Diabetes Type II – Prevention

 

11.9 million people in the UK are at increased risk of developing Type 2 diabetes but around three in five cases of Type 2 diabetes can be prevented or delayed by maintaining a healthy weight, eating well and being active.  The following will enable you to identify the patients at most risk of developing type 2 diabetes and lists strategies for mitigating this risk

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Risk assessment

GPs and other health professionals and community practitioners in health and community venues should implement a two-stage strategy to identify people at high risk of type 2 diabetes (and those with undiagnosed type 2 diabetes). First, a risk assessment should be offered. Second, where necessary, a blood test should be offered to confirm whether people have type 2 diabetes or are at high risk

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Encourage people to have a risk assessment

  1. Encourage the following to have a risk assessment:
    1. all eligible adults aged 40 and above, except pregnant women
    2. people aged 25–39 of South Asian, Chinese, African-Caribbean, black African and other high-risk black and minority ethnic groups, except pregnant women
    3. adults with conditions that increase the risk of type 2 diabetes
  2. Explain to people why, even though they feel healthy, they can still be at risk of developing type 2 diabetes. Explain the implications of being at risk and that this can be reduced by making lifestyle changes

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Risk identification (stage 1)

GPs and other primary healthcare professionals should use a validated computer-based risk-assessment tool to identify people on their practice register who may be at high risk of type 2 diabetes. The tool should use routinely available data from patients' electronic health records. If a computer-based risk-assessment tool is not available, they should provide a validated selfassessment questionnaire, for example, the Diabetes Risk Score assessment tool.   This is available to health professionals on request from Diabetes UK

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Risk identification (stage 2)

Trained healthcare professionals should offer venous blood tests (fasting plasma glucose [FPG] or HbA1c) to adults with high risk scores (stage 2 of the identification process)

They should also consider a blood test for those aged 25 and over of South Asian or Chinese descent whose body mass index (BMI) is greater than 23 kg/m2. The aim is to:

  • determine the risk of progression to type 2 diabetes (a fasting plasma glucose of 5.5–6.9 mmol/l or an HbA1c level of 42–47 mmol/mol [6.0–6.4%] indicates high risk) or
  • identify possible type 2 diabetes by using fasting plasma glucose, HbA1C or an oral glucose tolerance test (OGTT)

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Matching interventions to risk

Low risk

For people at low risk (that is, those who have a low or intermediate risk score), tell the person that they are currently at low risk, which does not mean they are not at risk – or that their risk will not increase in the future

Offer advice, which should cover:

  • the patient's risk factors and how they could improve their lifestyle to reduce overall risk
  • encouragement and reassurance to the patient
  • verbal and written information about appropriate local services designed to improve their diet and increase their physical activity

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Moderate risk

For people with a moderate risk (a high risk score, but with a fasting plasma glucose less than 5.5 mmol/l or HbA1c of less than 42 mmol/mol [6.0%]):

  • Tell the person that they are currently at moderate risk, and their risks could increase in the future.  Explain that it is possible to reduce the risk. Briefly discuss their particular risk factors, identify which ones can be modified and discuss how they can achieve this by changing their lifestyle
  • Offer the patient a brief intervention to help them change their lifestyle, e.g. walking programmes, slimming clubs or structured weight-loss programmes

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High risk

For people confirmed as being at high risk (a high risk score and fasting plasma glucose of 5.5–6.9 mmol/l or HbA1c of 42–47 mmol/mol [6.0–6.4%]):

  • Tell the person they are currently at high risk but that this does not necessarily mean they will progress to type 2 diabetes. Explain that the risk can be reduced. Briefly discuss their particular risk factors, identify which ones can be modified and discuss how they can achieve this by changing their lifestyle
  • Offer them a referral to a local, evidence-based, quality-assured intensive lifestyle change programme.  In addition, give them details of where to obtain independent advice from health professionals

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Health Improvement Service

The Health Improvement Service, run by Kent Community NHS Foundation Trust, offers a number of programmes for increased physical activity including the Exercise Referral and Health walks schemes, and the Health Trainers service.  Click here for further details on the Exercise Referral Scheme

The Health Improvement Service also offers a Healthy Weight programme that include advice on healthy eating as well as a specialist weight management service.  Click here for further details on the Healthy Weight Service

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Blood tests / Phlebotomy

If your practice does not have a practice nurse who is trained to take bloods, you can refer a patient to the Pathology Department at East Kent Hospitals for a blood test (find details here)

Alternatively, Buckland Hospital (Dover) and the Royal Victoria Hospital (Folkestone) both operate a walk-in service where no appointment is necessary, except for if the patient requires a Glucose Tolerance Test (GTT).  In the event that a GTT is required, please call 01304 222552 (for Buckland) and 01303 854484 (for Royal Victoria) to arrange a suitable appointment

Please ensure that the patient remembers to take with them their blood test form to the walk-in centres

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Diabetes Risk Assessment Tool

The Diabetes Risk Score Assessment Tool is available to health professionals on request from Diabetes UK

Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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