GPs have been urged to screen all patients aged over 40 years and offer annual checks to those at high risk of diabetes in a major drive to reduce the numbers of patients developing the disease launched by NICE today.
Practices will be expected to go through their lists and carry out a risk assessment in everyone aged 40 years or over without diabetes, and anyone 25 years or older in a high-risk group, under the NICE guidelines.
The public health guideline is designed to support commissioners and GP practices to design programmes to reduce the risk of patients developing diabetes, but has been criticised as ‘beyond the capability’ of most GP practices.
NICE recommends anyone identified as high risk should have a blood test, and those with HbA1c levels that put them at high risk of developing diabetes should be offered an ‘intensive lifestyle change programme’ and annual checks from practices.
In those whose blood glucose levels continue to rise, putting them at risk of diabetes, the guidelines also recommend GPs consider prescribing meformin off-label for the first time to ‘support lifestyle change’.
Those at moderate risk of diabetes should be offered a ‘brief intervention’ to help them modify their risk factors and three-yearly checks, and those at low risk should be given ‘brief advice’ and be reassessed every five years.
Professor Kamlesh Khunti, professor of primary care diabetes at the University of Leicester and chair of the programme development group at NICE, said: ‘Evidence has showed that an intensive lifestyle programme, where patients make simple changes, like changing their diet, can help prevent the onset of diabetes. This is really welcome guidance.’
NICE say the guideline is designed to complement the existing NHS Healthcheck programme, but GP leaders said it would have huge financial implications for all GP practices and they would need additional investment to implement it.
Dr Laurence Buckman, GPC chair, said the Department of Health had to provide the resources needed to make NICE’s proposals a success.
He said: ‘These current plans call for resources that are currently beyond the capability of most practices.’
‘If we are to make this ambitious initiative a reality the Government will need to commit significant extra resources, including additional diagnostic services, medication budgets and an expanded workforce necessary to deal with new patients.’
GPC negotiator Dr Peter Holden added: ‘It they are not willing to resource it then I am not willing to do it. GPs are already squeezed to the point where there is no more to squeeze.’
What does the guidance recommend?
The two-stage approach sees GPs risk assess all patients over 40, using a validated risk assessment tool or questionnaire, also including all patients over 25 who are in high-risk groups including patients in South Asian, Chinese or black ethnic minorities and following the NHS Health Check process and protocols.
In high-risk groups, GPs should consider a blood test for South Asian and Chinese people aged over 25 and with a BMI over 23.
NICE recommends that GPs use the validated risk assessment tool developed by Diabetes UK and the University of Leicester as this also take into account the higher risk of developing type 2 diabetes in some ethnic minority groups.
Those found to be at moderate risk of developing diabetes should be reassessed at least every three years, while those at high risk should have their BMI reassessed and blood testing done annually.
Those at high risk should also be offered an ‘intensive lifestyle change programme’ to increase physical activity, reduce weight and keep a healthier diet and meformin treatment should be considered for those who continue to have high glucose levels.
It has also suggested GP intervention should be reinforced by assessments in health and community services, workplaces, job centres, pharmacies, faith centres, libraries and shops.
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