Recommendations for research

The guideline committee has made the following recommendations for research.

1 Identification and monitoring

Which combination of risk-assessment tools and blood tests (HbA1c or fasting plasma glucose [FPG]) are most cost effective and effective at identifying and assessing the risk of type 2 diabetes among populations at high risk? In addition, how frequently should testing take place to be efficient? How does effectiveness and cost effectiveness vary for different black and minority ethnic groups, for example, African-Caribbean and black African; people aged 18–40, people aged 75 and over, and for high-risk vulnerable adults? [2012]

What are the demographic characteristics and rates of progression to type 2 diabetes among people with a high risk score but normal blood glucose levels (fasting plasma glucose of less than 5.5 mmol/l or HbA1c of less than 42 mmol/mol)? How does this compare with people who have both a high risk score and blood glucose levels that indicate impaired glucose regulation (fasting plasma glucose 5.5–6.9 mmol/l or HbA1c 42–47 mmol/mol (6.0–6.4%)? [2012]

What are the most effective and cost-effective methods of increasing uptake of type 2 diabetes risk assessments and monitoring among those at greatest risk? Those at greatest risk include people from lower socioeconomic and black and minority ethnic groups, and those aged 75 or over. [2012]

2 Lifestyle interventions

Which components of an intensive lifestyle-change programme contribute most to the effectiveness and cost effectiveness of interventions to prevent or delay type 2 diabetes in those at high risk? How does this vary for different black and minority ethnic groups, for people of different ages for example, aged 18–24, 25–39 and 75 and over, and for vulnerable adults? [2012]

How effective and cost effective are different types of dietary regime in reducing short- and long-term blood glucose levels and preventing or delaying type 2 diabetes? How does this vary for different subgroups, for example, African-Caribbean and black African and other minority ethnic groups and for people of different ages, for example, aged 18–24, 25–39 and 75 and over? [2012]

How effective and cost effective are different types (and levels and frequency) of physical activity in reducing short- and long-term blood glucose levels and preventing or delaying type 2 diabetes? How does this vary for different subgroups, for example, different black and minority ethnic groups and people of different ages, for example, aged 18–24, 25–39 and 75 and over? [2012]

3 Vulnerable groups

What are the most effective and cost-effective methods for identifying, assessing and managing the risk of type 2 diabetes among high-risk, vulnerable adults? This group includes: frail older adults, homeless people, those with severe mental illness, learning or physical disabilities, prisoners, refugees, recent migrants and travellers. [2012]

4 Digitally delivered intensive lifestyle-change programmes

What is the effectiveness of providing digitally delivered intensive lifestyle-change programmes in preventing type 2 diabetes in adults at high risk of type 2 diabetes?

Why this is important

There is a lack of good quality evidence on the effectiveness of digitally delivered intensive lifestyle-change programmes in preventing type 2 diabetes. [2017]

More detail on the gaps in the evidence identified during development of this guidance is provided in appendix D.

  • National Institute for Health and Care Excellence (NICE)