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NICE finalises guidance for GPs to refer to diabetes prevention scheme

NICE has published the final version of a new guideline focusing on diabetes prevention.

The plans will, as previously reported, see GPs incentivised to refer patients to the 'Healthier You' scheme, which focuses on lifestyle interventions.

The new guideline updates that first published in 2012, with a new focus on NHS's flagship Diabetes Prevention Programme.

A NICE spokesperson said: 'The NHS Diabetes Prevention Programme is currently being implemented throughout England in response to the 2012 recommendations in this guideline.

'Implementing the 2017 recommendations will allow this programme to be initially targeted at groups of the population who will benefit most, in a way that is consistent across the UK.'

 The new guidance says:

  • For people confirmed as being at high risk (a high risk score and fasting plasma glucose of 5.5–6.9 mmol/l or HbA1c of 42–47 mmol/mol [6.0–6.4%]):
  • Tell the person they are currently at high risk but that this does not necessarily mean they will progress to type 2 diabetes. Explain that the risk can be reduced. Briefly discuss their particular risk factors, identify which ones can be modified and discuss how they can achieve this by changing their lifestyle.
  • Offer them a referral to a local, evidence-based, quality-assured intensive lifestyle change programme. In addition, give them details of where to obtain independent advice from health professionals.
  • When commissioning local or national services to deliver intensive lifestyle change programmes (see recommendations 1.8.1–1.10.2) where the availability of places is limited, prioritise people with a fasting plasma glucose of 6.5–6.9 mmol/l or HbA1c of 44–47 mmol/mol [6.2–6.4%].
  • Ensure that intensive lifestyle-change programmes are designed to help as many people as possible to access and take part in them (see sections 1.1.5 and 1.16 for recommendations on providing information and services, and supporting lifestyle change in people who may need particular support).
  • Use clinical judgement on whether (and when) to offer metformin to support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated if: this has happened despite their participation in intensive lifestyle-change programmes or; they are unable to participate in an intensive lifestyle-change programme, particularly if they have a BMI greater than 35.

Pulse has previously reported that GP practices have convinced 18,000 patients to take up Zumba, cookery classes and other NHS-backed lifestyle interventions as part of the NHS Diabetes Prevention Programme.

Readers' comments (5)

  • Cobblers

    We know that if T2DM diabetics and so called pre-diabetics got off their collective backsides and moved a bit and also took a look at their diets then a lot of the descent into sugar land can be delayed if not prevented.

    What we don't know is if these referral schemes actually work? I would want to see independent evidence that the Diabetic referral trials have come up with promising results. To date am unimpressed.

    And the costs! The Times today suggests that each referral may cost £475 EACH! There sure as hell ain't no money tree to quote some personage who might be PM, or not. To do this would mean billions redirected from other areas of medical care. Volunteers?

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  • The DIabetes Prevention Scheme,is seductive, especially as it's "evidence based", but the weight of the evidence is from the DPP, the Diabetes programme.
    The DPP used a highly selected group of highly motivated American patients, it was for 5years and cost about $1000/year, the Finnish Diabetes Prevention Study published the same time probably cost less but had ongoing regular support.
    The benefits of the DPS with less selection and less input are likely to be much less, and effect will fade away.
    In the DPP and Finnish study the diet and exercise group did get better results than the metformin group; but in the young and Obese metformin was actually just as effective and cost just £10/year. It's probably far more applicable for the general population.
    It's also approved by NICE but it remains little used, and GPs who prescribe it take on more work for no remuneration.
    Arguably putting it in the QoF would be far better use of resource.

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  • Adopting the 'Low Carbohydrate High Fat' diet would be far more effective and no cost to the health service. It is evidence based, but of course big pharma would much prefer people to consume ever larger quantities of the latest 'gliptin'

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  • Oh well no good without council actually commisioning a service

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  • Edoardo Cervoni

    It is perplexing that we are still suggested to be looking "for people confirmed as being at high risk of DM because of a fasting plasma glucose of 5.5–6.9 mmol/l or HbA1c of 42–47 mmol/L". It seems that a blood result is what we should need to raise concerns about DM. DM is endemic and it would not be shifting a sign-post to 5.5 mmol/L (which has been the case for a while now) to make the difference. If we really want to make a difference instead, we should not wait for that long and for a blood test result. As a matter of fact, observation and just using a simple weight scale could be an immediate, cheap, and helpful starting point. It can be argues that when blood tests start to show some degree of derangement, something is already going "wrong". We have known for many years that lifetime diabetes risk at 18 years of age increases significantly with BMI. It has been suggested that this varies from 7.6 to 70.3% between underweight and very obese men and from 12.2 to 74.4% for women. The promise of early intervention is that not only does it mean providing effective, timely support to those at risk to prevent poor later life outcomes and the intergenerational cycle of disadvantage, but it delivers savings to both local and national agencies at a time of increasing budgetary pressures.

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