Quality statement 1: Preventing type 2 diabetes

Quality statement

Adults at high risk of type 2 diabetes are offered a referral to an intensive lifestyle-change programme. [new 2016]

Rationale

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 the condition for those at high risk.

Quality measures

Structure

Evidence of local arrangements to ensure that adults at high risk of type 2 diabetes are offered a referral to an intensive lifestyle-change programme.

Data source: Local data collection.

Process

a) Proportion of adults 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 adults at high risk of type 2 diabetes.

Data source: Local data collection.

b) Proportion of adults at high risk of type 2 diabetes who attend an intensive lifestyle-change programme after a referral.

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

Denominator – the number of adults at high risk of type 2 diabetes who are referred to an intensive lifestyle-change programme.

Data source: Local data collection.

Outcome

a) Weight loss of participants in intensive lifestyle-change programmes.

Data source: Local data collection.

b) Incidence of type 2 diabetes in adults.

Data source: Local data collection.

What the quality statement means for service providers, health and public health practitioners, and commissioners

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 an intensive lifestyle-change programme.

Health and public health practitioners (such as those carrying out diabetes risk assessments and other health checks, GPs and pharmacists) ensure that they offer adults at high risk of type 2 diabetes a referral to an intensive lifestyle-change programme.

Commissioners (such as local authorities and NHS England) ensure that they commission services in which adults at high risk of type 2 diabetes are offered a referral to an intensive lifestyle-change programme.

What the quality statement means for patients, service users and carers

Adults who have been told they are at high risk of getting type 2 diabetes are offered a referral to a programme that will help them to change their lifestyle (for example, by become more physically active and improving their diet) and so reduce their risk.

Source guidance

Definitions of terms used in this quality statement

High risk of type 2 diabetes

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%) indicates that a person is at 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 descent whose BMI is greater than 23 kg/m2.

[Adapted from NICE's guideline on Type 2 diabetes: prevention in people at high risk, recommendations 4 and 5]

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.

An example is the NHS Diabetes Prevention Programme.

[Adapted from NICE's guideline on Type 2 diabetes: prevention in people at high risk, recommendation 5 and glossary]

Equality and diversity considerations

Information should be provided in an accessible format (particularly for people with physical, sensory or learning disabilities and those who do not speak or read English) and educational materials should be translated if needed.

Programmes should be offered at times, and in locations, that meet the needs of groups such as older people, people from minority ethnic backgrounds and vulnerable or socially disadvantaged people. Provision should also be made for people who may have difficulty accessing services in conventional healthcare venues.