Diabetes Prevention Programmes

Scope

From April 2018, NHS National Type 2 Diabetes Prevention Programme has been launched in the NHS Devon area aiming to prevent the onset of Type 2 Diabetes in the at-risk population. The scheme will be delivered by Xyla Health & Wellbeing for the Framework 3 from August 2022.

The scheme 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
  • People who undergone bariatric surgery in the last 2 years
  • People with active eating disorder
  • People with severe/moderate frailty

Assessment

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)

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 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.

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/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 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 women with a history of GDM and patients aged over 80 years old, please only use the referral form and send to scwcsu.devon-ndpp@nhs.net, do not use the self-initiative letter.

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

We will cover in detail:

Topics
The risk factors for diabetes and what is happening in the body to cause elevated levels of blood glucose.
What changes might be beneficial in safeguarding against type 2 diabetes and the associated complications.
What to eat to achieve a nutritional balance for optimal health.
The impact of mental and physical stress on the body and how this causes elevated levels of blood glucose.
The impact of poor quality or insufficient amounts of sleep on your health.
The required amount of daily movement for optimal health and how this can be achieved.

NDH (pre-diabetes) patient information

NDH (pre-diabetes) referrer information

Pre-diabetes patient information - MyHealth

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 CCG.

Publication date: April 2020

Updated: July 2022

Last updated: 01-07-2022

 

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