Quality statement 3: Referring people at high risk of type 2 diabetes

Quality statement

People from black, Asian and other minority ethnic groups at high risk of type 2 diabetes are referred to an intensive lifestyle change programme.

Rationale

People from certain ethnic communities have a higher risk of developing type 2 diabetes than those in the white European population. This includes people of South Asian, Chinese, black African and African-Caribbean family origin. In these populations, the risk of type 2 diabetes increases at an earlier age and at a lower BMI level. Many cases of type 2 diabetes are preventable through changes to a person's diet and physical activity levels. Evidence-based intensive lifestyle change programmes can significantly reduce the risk of developing type 2 diabetes for those at high risk.

Quality measures

Structure

Evidence of local arrangements for identifying and referring people from black, Asian and other minority ethnic groups at high risk of type 2 diabetes.

Data source: Local data collection, for example, GP contracts.

Process

a) Proportion of people from black, Asian and other minority ethnic groups identified as being at high risk of type 2 diabetes who are referred to an intensive lifestyle change programme.

Numerator – the number in the denominator who are referred to an intensive lifestyle change programme.

Denominator – the number of people from black, Asian and other minority ethnic groups who are identified as being at high risk of type 2 diabetes.

Data source: The Diabetes UK and NHS Digital National Diabetes Audit and local data collection, for example, GP patient records or data providers such as Commissioning Support Units (CSUs).

b) Proportion of people from black, Asian and other minority ethnic groups referred to an intensive lifestyle change programme who attended the programme.

Numerator – the number in the denominator who attended an intensive lifestyle change programme.

Denominator – the number of people from black, Asian and other minority ethnic groups who are at high risk of type 2 diabetes referred to an intensive lifestyle change programme.

Data source: The Diabetes UK and NHS Digital National Diabetes Audit and local data collection, for example, GP patient records or data providers such as CSUs.

c) Proportion of people from black, Asian and other minority ethnic groups referred to an intensive lifestyle change programme who completed the programme.

Numerator – the number in the denominator who completed an intensive lifestyle change programme.

Denominator – the number of people from black, Asian and other minority ethnic groups who are at high risk of type 2 diabetes referred to an intensive lifestyle change programme.

Data source: The Diabetes UK and NHS Digital National Diabetes Audit and local data collection, for example, GP patient records or data providers such as CSUs.

Outcome

a) Change in BMI among people from black, Asian and other minority ethnic groups completing intensive lifestyle change programmes.

Data source: Local data collection, for example, GP patient records.

b) Change in blood pressure among people from black, Asian and other minority ethnic groups completing intensive lifestyle change programmes.

Data source: Local data collection, for example, GP patient records.

c) Change in HbA1c among people from black, Asian and other minority ethnic groups completing intensive lifestyle change programmes.

Data source: Local data collection, for example, GP patient records.

d) Prevalence of type 2 diabetes among people from black, Asian and other minority groups.

Data source: The Diabetes UK and NHS Digital National Diabetes Audit and Public Health England's Diabetes prevalence estimates for local populations.

What the quality statement means for different audiences

Service providers (such as GPs and community healthcare providers) ensure that people from black, Asian and other minority ethnic groups who are identified as being at high risk of developing type 2 diabetes are referred to an intensive lifestyle change programme. They also ensure that systems are in place to start diabetes prevention interventions at a lower BMI threshold in people from minority ethnic groups at increased risk of type 2 diabetes. This may involve people in peer and lay roles raising awareness, assessing risks and providing advice on diabetes prevention among those ethnic minorities.

Health and public health practitioners (such as GPs, practice nurses and community healthcare providers) are aware that some black, Asian and other minority ethnic groups have an increased risk of type 2 diabetes. They refer people who are at high risk to an intensive lifestyle change programme and provide advice to those with a lower level of risk.

Commissioners (clinical commissioning groups, NHS England and local authorities in sustainability and transformation partnership areas) ensure that intensive lifestyle change programmes are available for people from black, Asian and other minority ethnic groups at high risk of type 2 diabetes. They work with ethnic minorities to ensure that programmes include a range of culturally sensitive and appropriate behaviour change interventions.

People from black, Asian and other minority ethnic group at high risk of type 2 diabetes are referred to culturally sensitive and appropriate services that can help them achieve healthy weight and be more active. Those who are not currently at high risk of type 2 diabetes are given information and further support relevant to their needs.

Source guidance

Definitions of terms used in this quality statement

Intensive lifestyle change programme

A structured and coordinated range of interventions provided in different venues for people identified as being at high risk of developing type 2 diabetes. It should be local, evidence-based and quality-assured. The aim is to help people to become more physically active and improve their diet. If the person is overweight or obese, the programme should result in weight loss. Programmes may be delivered to individuals or groups (or involve a mix of both) depending on the resources available. They can be provided by primary care teams and public, private or community organisations with expertise in dietary advice, weight management and physical activity.

[NICE's guideline on preventing type 2 diabetes in people at high risk, glossary]

High risk of type 2 diabetes

High risk is defined as a fasting plasma glucose level of 5.5–6.9 mmol/litre or an HbA1c level of 42–47 mmol/mol (6.0–6.4%). These terms are used instead of specific numerical scores because risk assessment tools have different scoring systems. Examples of risk assessment tools include: Diabetes risk score assessment tool, QDiabetes risk calculator and Leicester practice risk score. Risk can also be assessed using the NHS Health Check.

[NICE's guideline on preventing type 2 diabetes in people at high risk, glossary]

Lower thresholds (23 kg/m2 to indicate increased risk and 27.5 kg/m2 to indicate high risk) should be used for BMI to trigger action to prevent type 2 diabetes among Asian (South Asian and Chinese) populations compared to those used for the general population.

[NICE's guideline on BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups, recommendation 1]

Equality and diversity considerations

Due to language and communication difficulties, or past experiences of racism and prejudice, some people from black, Asian and other minority ethnic groups may find it difficult to engage with services. Intensive lifestyle change programmes need to be culturally appropriate, accessible and tailored to the diverse needs of the local population.