Turning the tide of type 2 diabetes
Diabetes is one of the world's fastest growing conditions, with the rate of people developing the condition showing no signs of slowing down.
In the last three decades, the number of adults worldwide with diabetes has risen by more than double, to an estimated 347 million.
Around 3 million people have the condition in the UK, and rates of diagnosis increased by 25 per cent between 2006 and 2011.
There are two forms of the condition; of these type 2 diabetes is the most common, and present in among 85% of cases.
Yet despite the rising prevalence, many live with diabetes not realising they have it, giving it the reputation of being a 'silent killer'.
In the UK alone, up to 850,000 people have diabetes without knowing it, and many more don't recognise their symptoms until it is too late; resulting in them developing associated complications.
These include stroke, heart disease, lower limb amputation and blindness, which together cost the NHS around £8.8 billion a year - just over 8 per cent of its annual budget.
While anyone can develop type 2 diabetes, some people are at higher risk. These include those from certain minority ethnic groups, and those with conditions such as obesity and cardiovascular disease.
However, type 2 diabetes is a preventable condition, and even those at high risk can significantly reduce their chances of developing it through simple actions such as losing some weight, increasing physical activity, and eating less fat and more fibre.
NICE's latest guidance, published today, adds to the existing NICE pathway on preventing type 2 diabetes. It focuses on identifying people at high risk of type 2 diabetes, and providing them with ways of preventing or delaying development of the disease.
Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE says: "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."
A two-stage approach to identifying those at risk
NICE recommends that GPs and other primary healthcare professionals should take a two-stage approach to identifying people at high risk of type 2 diabetes.
The first stage is to offer a risk assessment. NICE says that GPs and other primary healthcare professionals should use a computer-based risk-assessment tool, such as the Cambridge diabetes score, Leicester practice score or the QDiabetes score, to identify those on their practice register who may be at high risk of type 2 diabetes.
The tools should use data that is routinely available from patients' electronic health records.
If such tools are not available, then they should provide a validated self-assessment questionnaire, such as the Diabetes Risk Score assessment tool provided by the charity Diabetes UK.
Deepa Khatri, Clinical Adviser at Diabetes UK, says the assessment tool has already proved popular among health professionals.
"Our risk score assessment tool has been produced in conjunction with the University of Leicester and University Hospitals of Leicester NHS Trust, and practices can download it from our website," she says.
"It is designed to identify those at higher risk of type 2 diabetes, and has been requested by lots of healthcare professionals in the two years since it was launched."
As certain members of the population are at higher risk of developing the condition than others, NICE says that particular people within the community should be encouraged to take the risk assessment, to help delay or prevent onset of the disease.
- all eligible adults aged 40 and above, except pregnant women
- people aged 25-39 of South Asian, Chinese, African-Caribbean, black African and other high-risk black and minority ethnic groups, except pregnant women
- adults with conditions that increase the risk of type 2 diabetes, such as cardiovascular disease, hypertension, obesity and polycystic ovary syndrome.
Ms Khatri says: "According to our statistics, people from South Asian backgrounds are at six times increased risk of developing diabetes than the general population.
"Those from black African backgrounds have a three times higher risk of developing it than the general population."
The guidance also says that self-assessment tools should be provided at a wide range of venues, such as workplaces, job centres, community pharmacies, faith centres, libraries and shops.
This is so that people from diverse backgrounds have equal access to assessing their risk of diabetes.
For the second stage of risk identification, NICE says trained healthcare professionals such as GPs and practice nurses, should offer venous blood tests to adults with high risk-assessment scores.
This is to determine the risk of progression to type 2 diabetes, or to identify whether type 2 diabetes is already present.
The blood tests should either check fasting plasma glucose (FPG) levels or a non-fasting blood test of levels of HbA1c.
A high risk of developing type 2 diabetes is indicated by an FPG score of 5.5-6.9 mmol/l, or an HbA1c level of 42-47 mmol/mol 6.0-6.4%.
NICE recommends also offering blood tests for those aged 25 and over of South Asian or Chinese descent whose body mass index (BMI) is greater than 23 kg/m2.
People from these groups should be offered the tests in addition to those who have scored highly from a risk assessment, due to their elevated risk of type 2 diabetes.
Preventing type 2 diabetes in those at high risk
While a person might be categorised as at higher risk of developing type 2 diabetes, this does not guarantee that they will end up with the condition.
Professor Kelly says that "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".
These simple steps consist of making changes to lifestyle through losing weight, increasing physical activity and healthier diets.
NICE recommends that type 2 diabetes prevention plans should be developed by health and wellbeing boards and public health commissioners working with clinical commissioning groups.
These plans should include actions to raise awareness of the disease, adoption of the two-stage approach to identification, and carrying out intensive lifestyle-change programmes for those people at high risk of developing type 2 diabetes.
NICE says the intensive lifestyle-change programmes should be given by specialists who provide advice and support on physical activity, diet and weight management.
The programmes should be provided for groups of 10-15 people who are at high risk, and encourage people to carry out a range of activities.
- undertake a minimum of 150 minutes of ‘moderate-intensity' physical activity per week
- lose 5-10% weight in one year initially, then gradually reach and maintain a BMI within the healthy range
- increase their consumption of wholegrains, vegetables and other foods that are high in dietary fibre
- reduce the total amount of fat in their diet
- eat less saturated fat.
People who attend such programmes might be from a variety of ethnic and cultural backgrounds, particularly as those from minority ethnic groups tend to be at higher risk.
Consequently, NICE recommends that programme providers should tailor their approach so that it is sensitive and flexible to the needs, ability and cultural and religious norms of black and minority ethnic and vulnerable groups.
Ms Khatri comments: "There's lots of clinical research from around the world, which suggests that losing weight and following a diet can limit person's risk of developing type 2 diabetes.
"It's great that NICE is putting new guidance out which tackles this, because it is important to get the message out about introducing intensive lifestyle changes."
Visit the NICE pathway on preventing type 2 diabetes to see all of NICE's recommendations on the topic and for more on identifying and preventing the condition.
12 July 2012