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Summary of guidance relevant to general practice in July 2012

Preventing type 2 diabetes- risk identification and interventions for individuals at high risk

GP practices should identify patients on their register who are at high risk of developing type 2 diabetes and refer them for lifestyle interventions, NICE says.

Latest guidance from NICE recommends identifying those at high risk so that they can make lifestyle changes to reduce or even prevent them from developing type 2 diabetes.

GPs and practice nurses should do this by using validated computerised risk scores such as the Cambridge diabetes score, Leicester practice score or the QD score.

If a computer-based risk-assessment tool is not available, then practice staff should use a self-assessment questionnaire, such as the Diabetes Risk Score tool available from Diabetes UK.

The recommendations complement the current NHS Health Check programme which aims to ensure that everyone aged 40-74 is risk assessed for diabetes, cardiovascular disease, stroke and kidney disease.

NICE recommends that GPs encourage people aged 25-39 who are of South Asian, Chinese, African-Caribbean or Black African decent and other high risk black and minority ethnic groups to have a risk assessment for diabetes.

People with conditions that increase the risk of type 2 diabetes and those over the age of 75 should also be encouraged to have a risk assessment.

The second part - of a stepped approach to risk assessment - involves offering either a fasting blood glucose or HbA1c test to confirm whether a patient is at high risk of developing the condition.

A blood test should also be considered for South Asian and Chinese people aged 25 and over with a BMI greater or equal to 23kg/m2.

Those who are considered as high risk, a fasting plasma glucose of 5.5-6.9 mmol/l or an HbA1c level of 42-47 mmol/mol, should then be referred to a local, evidence-based, intensive lifestyle-change programme.

These programmes provide ongoing, practical, tailored advice, support and encouragement to help people be more physically active, achieve and maintain a healthy weight and eat a healthier diet.

GPs should reassess weight and BMI and offer a blood test at least once a year to all patients at high risk.

A second blood test should be carried out for people with possible type 2 diabetes - a fasting plasma glucose of 7.0mmol/l or above or HbA1C of 48mmol/mol but no symptoms of type 2 diabetes.

Patients with confirmed type 2 diabetes should be treated in line with current NICE management guidance.

Those who are considered to be at low or intermediate risk of type 2 diabetes should be offered brief advice on the risks of developing diabetes and reassessed at least every 5 years.

Support tools to help you put this guidance into practice

NICE has developed a baseline assessment tool, a costing report, costing template and shared learning examples to offer advice on how to put this guidance into practice.

Rivaroxaban for VTE

Patients with blood clots can be now be offered rivaroxaban as an alternative to warfarin for the treatment of blood clots following latest guidance from NICE.

Deep vein thrombosis (DVT) is a condition where a blood clot forms in a deep vein of the leg or pelvis, and then dislodges to travel in the blood.

This can lead to blood flow being limited by the clot, and can cause pain or swelling in the leg. It can also cause a pulmonary embolism, a potentially fatal event where the clot blocks the bloody supply to the lungs.

Estimates suggest there will be more than 46,000 cases of acute DVT in England and Wales during 2012, which will rise to nearly 50,000 cases by 2016, due in part to the country's ageing population.

Warfarin has been used to treat the condition in the past, but some patients find it inconvenient due to the careful monitoring, regular blood tests, and frequent clinic visits required to prevent excessive bleeding from cuts or stomach ulcers.

In final guidance, NICE says rivaroxaban can be used as an option for treating DVT and for preventing DVT and pulmonary embolism in adults diagnosed with DVT.

Rivaroxaban is a drug, orally taken, that prevents blood from clotting by preventing a substance called Factor Xa from working, which is necessary for the formation of key components in blood clots.

The recommendation follows further information requested by NICE in its previous draft guidance and now received from the manufacturer.

Support tools to help you put this guidance into practice

NICE has produced a costing template to accompany this guidance.

25 July 2012

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.