Diabetes Prevention Programmes

Scope

From April 2018, two schemes have been launched in the Devon STP area aiming to prevent the onset of Type 2 Diabetes in the at-risk population. The schemes will both be delivered by WW Health Solutions and a local provider, Westbank, through a direct contract for a national programme [Healthier You] and a local contract [Healthier Devon] commissioned by Devon County Council. Both schemes have the same eligibility criteria.

The schemes deliver evidence-based behavioural interventions to individuals at high risk of developing Type 2 diabetes and associated long-term illnesses.

Out of Scope

  • People under the age of 18 years old
  • People with a diagnosis of Type 1 or Type 2 Diabetes
  • People that are pregnant

Assessment

Non Diabetic hyperglycaemia (NDH) identified by blood test in last 24 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)

Women 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

Investigations

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

Management

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 ww.devon@nhs.net

The provider of the service will provide:
  • Individual patient assessment:
    • Weight
    • Height
    • Waist circumference [Healthier Devon only]
    • BP [Healthier Devon only]
  • Patient Group Sessions:
    • EQ5D (5 dimensions measure of health outcome: mobility, self-care, usual activities, pain/discomfort, anxiety/depression)
    • EQVAS (EuroQuol vertical visual analogue scales of overall health) [Healthier Devon Only]
    • Evidence based behavioural interventions (please see supporting information)

Non-engagement:

  • Missed sessions: If patient misses 3 consecutive sessions for no known reason they will be lapsed from the service. GP notified that patient is 'lapsed'. If patient wishes to reengage with the service a new referral will need to be raised.

Referral

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.

Referral Criteria

  • Age 18+
  • HbA1c = 42 – 47 mmol/mol (HbA1c within the last 24 months) or Fasting Plasma Glucose = 5.5–6.9 mmol/L or Glucose Tolerance Test = 7.8 - 11.0 after glucose challenge
  • Ready to make lifestyle changes
  • Not pregnant
  • Women with a history of Gestational Diabetes Mellitus (GDM) and normoglycaemia (FPG lower than 5.5mmol/l or HbA1c lower than 42 mmol/mol)

Referral Instructions

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

Referral Forms

Diabetes Prevention Programmes patient self initiative letter template

Diabetes Prevention Programme referral form

Supporting Information

Patient Information

Topics covered for Diabetes Prevention Programmes
Topics
Introduction, including risk and prevention of Type 2 diabetes; goal setting
Pre-diabetes and a healthy lifestyle including: 5 key healthy lifestyle messages: (1 Eating a healthy diet; 2 Undertaking regular exercise; 3 Achieving and maintaining a healthy weight; 4 Positive mental health and wellbeing; 5 Making healthy lifestyle choices)
Healthy Easting, including risk and prevention of Type 2 diabetes; goal setting
Barriers to Healthy Eating, including risk and prevention of Type 2 diabetes.
Eating Less and Food Labelling
Physical Activity, including risk and prevention of Type 2 diabetes; goal setting
Physical Activity Barriers, including risk and prevention of Type 2 diabetes; goal setting
Barriers to Behaviour Change
Positive Mental Health and Wellbeing, including risk and prevention of Type 2 diabetes; goal setting

Pre-diabetes patient information - MyHealth

Diabetes Prevention Programme Infographic

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 or 24 month programme. There is good published evidence of a 26% reduction in progression to diabetes for people who complete the programme.

Pathway Group

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

Publication date: April 2020

Updated: July 2021

Last updated: 09-07-2021

 

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