematically invites adults between the ages of 40 and 74 for risk awareness and assessment every five years and includes a diabetes risk assessment and referral for a blood test for those identified at risk.
In the past, options for evidence based, ongoing support for individuals with non-diabetic hyperglycaemia may have been limited, and the NHS DPP should provide an important route to help these individuals reduce their risk.
How our practice provides proactive care
We’re waiting for the NHS DPP to be launched in the area where I practice, but since 2010 we have been very proactive in trying to reduce the risk of progression to diabetes within our high risk population.
We have offered brief lifestyle intervention within the practice via a review with the nurse, with health education, management of risk factors and signposting to other relevant health professionals such as health trainers, exercise consultants, dietitians and smoking cessation advisers.
We’ve seen some positive results – in one year of audit, 93 patients were seen and after second readings were obtained, HbA1c had decreased in 77 people (83%), HbA1c remained the same in five people (5%) and increased in only five people (5%). Seven patients did not return for follow up (7%).
The importance of prevention
Prevention is the only way to tackle the increasing number of people at risk of type 2 diabetes and I believe it is hugely positive the NHS and Diabetes UK are investing in evidence-based routes for prevention.
Although long-term outcomes are uncertain, the problem is acute - diabetes is now the biggest health crisis the country is facing. Investment in the NHS DPP is to be applauded.
There is going to be more work for GP practices initially, but local incentive schemes can help support and reduce the workload as we know GP practices are already working to capacity. Some areas are using nurse facilitators to help with identification and referrals to the programme. Other avenues of referral need to be explored such as community initiatives, self-assessment and self-referral.
One person every two minutes is diagnosed with diabetes in the UK so it’s imperative we embrace this important opportunity to reduce the numbers and help achieve a healthier nation with a legacy for generations to follow.
- Dr Naresh Kanumilli is a GP in south Manchester and clinical champion for Diabetes UK
*Non-diabetic hyperglycaemia is a term used to define elevated blood glucose levels, HbA1c 42-47mmol/mol (6.0-6.4%), that are below diagnosis level but indicate a high risk of developing type 2 diabetes. It is sometimes known as prediabetes or impaired glucose regulation.