Non Diabetic hyperglycaemia (NDH) identified by blood test in last 12 months (without diabetes diagnosis) e.g.:

• Haemoglobin A1c (HbA1c) : *¹42 – 47 mmol/mol or
• Fasting Plasma Glucose (FPG) : 5.5 – 6.9 mmol/L or
• Glucose Tolerance test: Blood glucose of 7.9 – 11.0 mmol/L after glucose challenge (HbA1c unsuitable for people with abnormal red cell turnover)

People with a history of Gestational Diabetes Mellitus (GDM) and normoglycaemia (FPG lower than 5.5mmol/l or HbA1c lower than 42 mmol/mol)

Differential Diagnosis

Consider red cell abnormalities

• HbA1c or
• Fasting Plasma Glucose or
• Glucose Tolerance Test

Health Care Professional (HCP) (e.g. GP, practice nurse, community nurse) sends/gives a self-initiative letter to eligible patients, which encourages patients to directly contact the provider to book an appointment.

Fill out and send the referral form to scwcsu.devon-ndpp@nhs.net

The provider of the service will provide:

Individual patient assessment:

• One-to-one review (collection of baseline data)
• Understand motivations, perceived obstacles and readiness to change
• Identify individual preferences and needs, establish weight management goals and set appropriate targets.

Primary intervention offers:

• Face to Face service:
  • Fortnightly group sessions x 6
  • Followed by monthly group sessions x 7

(please see supporting information for further details)

Digital service:

• One-to-one phone-based coaching through smartphone apps and telephone calls.

(please see supporting information for further details)

End of programme review:

• Review health plan and achievements (collection of all completion data)
• Identify follow-up support options/provide local-national activity information to aid sustainability
• Assessment of goal achievement/celebrate successes
• Request feedback

Tailored remote group-based sessions:

• For groups of service users more likely to experience health inequalities
• These include: GDM, hearing impairment, visual Impairment, those from Bangladeshi or Pakistani backgrounds.

Remote catch-up sessions:

• Remote sessions will also be available for participants in the Face-to-Face service who require a remote catch-up in place of a missed in-person session. For groups of service.

Non-engagement:

• Missed sessions: If a service user (SU) misses 3 consecutive sessions for no known reason they will be discharged from the service. GPs will be notified that the SU has been discharged. If the SU wishes to reengage with the service a new referral will need to be completed.

Please note pre-referral criteria are applicable in this referral and referrals may be returned if this information is not contained within the referral letter/form.

Referral Criteria

• HbA1c results between 42–47.9 mmol/mol (6.0–6.4%), or Fasting Plasma Glucose [FPG] result between 5.5-6.9 mmols/l dated within the last 12 months. If patient has a history of Gestational Diabetes (GDM) then patient is eligible with HbA1c less than 42 mmol/mol or FPG less than 5.5mmol/l.
• Where applicable, a previous history of GDM should be indicated under the ‘Referral Information’ section, regardless of whether current glycaemic status is normoglycaemic or non-diabetic hyperglycaemia.
• Patient does not have Type 2 Diabetes - if a reading is in the diabetic range (HbA1c greater than or equal to 48 or FPG greater than or equal to 7) the individual is not eligible. If two blood test readings are provided on the referral, and one is in the diabetic range, you will be asked to confirm that the patient is not being treated as diabetic.
• Patient is registered with a GP Practice within NHS Devon, is not pregnant (except for GDM patients) and aged 18 years or over. If aged over 80, you must confirm that you consider that the benefits of this programme are likely to outweigh the potential risks.
• There is no medical reason why this patient should not take part in a programme that includes light-moderate physical activity.

Referral Instructions

Send the self-initiative letter directly to eligible patients including NHS number, blood test result and date.

For patients aged 80 years old and over, please only use the referral form and send it to scwcsu.devon-ndpp@nhs.net, do not use the self-initiative letter.

For people with a history of GDM, blood test results are no longer required from March 2024. These patients (age 18-79 years old) can self-refer to the programme via Gestational Diabetes - Preventing Diabetes (preventing-diabetes.co.uk) or by calling on 0333 577 3010, or emailing to info@preventing-diabetes.co.uk stating the patient has a history of gestational diabetes. This includes those who have current GDM (i.e. are currently pregnant), although they can only start the programme post-pregnancy. GP practices may also refer these patients using the referral form.

Referral Forms

Diabetes Prevention Programmes patient self initiative letter template

Diabetes Prevention Programme referral form

Patient Information

Topics covered for Diabetes Prevention Programmes

We will cover in detail:

NDH (pre-diabetes) patient information

NDH (pre-diabetes) referrer information

Pre-diabetes patient information - MyHealth Devon

Evidence

Patients have said that they want more support to manage their condition. Consultants, GPs and nurses have said that they want to be able to support patients to self-care more easily.

People joining the programme have seen HbA1c reduced to below the 'at risk' range quickly, have reduced their weight and made lasting changes to their lifestyle during the 9 month programme. There is good published evidence of a 40% reduction in progression to diabetes for people who complete the programme.

NHS Prevention Programme cuts chances of type 2 diabetes for thousands | NIHR

Pathway Group

This guideline has been signed off by the Diabetes Prevention Programme working group on behalf of NHS Devon.

Publication date: April 2022

Updated: August 2024