Northern England Strategic Clinical Network Conference

Rahul NayarSCN – Diabetes Lead

15th May 2015

A TYPE 2 DIABETES PREVENTION PROGRAMME

Dr Mike LavenderConsultant in Public Health Medicine

Durham County Council

Diabetes Prevention Programme

58%

31%

39%

Recommendations include:• Identifying people at risk of developing type 2 diabetes using a staged

(or stepped) approach. • Providing those at high risk with a quality-assured, evidence-based,

intensive lifestyle programme to prevent or delay the onset of Type 2 Diabetes.

NHS Health Checks• National programme

launched in 2008• Aims to identify people who

are at a high risk of developing heart disease and stroke

• Target group aged 40 to 74 with no existing heart disease, stroke or diabetes

• 5 year rolling programme

By setting

GP Practice76%

Pharmacy5%

Community19%

Health Checks in County Durham2009 to 2014 – 72 practices plus community programme:– 260,000 people in the target age group– 64,111 (25%) ineligible due to CVD(35%), diabetes

(38%), CKD(20%)

Of the 195,000 eligible for a Health Check – 95,179 (49%) received a Health Check– 41,881 (44%) high risk for diabetes using HC filter

• SBP > 140 mmHg or• DBP > 90 mmHg or• BMI > 30 or• BMI > 27.5 South Asian

Patient C4l Personal Report

Check4Life Health Check

August 2014 to February 2015 - 6 months• 26 practices• 1,408 Health Checks with both checks• 538 (38%) high risk for diabetes using filter• 449 (32%) high/very high Diabetes UK Risk Score

>15

County Durham Diabetes Prevention ProgrammeProgramme

• 6 months of weekly educational and support sessions• 2 weekly physical activity sessions• An individual mentor to provide support• Regular support meetings for up to 2 yearsAims• Reduce risk of developing diabetes• Improve diet • Weight loss of 5-10kg or 5% • Increase physical activity levels

County Durham Diabetes Prevention ProgrammeAssumptions

• Eligible population for Health Checks = 111,633• Target number of health checks per year 20% =

22,326• Likely number of health checks 50% coverage =

11,163• Diabetes UK Risk Score >15 28% = 3,126• Take up offer of JBI 32% = 1000

County Durham Diabetes Prevention ProgrammePilot project

• 13 recruited • 7 completed the 6 month programme• 4 achieved CMO recommended physical activity level• All lost weight at 6 months• 4 lost 5-10kg or 5% of baseline weight at 6 monthsRoll out so far• 4 groups of 10 participants each Next stage• Menu of programmes of different length and intensity

National Diabetes Prevention Programme• A commitment of the NHS Five Year Forward View

– During 2015/16 have the new NHS Diabetes Prevention Programme up and running and available to 10,000 at risk individuals

– By March 2016 develop a comprehensive plan for the roll-out of the diabetes prevention programme in 2016/17

• Aim to identify those at risk early and refer them into evidence-based lifestyle interventions so that:– More people at risk receive interventions to lower their risk– The incidence of Type 2 diabetes and associated complications and

mortality decrease over the longer term.

Distribution of Diabetes UK risk levels

*Number above bar is an estimate of the number of new cases of diabetes in ten years

Distribution of Diabetes UK risk levels

79 74

*Number above bar is an estimate of the number of new cases of diabetes in ten years

Diabetes prevention: Targeted v Population approaches

Not Targeted

63626of whom

3181will develop diabetes in

10 years

115311of whom

11531will develop diabetes in

10 years

Targeted

74262of whom

10612will develop

diabetesin 10 years

9516of whom

3172will develop

diabetesin 10 years

14712will develop type 2diabetes in 10 years

13784will develop type 2diabetes in 10 years

Low Increased High Very High

of those who will develop diabetes in

County Durham will

be missed

focusing on those at high and very high

risk means

Projection of numbers in groups based on Healthcheck data gathered between July 2014 and February 2015 and applied to the number of people identified as part of the Healthcheck program between October 2008 and December 2013. Risk Levels use Diabetes UK Risk Score.

52%