Quality standard
Quality statement 1: Preventing type 2 diabetes
Quality statement 1: Preventing type 2 diabetes
Quality statement
Adults at high risk of type 2 diabetes are offered a referral to the NHS Diabetes Prevention Programme. [2016, updated 2023]
Rationale
Many cases of type 2 diabetes can be delayed or prevented through changes to a person's diet and physical activity. Evidence-based intensive lifestyle-change programmes, such as the NHS Diabetes Prevention Programme, can significantly reduce the risk of developing the condition for those at high risk. Adults should be referred to the NHS Diabetes Prevention Programme in a timely manner following identification that they are at high risk of developing type 2 diabetes, recognising that they may be more open to change at this time.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly. Services may want to use these measures to focus on dimensions of health inequality, for example by reporting data grouped by age, ethnicity or indices of deprivation.
Process
a) Proportion of adults at high risk of type 2 diabetes who are offered a referral to the NHS Diabetes Prevention Programme.
Numerator – the number in the denominator who are offered a referral to the NHS Diabetes Prevention Programme.
Denominator – the number of adults at high risk of type 2 diabetes.
Data source: The National Diabetes Audit diabetes prevention programme non-diabetic hyperglycaemia report collects and reports data on the number of people registered in GP practices in England who had a glycaemic test result in the non-diabetic hyperglycaemia range within the last 12 months who were offered a referral to the NHS Diabetes Prevention Programme.
b) Proportion of adults at high risk of type 2 diabetes who complete the NHS Diabetes Prevention Programme.
Numerator – the number in the denominator who complete the NHS Diabetes Prevention Programme.
Denominator – the number of adults at high risk of type 2 diabetes referred to the NHS Diabetes Prevention Programme.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from patient records.
Outcome
a) Weight loss of participants in the NHS Diabetes Prevention Programme.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, body mass index (BMI) recorded in patient records at referral and completion of the programme.
b) Reduction in HbA1c of participants in the NHS Diabetes Prevention Programme.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example HbA1c recorded in patient records at referral and completion of the programme.
What the quality statement means for different audiences
Service providers (such as local authorities who provide the NHS Health Check programme) ensure that systems are in place for adults at high risk of type 2 diabetes to be offered a referral to the NHS Diabetes Prevention Programme.
Health and public health professionals (such as GPs, pharmacists and people carrying out diabetes risk assessments and other health checks) ensure that they offer a referral to the NHS Diabetes Prevention Programme to adults at high risk of type 2 diabetes. They should ensure adults with type 2 diabetes are given clear information on the NHS Diabetes Prevention Programme and help to access it. Health and public health professionals should recognise when offering a behaviour change intervention may not be appropriate due to personal circumstances.
Integrated care systems ensure that they identify adults at high risk of developing type 2 diabetes and refer them to the NHS Diabetes Prevention Programme.
Adults who have been told they are at high risk of getting type 2 diabetes are offered a programme that will help them change their lifestyle to reduce their risk. This includes support to become more physically active and improve their diet. They receive clear information on the programme and are helped to access it.
Source guidance
Type 2 diabetes: prevention in people at high risk. NICE guideline PH38 (2012, updated 2017), recommendation 1.5.4
Definitions of terms used in this quality statement
High risk of type 2 diabetes
Fasting plasma glucose or HbA1c tests should be offered to adults with high-risk scores from a validated computer-based risk-assessment tool or a validated self-assessment questionnaire. A blood test should also be considered for those aged 25 and over of South Asian or Chinese family background whose BMI is greater than 23 kg/m2. A fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre or an HbA1c level of 42 mmol/mol to 47 mmol/mol (6.0% to 6.4%) indicates that a person is at high risk of type 2 diabetes (non-diabetic hyperglycaemia). [Adapted from NICE's guideline on type 2 diabetes: prevention in people at high risk, recommendations 1.3.1 and 1.4.1 and the National Diabetes Audit's Diabetes Prevention Programme non-diabetic hyperglycaemia report]
Equality and diversity considerations
Adults at high risk of type 2 diabetes should be given information that they can easily read and understand themselves, or with support, so they can communicate effectively with health and care services. Information should be in a format that suits their needs and preferences. It should be accessible to adults who do not speak or read English, and it should be culturally appropriate and age appropriate. Adults should have access to an interpreter or advocate if needed.
For adults with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.
Programmes should be tailored to meet the needs of adults with a high risk of developing type 2 diabetes and particularly groups such as older people, adults of different socioeconomic status, adults from minority ethnic family backgrounds, vulnerable or socially disadvantaged adults and disabled adults, including those with a hearing impairment, a visual impairment or a learning disability. Provision should also be made for adults who may have difficulty accessing services in conventional healthcare venues. Programmes should take into account the local social and cultural contexts.