NICE: GPs must target diabetes prevention

By Caroline Price

Guidance for the prevention of type 2 diabetes out today from NICE urges GPs to step up efforts to get high-risk patients onto lifestyle intervention programmes. As trailed at the end of last year, the guidance recommends that GPs run checks on their practice register using a validated computerised diabetes risk tool and invite those falling into high-risk groups for a proper risk assessment, in line with the NHS Health Check programme.

This means targeting anyone aged 40 years or older and those aged 25-39 years of South-Asian, Chinese, African-Caribbean or Black-African descent or from another black and ethnic minority group (except pregnant women), as well as people with conditions that increase diabetes risk.

The guidance also encourages use of the nonfasting HbA1c test to confirm patients' level of risk and whether or not they already have diabetes. Speaking at a press briefing at the NICE headquarters in London, Professor Kamlesh Khunti (University of Leicester) explained that the nonfasting test is likely to increase uptake, as it is more convenient for patients.

Professor Khunti, who led the guidelines development group, noted that practices could choose whether to use the computerised Cambridge, Leicester or QRISK tools depending on the make-up of their population - those currently without a computerised tool should provide a validated self-assessment questionnaire, such as the Diabetes Risk Score. He said that the new measures outlined in the guidance should not increase GPs' workload overall, because they involve targeting specific groups instead of the whole population.

It is estimated that 15% of the population in the UK - between 10 and 12 million - are at high risk of diabetes. NICE hopes the guidance will markedly reduce the number who progress to diabetes - currently around 5% of high-risk patients develop the condition each year - as intensive lifestyle programmes have been shown to more than halve the likelihood of developing diabetes across all subgroups.

"We used to talk about diabetes as being an epidemic, now we call it a tsunami because it is overtaking most of the other chronic diseases in prevalence," remarked Professor Khunti. "The problem with diabetes is not the ones who have got it - we can manage them - but there are three times as many people who are at high risk for diabetes, and unless we identify them and manage them appropriately, this tsunami is going to get worse."

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