Type 2 diabetes: prevention in people at high risk

Context

Diabetes is a chronic disease characterised by an inability to regulate blood glucose. It is one of the most prevalent and costly chronic diseases. There are 3.9 million people living with diabetes in the UK, and 90% of those with the condition have type 2 diabetes. Type 2 diabetes occurs when the pancreas no longer produces enough insulin to maintain a normal blood glucose level, or the body is unable to use the insulin that is produced (known as insulin resistance).

People with type 2 diabetes have an increased risk of coronary heart disease, peripheral vascular disease and stroke, and they are more likely to have hypertension, dyslipidaemia (abnormal blood lipid and lipoprotein levels) and obesity. People who are overweight or obese are more likely to develop type 2 diabetes, and the risk rises as body weight increases.

NHS England, Public Health England and Diabetes UK have developed the NHS Diabetes Prevention Programme (NHS DPP), which is based on recommendations from this guideline. The NHS DPP interventions are commissioned centrally by NHS England. Given that there are an estimated 5 million people at risk of type 2 diabetes in England, and that the NHS DPP interventions will be available to only 100,000 people annually, there is a need to identify and prioritise which people are likely to benefit most from the intervention.

This guidance focuses on identifying people at high risk of type 2 diabetes and offering them effective lifestyle-change programmes to prevent or delay the condition. In the 2017 update, the level of risk needed to be reviewed to identify when individualised interventions should be used to prevent the development of type 2 diabetes, in terms of individual risk and NHS resources. The clinical and cost effectiveness of intensive lifestyle modification programmes in subgroups of this high-risk population were assessed to help commissioners target the intervention to people who will gain most benefit. The update also assessed the clinical and cost effectiveness of metformin and digitally delivered lifestyle interventions among the same population subgroups.