Preventing Type 2 diabetes

Guidance on how to optimise the NHS Diabetes Prevention Programme in order to identify those at risk of Type 2 diabetes and help lower their risk of developing the disease | Public Health England

NHS DPP
Image source: www.gov.uk

Healthier You: NHS Diabetes Prevention Programme (NHS DPP)

The NHS DPP is a joint commitment from Public Health England, NHS England and Diabetes UK. The Programme, launched in 2015, delivers evidence based behavioural interventions at scale for individuals identified as being at high risk of developing Type 2 diabetes.

The NHS DPP is underpinned by a strong evidence base. PHE has published a systematic review and meta-analysis examining the effectiveness of diabetes prevention programmes.

The goals of the NHS DPP are to:

  • reduce the incidence of Type 2 diabetes
  • reduce the incidence of complications associated with Type 2 diabetes – heart, stroke, kidney, eye and foot problems related to diabetes
  • reduce health inequalities associated with incidence of Type 2 diabetes, over the longer term

In the short-term, the Programme recognises that a stronger focus on identifying people who are at risk of diabetes is likely to increase recorded incidence of diabetes as more undiagnosed cases are uncovered. This is important to recognise as it is possible to live for some time with undiagnosed Type 2 diabetes; in 2015, an estimated 900,000 people had Type 2 diabetes but were undiagnosed.

There is strong international evidence that demonstrates how behavioural interventions, with a focus on supporting people to maintain a healthy weight and be more active, can significantly reduce the risk of developing Type 2 diabetes. The NHS DPP behavioural intervention reflects this evidence, as it is underpinned by 3 core goals:

  • achieving a healthy weight
  • achievement of dietary recommendations
  • achievement of the Chief Medical Officers’ (CMO) physical activity recommendations
Dr Jonathan Valabhji outlines the aims of NHS Diabetes Prevention Programme

Full detail: Health matters: preventing Type 2 Diabetes

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2008 recession led to increase in obesity, diabetes and mental health issues

The 2008 recession resulted in changes to individuals’ health behaviour, with a significant increase in the likelihood of obesity, diabetes and mental health problems | Social Science & Medicine | Story via ScienceDaily.

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Researchers from City University London and King’s College London looked at data from the Health Survey for England (HSE), a cross-sectional survey taken yearly from a representative sample of about 9,000 English households. They specifically used data on respondents above 16 years of age for the period 2001-2013. In addition to socio-economic characteristics, the HSE includes information on a wide range of health lifestyles and health conditions.

The results of the study suggest that the start of the recession was associated with worse dietary habits and increased BMI and obesity. It was also associated with a shift away from risky behaviours, as a decrease in smoking and alcohol consumption was seen. In addition, there was an increase in the use of medicines and a higher likelihood of suffering diabetes and mental health problems, all of which were generally experienced more acutely by those with less education and by women.

Researchers discovered that the probability of being obese and severely obese increased by 4.1 and 2.4 percentage points respectively. Similarly, the probability of having diabetes was 1.5 percentage points higher after 2008, with the prevalence of mental health problems increasing by 4 percentage points.

Full story at ScienceDaily

Full reference: Mireia Jofre-Bonet, Victoria Serra-Sastre, Sotiris Vandoros |  The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England | Social Science & Medicine, 2018.

Type 2 diabetes can be reversed with very low-calorie diet

Study shows that it is possible to achieve remission from type 2 diabetes by dieting | The Lancet | via National Institute for Health Research

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Type 2 diabetes is a growing epidemic, costing the NHS £23.7 billion per year. By 2016 there were nearly 3.6 million people diagnosed with diabetes in the UK and a further one million estimated to have undiagnosed type 2 diabetes. Rates of diabetes appear to be increasing.

This study aimed to see if a very low-calorie diet program delivered in primary care could lead to at least 15kg weight loss and remission of type 2 diabetes.

The study found that by 12 months:

  • Weight loss of 15kg or more was achieved by 24% of the intervention group compared to none of the usual care group. Average weight loss was 10kg in the intervention group versus 1kg in the usual care group.
  • Diabetes remission occurred in 46% of the intervention group compared to 4% of the usual care group. It only occurred in people who had lost weight.
  • Remission was 20 times more likely with the intervention.
  • Better adherence to the regime increased the amount of weight loss and the chance of diabetes remission.
  • Diabetes medication did not need to be reintroduced for 74% of the intervention group. This was compared to 18% of the usual care group who were able to stop them. Blood pressure tablets were also no longer required for 68% of the intervention group compared to 39% of the usual care group.

Full reference: Lean MEJ, Leslie WS, Barnes AC, et al. |  Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.  | Lancet. 2017. [Epub ahead of print].

NICE recommends ‘lifestyle tips’ for 1.7m at risk of type 2 diabetes

People at the highest risk of type 2 diabetes should be given intensive exercise and weight loss help by the NHS, NICE has recommended.

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Healthcare professionals, from GPs to community nurses and pharmacists, should refer people with elevated blood sugars to exercise classes and nutrition courses, NICE has said in updated guidance.  Lifestyle-change programmes, such as NHS England and Public Health England (PHE)’s ‘Healthier You: NHS Diabetes Prevention Programme’, provide personalised help for patients to change their diet and increase their physical activity.

NICE has identified 1.7 million people as having the highest risk of developing type 2 diabetes, and  recommends that GPs should see specific groups of patients for a diabetes risk assessment.

Full guidance: Type 2 diabetes: prevention in people at high risk

Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes

Barry, E. et al. BMJ. 356:i6538

Objectives To assess diagnostic accuracy of screening tests for pre-diabetes and efficacy of interventions (lifestyle or metformin) in preventing onset of type 2 diabetes in people with pre-diabetes.

 

Conclusions: HbA1c is neither sensitive nor specific for detecting pre-diabetes; fasting glucose is specific but not sensitive. Interventions in people classified through screening as having pre-diabetes have some efficacy in preventing or delaying onset of type 2 diabetes in trial populations. As screening is inaccurate, many people will receives an incorrect diagnosis and be referred on for interventions while others will be falsely reassured and not offered the intervention. These findings suggest that “screen and treat” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes.

Read the full article here

 

A Structured Transition Program Among Young Adults With Type 1 Diabetes

Pyatak, E. et al. Journal of Adolescent Health. Published online: November 23 2016

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Purpose: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care.

Conclusions: Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.

Read the full abstract here

NICE guidance update: Diabetes (type 1 and type 2)

NICE has updated its guideline Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NG18).

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Image source: http://www.nice.org.uk

This guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18.  It has been amended to add information to recommendations 1.2.115 and 1.3.52 on when eye screening should begin and referral for eye screening should happen.
Related:  NICE Pathway – Diabetes in children and young people