Type 2 diabetes prevention: population and community-level interventions

Low carbohydrate diets

Several stakeholders suggested that the guideline should be updated to address low carbohydrate diets. However, none of the studies provided by stakeholders were included in the summary of evidence because they addressed a population that was not relevant to the diabetes prevention guidelines.

A new risk assessment tool (QDiabetes-2018)

One stakeholder suggested that the guideline should be updated to include the QDiabetes-2018 risk assessment tool. The current recommendations specify that GPs and other primary healthcare professionals should use a validated computer-based risk-assessment tool. If a computer-based risk-assessment tool is not available, they should provide a validated self-assessment questionnaire, for example, the Diabetes Risk Score assessment tool. Other providers, such as pharmacists should offer a validated self-assessment tool, with the Diabetes UK tool cited as an example. With recommendations that are permissive of choice in risk assessment tools, and no clear indication of superiority of a particular tool, an update in this area is not necessary at this time.

Non-alcoholic fatty liver disease

One stakeholder noted that non-alcoholic fatty liver disease is a known risk factor for type 2 diabetes, which is supported by the recommendations in non-alcoholic fatty liver disease (NAFLD): assessment and management (NICE guideline NG49). We will make an editorial amendment to footnote 1 of the recommendations (a list of conditions that can increase the risk of type 2 diabetes). This will note that NALD also increases risk of type 2 diabetes, with reference to the NAFLD guideline.

Blood glucose self-monitoring

One stakeholder indicated that blood glucose self-monitoring devices may have variable accuracy. This issue was thought to be not relevant to the guidelines on diabetes prevention, but has been logged for consideration in surveillance of guidelines on treating diabetes.

Digital technologies

One stakeholder suggested that the guideline should be updated to include the use of digital technologies such as wearable devices and apps. However, NICE has guidance on individual approaches to behaviour change (NICE guideline PH49), which is being updated to consider the use of technology such as apps, text messaging and the internet to drive improvements in behaviours such as physical activity, diet and weight. Additionally, The NHS DPP will be contributing future evidence to this specific question; a pilot in 5,000 people is live, and will assess whether digital behaviour change interventions delivered at scale and under service conditions are associated with change in clinical outcomes associated with diabetes prevention. We will check for publications resulting from this pilot, and consider any impact the results have on the guideline.

Bariatric surgery

One stakeholder suggested that the new evidence showing reduced incidence of type 2 diabetes after bariatric surgery should be included in an update. However, bariatric surgery is covered in the guideline on identification, assessment and management of obesity, which remains the primary indication for this procedure. The stakeholder additionally noted issues with implementation of recommendations on bariatric surgery. This has been logged for consideration in surveillance of the guideline on obesity.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.