By Sally Robertson
Identifying people who are at risk for Type 2 diabetes should become "a focus for everybody," say new UK guidelines.
Health and community services, pharmacies, faith centers, libraries, workplaces, and even shops should all pull together to identify people who are at high risk for developing the condition.
Such individuals can then be offered effective lifestyle-change intervention programs to prevent or delay the condition, say the National Institute for Health and Clinical Excellence (NICE) guidelines.
"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 Kamlesh Khunti (University of Leicester, UK) in a press briefing at the NICE headquarters in London.
"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."
The guidelines say that individuals at particular risk for developing diabetes include adults aged 40 and over (except pregnant women), people aged 25-39 years and from high-risk Black and minority ethnic groups, and adults with conditions that increase the risk for Type 2 diabetes.
General practitioners (GPs; family physicians) and other health professionals and community practitioners are being urged to implement a two-stage strategy to target these specific groups for intervention.
First, service providers, including pharmacists, managers of local health and community services, employers, and leaders of faith groups, should encourage people to carry out a self-assessment using a validated tool such as the Diabetes Risk Score. In addition, GPs should use a validated computer-based risk assessment tool to identify people on their practice register who may be at risk.
Second, people identified as being at high risk should be provided with a quality-assured, evidence-based, intensive lifestyle-change program to prevent or delay the onset of Type 2 diabetes.
"This is everybody's business," said Jill Hall from the Birmingham Community Healthcare Trust. "It's also the person at risk's business to look out for their lifestyle because that's what will make the biggest difference, not the complicated treatment, but the simple changes people can make in their everyday lives."
Hall also pointed out that one barrier to successful intervention among people from high-risk ethnic groups can be believing that diabetes onset is inevitable, as the condition has affected earlier generations in their family. This mind-set needs to be challenged, to help people to understand that progression is not inevitable and that they can substantially reduce their risk for developing diabetes simply by adopting a healthier lifestyle, she said.
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