Pre-Diabetes Pilot Project with Public Health Wales

 

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A pilot project commenced in February 2020 within South Cynon focusing on pre-diabetes. Phase 1 focuses on the  identification of individuals from GP practice registers who have previously had a HbA1c blood test result which identifies them as ‘pre diabetic’ and thus at a higher risk of developing type 2 diabetes mellitus.

After being invited for a repeat blood test if required, all individuals age 18-74 years who are not on a diabetic register but have a HbA1c within ‘pre diabetic range’ will be invited into the practice for a 20-minute structured brief intervention with a band 3 Health Care Support Worker who has received additional training on prediabetes, nutrition and physical activity advice. The consultation will also include measurement of height, weight, BMI and blood pressure.

Patients will be contacted again at 12 months’ post intervention and offered a repeat HbA1c and follow up appointment with a healthcare support worker. Measurements will be repeated together with a discussion of any lifestyle changes undertaken. Evaluation of patient experience and outcomes will be supported by academic partners.

 

Background and rationale for the pilot:

Diabetes mellitus is one of the most common chronic diseases in Cwm Taf Morgannwg University Health Board (CTM UHB) with a prevalence of 7.9% (approx. 28,000 people) of those aged 16 years and over.  It is projected to increase to affect around 45,000 people in CTM by 2025.  Diabetes is associated with a number of health risks and complications and linked to increasingly high health service expenditure.

‘Pre-diabetes’ or non-diabetic hyperglycemia is where blood glucose is above normal but below the threshold for a diagnosis of diabetes1.  ‘Pre-diabetes’ is a high-risk state for developing type 2 diabetes and its associated complications.

Research in England found that over 50% of the overweight population aged 40+ years have ‘pre-diabetes’ and are thus at a higher risk of developing type 2 diabetes mellitus.  Evidence suggests that 5-10% of those with ‘pre-diabetes’ will progress to type 2 diabetes each yearwith the same proportion converting back to normoglycaemia.

There is a growing evidence base to support interventions aimed at ‘pre- diabetic’ patients. A systematic review found that behavioural interventions conducted in ‘real world’ settings were effective in reducing weight and reducing the incidence of type 2 diabetes.  Overall incidence was reduced by 26% over 12-18 months post-intervention3.

Subsequently, in June 2016, Public Health England, NHS England and Diabetes UK initiated roll out of the “Healthier You: NHS Diabetes Prevention Programme (NHS DPP)”.  This programme was designed to refer adults of high risk of type 2 diabetes (HbA1c 42-47) to an evidence-based behavioural intervention in order to prevent or delay the onset of type 2 diabetes4.

 

Patient inclusion/exclusion criteria

Inclusion

  • Age 18-74 years
  • Prior HbA1c 42-42 mmol/l OR Fasting plasma glucose 6.1-6.9mmol/l

Exclusion

  • On diabetes register
 

Governance and Reviews

Development, implementation and evaluation of the project will be overseen by a multiagency Task and Finish Group who will report back in the diabetic delivery plan group.  The formal governance and reporting route for this Prevention and Early Years fund as a whole within the Health Board is to be determined.

The overall prevention programme of which this project is part, will need to demonstrate clear alignment with the themes and priorities agreed by the Building a Healthier Wales Strategic Coordinating Group. The Strategic Coordinating Group will be responsible for maintaining system oversight and for monitoring improvement on a regional and national scale.