PH38: Preventing type 2 diabetes
Professor Kamlesh Kunti, Chair of the public health guidance group, discusses the latest public health guidance on preventing type 2 diabetes.
This podcast was added on 13 Jul 2012
Hello, and welcome to this podcast from NICE about the NICE public health guidance on preventing type 2 diabetes.
I'm with Professor Kamlesh Khunti, Guidance Chair and Professor of Primary Care Diabetes and Vascular Medicine, at the University of Leicester.
Professor Kunti, could you explain to me, what is type 2 diabetes, and why does it seem to be increasing in prevalence?
Type 2 diabetes is a condition where you have gradual decline in the amount of insulin that your pancreas produces. At the same time, the insulin that the body is producing isn't used as well in peripheral tissues such as muscles.
The reasons for the prevalence increasing are quite complex. There are some genetic factors, but overall it's because of the changes in the environment, in particular our lifestyles. We're not exercising as much and our energy intake has increased over the years as well.
And, are there certain kinds complications associated with type 2 diabetes? What are the symptoms, and what would you say the complications are?
Well this is the worrying thing about diabetes, that at the early stages, you do not get symptoms at all. By the time you develop symptoms you already have some complications of diabetes. And these complications are usually some narrowing of your arteries and your heart, narrowing of the arteries in the legs, changes in the sensation of your feet (pain), and also changes in the back of your eyes and the kidneys. So eventually, 70% of people will die of heart disease. But many people will suffer from complications of blindness, amputations, kidney failure and then going into dialysis.
Thank you. In terms of the general population, are there certain groups of people that you would say are more at risk of developing type 2 diabetes?
Well in a pragmatic way, everyone is at risk of diabetes, if you live long enough, you will develop diabetes, but there are certain groups who develop diabetes much earlier. And these groups are people who are obese, people who have a family history of diabetes, people who are of certain ethnic groups, for example South Asian groups, and also age is a big factor. As you age you are more likely to get diabetes as well. The other people who are at high risk are people who have diabetes in pregnancy, and people who have things like polycystic ovarian syndrome.
What recommendations does the NICE guidance make to reduce the inequality of services perhaps, that these people are currently experiencing?
I think we are very pleased in terms of the guidance, it makes clear recommendations for the population at large, but more so, people who are at much higher risk. So these are people who are from certain ethnic groups, certain people with mental health problems who are on certain drugs, that puts them at high risk, and there are low socioeconomic groups, and travellers who are also at high risk who don't get their health-seeking behaviours consistently. There's some clear advice on what these people should do and how they should get their risks assessed and how they should be referred for these prevention programmes.
So in the new guidance, what does NICE recommend that GPs and other primary healthcare professionals should do to identify these at-risk groups of people that you mention?
Well we are very pleased that this guidance not only looks at identification but also prevention as well. In terms of identification, the recommendations are that we should identify people being at high risk of diabetes using simple tools. These are non-invasive tools that the patients can use themselves For example the risk score that's available on the Diabetes UK website - people can assess it and determine if they are at high risk or not. These can also be downloaded on paper-based forms as well which can be used in faith centres or pharmacists.
That's one method, the other method is that the UK general practice computer systems have the best data in the world for patients. So, from the data about the patient, about their age, about their ethnicity, about their BMI, one can identify from the computer database if someone's likely to be high risk.
And how will the risk assessment tools be targeted to those people?
Again, the recommendations say that it's everyone's responsibility to identify these people. So travellers do access opticians, they do access pharmacists, they do go to supermarkets. And these are all places where these simple risk scores could be available. And obviously there's a website that people can log on to and assess their risk themselves.
On the basis of this, if you are at high risk, just using these simple risk scores, you can say there are certain people who are at high risk who would need a blood test to have a definitive diagnosis of either diabetes or being at high risk. The blood test would be either a fasting blood glucose or a non-fasting glycated haemoglobin (HbA1c). And so these are making very simple recommendations of how we can identify people who are at high risk.
Thank you. You mention the blood tests - could you explain to me what the difference is between the blood tests?
Fasting blood glucose tells you about the glucose at the time in your body when the blood is taken. While HbA1c is an average of what blood glucose levels have been over the previous 8 weeks.
The advantage of the HbA1c is that you can have it done in a non-fasted state. While the fasting one you have to have it before 11 o'clock. You have to fast from midnight and come into your surgery to have a blood test anytime between 8 and 11, so it limits the number of people who may have access to this. And HbA1c you can get done any time.
Great thanks, and so once someone has been identified after this process that you mention as being at high risk of developing type 2 diabetes, what measures can they do to prevent or delay the actual onset of developing it?
Well the messages we have given out in this guidance are quite simple, regarding changing diet and changing exercise patterns. Very simple things done consistently will prevent or delay diabetes.
As part of the guidance recommendations, the evidence base is people who are identified as being at high risk are referred for an evidence-based structured education programme, where they would go and see a specialist - these are not medical specialists - and in groups of 10-12 people, going on a regular basis over 18 months, getting messages about their risk, and how they can lower their risk, how they can set goals in terms of how much walking they need to do; we know all these messages will lead to the prevention of diabetes by about 50%.
And in terms of these lifestyle change programmes that you mention, who will be carrying out these programmes?
Well the identification initially, in terms of the blood tests, will occur at the practice. Following this, there should be programmes in place within the area that the patients are in - what we call clinical commissioning groups - in the local authorities. They will have the remit of identifying what programmes are available, they will need to map out what's already available to see if they want to tweak them and have a more coordinated programme for these high-risk groups.
Professor Khunti, thank you very much.
This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.
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This page was last updated: 19 September 2012