Evidence

Surveillance report 2018 – Type 2 diabetes prevention: population and community-level interventions (2011) NICE guideline PH35 and Type 2 diabetes: prevention in people at high risk (2012) NICE guideline PH38

Surveillance decision

Surveillance decision

We will not update the following guidelines on diabetes prevention at this time:

Reason for the decision

The evidence – population and community-level interventions

The surveillance review found a number of studies that included evidence supporting current recommendations on:

  • developing a local strategy

  • conveying messages to the whole population

  • promoting a healthy diet: national action

  • promoting a healthy diet: local action

  • promoting physical activity: local action.

We did not find any evidence related to:

  • integrating national strategy on non-communicable diseases

  • local joint strategic needs assessment

  • interventions for communities at high risk of diabetes

  • promoting physical activity: national action

  • training those involved in promoting healthy lifestyles.

The evidence – prevention in people at high risk

The surveillance review found a number of studies, which included evidence supporting current recommendations on:

  • encouraging people to have a risk assessment

  • risk identification

  • matching interventions to risk

  • design and delivery, and quality assurance of quality-assured, intensive lifestyle-change programmes

  • providing tailored advice on physical activity

  • dietary advice

  • information and services for, and supporting lifestyle change in, vulnerable groups

  • metformin.

We found evidence that bariatric surgery reduces incidence of diabetes, which was not covered in the current guideline. Although the new evidence is relevant to preventing diabetes, bariatric surgery is already covered by NICE's guideline on identification, assessment and management of obesity. The new evidence did not suggest that bariatric surgery should be considered in people not covered by the obesity guideline. Therefore, new recommendations in this area should not be added at this time.

We did not find any evidence related to:

  • risk assessment

  • content or quality assurance of quality-assured, intensive lifestyle-change programmes

  • raising awareness of the importance of physical activity

  • weight management advice

  • training and professional development

  • orlistat.

Ongoing research

The NHS Diabetes Prevention Programme is rolling out in a joint commitment between the stakeholders Public Health England, NHS England and Diabetes UK. The NHS Diabetes Prevention Programme is based on a service specification that adheres closely to NICE guidelines. Evaluation data from the NHS Diabetes Programme are expected from 2020. We will check for publications from this programme, including:

Additionally, ongoing studies identified by topic experts and stakeholders were assessed for the potential to impact on the guideline. The following 3 studies will be monitored by the surveillance programme:

When publications relating to these studies are identified, the impact of the results on recommendations, and any associated need to update the guidelines will be assessed.

Equalities

The guideline already recognises that the risk of type 2 diabetes is higher in people of South Asian or Chinese descent at lower BMI than other populations. New evidence supporting the current recommendations in these populations was identified.

Editorial amendments

During surveillance of the guideline we identified the following issues with the NICE version of the guideline that should be corrected.

Population and community-level interventions for preventing type 2 diabetes

Footnote 1 of the recommendations notes that a definition of diabetes is an edited extract from an older guideline on type 2 diabetes (NICE guideline CG66), which has since been updated (now NICE guideline NG28), which does not contain similar information. Therefore, footnote 1 should be deleted.

Footnote 4 notes the BMI classification as an extract from the guideline on obesity prevention (NICE guideline CG43), however the relevant section has been updated and is now contained in obesity: identification, assessment and management (NICE guideline CG189). The footnote should be updated to refer to NICE guideline CG189.

Preventing type 2 diabetes in people at high risk

NICE guideline PH38 recommendations 1.11.5 and 1.13.8 have a cross reference to the guideline on obesity prevention (NICE guideline CG43), but the relevant sections have been updated in obesity: identification, assessment and management (NICE guideline CG189). This is potentially confusing because the public health recommendations in NICE guideline CG43 still exist. The cross reference should be updated to take the reader directly to NICE guideline CG189.

PH38 has a general cross reference to four commonly used methods to increase physical activity (NICE guideline PH2) at the end of section 1.12. However, this guidelines has been updated and replaced by 3 new guidelines: walking and cycling (NICE guideline PH41); physical activity: brief advice for adults in primary care (NICE guideline PH44); and exercise referral schemes to promote physical activity (NICE guideline PH54). This cross reference should be updated.

One stakeholder noted that non-alcoholic fatty liver disease is a known risk factor for type 2 diabetes, which is supported by the recommendations in non-alcoholic fatty liver disease (NAFLD): assessment and management (NICE guideline NG49). We will make an editorial amendment to footnote 1 of the recommendations (a list of conditions that can increase the risk of type 2 diabetes) to note that NALD also increases risk of type 2 diabetes, with reference to the NAFLD guideline.

Overall decision

After considering all the evidence and views of topic experts and stakeholders, we decided that the recommendations in both guidelines are still current and no updates are necessary.


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