Northern England Strategic Clinical Network Conference Rahul Nayar SCN – Diabetes Lead 15 th May 2015

A TYPE 2 DIABETES PREVENTION PROGRAMME Dr Mike Lavender Consultant in Public Health Medicine Durham County Council

Diabetes Prevention Programme 58% 31% 39%

Recommendations include: Identifying people at risk of developing type 2 diabetes using a staged (or stepped) approach. Providing those at high risk with a quality-assured, evidence-based, intensive lifestyle programme to prevent or delay the onset of Type 2 Diabetes.

NHS Health Checks National programme launched in 2008 Aims to identify people who are at a high risk of developing heart disease and stroke Target group aged 40 to 74 with no existing heart disease, stroke or diabetes 5 year rolling programme

By setting

Health Checks in County Durham 2009 to 2014 – 72 practices plus community programme: – 260,000 people in the target age group – 64,111 (25%) ineligible due to CVD(35%), diabetes (38%), CKD(20%) Of the 195,000 eligible for a Health Check – 95,179 (49%) received a Health Check – 41,881 (44%) high risk for diabetes using HC filter SBP > 140 mmHg or DBP > 90 mmHg or BMI > 30 or BMI > 27.5 South Asian

Patient C4l Personal Report

Check4Life Health Check August 2014 to February months 26 practices 1,408 Health Checks with both checks 538 (38%) high risk for diabetes using filter 449 (32%) high/very high Diabetes UK Risk Score >15

County Durham Diabetes Prevention Programme Programme 6 months of weekly educational and support sessions 2 weekly physical activity sessions An individual mentor to provide support Regular support meetings for up to 2 years Aims Reduce risk of developing diabetes Improve diet Weight loss of 5-10kg or 5% Increase physical activity levels

County Durham Diabetes Prevention Programme Assumptions Eligible population for Health Checks = 111,633 Target number of health checks per year 20% = 22,326 Likely number of health checks 50% coverage = 11,163 Diabetes UK Risk Score >15 28% = 3,126 Take up offer of JBI 32% = 1000

County Durham Diabetes Prevention Programme Pilot project 13 recruited 7 completed the 6 month programme 4 achieved CMO recommended physical activity level All lost weight at 6 months 4 lost 5-10kg or 5% of baseline weight at 6 months Roll out so far 4 groups of 10 participants each Next stage Menu of programmes of different length and intensity

National Diabetes Prevention Programme A commitment of the NHS Five Year Forward View – During 2015/16 have the new NHS Diabetes Prevention Programme up and running and available to 10,000 at risk individuals – By March 2016 develop a comprehensive plan for the roll-out of the diabetes prevention programme in 2016/17 Aim to identify those at risk early and refer them into evidence-based lifestyle interventions so that: – More people at risk receive interventions to lower their risk – The incidence of Type 2 diabetes and associated complications and mortality decrease over the longer term.

Distribution of Diabetes UK risk levels *Number above bar is an estimate of the number of new cases of diabetes in ten years

Distribution of Diabetes UK risk levels *Number above bar is an estimate of the number of new cases of diabetes in ten years

Diabetes prevention: Targeted v Population approaches Not Targeted of whom 3181 will develop diabetes in 10 years of whom will develop diabetes in 10 years Targeted of whom will develop diabetes in 10 years 9516 of whom 3172 will develop diabetes in 10 years will develop type 2 diabetes in 10 years will develop type 2 diabetes in 10 years Low Increased High Very High of those who will develop diabetes in County Durham will be missed focusing on those at high and very high risk means Projection of numbers in groups based on Healthcheck data gathered between July 2014 and February 2015 and applied to the number of people identified as part of the Healthcheck program between October 2008 and December Risk Levels use Diabetes UK Risk Score. 52%