1. Diabetes Prevention Dr Neel Basudev Lambeth CCG Diabetes Lead
Clinical Director Health Innovaton Network

2. Healthier Who?

3. Overview
Free, nine month community-based behaviour change programme to help people prevent the onset of Type 2 diabetes
Lambeth is one of the first wave sites and has “gone live”. Partnership across South London lead by HIN and Southwark CCG
18 supportive, group-based sessions for up to 20 people delivered by trained, local staff. Provider is Reed Momenta
Programme designed by experts and underpinned by a decade of research into community-based diabetes prevention

4. Flow chart

5. Patient Journey
Three stage approach
Engagement
Individual Assessment
Behavioural Intervention

6. Referral Criteria
Aged 18 years or older
Be registered to a Lambeth GP practice
Not have been diagnosed with Type 2 diabetes
Not be pregnant at the time of referral
Have a HbA1c of mmol/ml ( %) or an FPG of mmol/l tested in the last 12 months

7. A CASE OF CONFUSION
HbA1c Reading
HbA1c Date
FPG Reading
FPG Date
BMI 33
11/08/2016
5.6
09/02/2016
38.6
13/07/2016
5.9
29.5 34
25/07/2016
5.7
35.8 36
08/06/2016
5.5
28.2
22/08/2016
5.8
36.7
25/06/2014
6.5
21/07/2016 37
24/11/2015
33.25
19/08/2016
6.3
32.1 38
13/11/2015
36.4
15/09/2015
6.6
04/08/2016
35.1 39
19/07/2016
25.9
26/08/2016
30.9
12/06/2014
25.47 40
09/05/2016
37.26
18/07/2016
6.2
34.7
12/07/2016
32.6
28.9
20/06/2016
33.4 41
27/06/2016 6
25.7 48
31.6 68
02/09/2016
10/02/2016
28.5
You will gain nothing by doing both FPG and HbA1c other than confusion….

8. Phenotypically, these are different populations.
Different tests
575 (6.6%)
FPG
1685 (19.4%)
HbA1c
1610
(18.5%)
1110
(12.8%)
1035
(11.9%)
Phenotypically, these are different populations.

9. This is going to get ugly
Sensitivity
Reproducibility
Ease of use
Cost
Limitations

10. What’s involved Initial assessment
Includes:
Blood glucose test (if referral reading is >3 months)
Height, weight and BMI calculation
Warwick-Edinburgh Mental Wellbeing Score (WEMWBS)
Delivered from:
LloydsPharmacy
Third-partner affiliate pharmacies e.g. Cooperative
Community locations

11. What’s involved getting started
Session one: 1.5 hours
Sessions two-six: weekly, one hour
Sessions seven-eight: fortnightly, one hour
Example Topics
Introducing prediabetes
Eatwell guide and a healthy balanced diet
Cardiovascular activity

12. What’s involved Embedding change
Session 9-12: fortnightly, one hour
Example Topics
Enlisting social support
Healthier eating outside the home

13. What’s involved Moving forwards
Session 13-18: monthly, one hour in length
Blood tests are repeated at session 13 (6 months) and 18 (9 months)
Example Topics
Relapse prevention
Unhelpful thinking patterns

14. Healthier You Session overview
Session Number
Session Title
Session Content 1
Understanding non-diabetic hyperglycaemia
Helps participants understand the diagnosis of non-diabetic hyperglycaemia and teaches them the basic principles of lifestyle modification that will be used throughout the programme. 2
Make everyday active
Helps participants to increase levels of daily activity using behaviour modification principles. 3
Know how to eat well
Teaches participants the basic principles of healthy eating based on the Eatwell Guide and reinforces the use of self-monitoring of behaviour as important strategy for lifestyle change. 4
Keeping regular
Supports clients to develop skills to regulate their appetite to support weight control. 5
Carbs, Carbs, Carbs
Helps participants understand the role of complex carbohydrates for weight control and diabetes prevention. 6
Fats under the spotlight
Helps participants understand the role of different types of fat for health, weight control and diabetes prevention. 7
Get Your heart rate up
Helps participants understand the importance of cardiovascular activity for health, weight control and diabetes prevention. 8
Know Your External Triggers
Supports participants to identify and change aspects of their environment that lead to unhealthy behaviours.
9 & 10
Sugars Under The Spotlight
Helps participants understand the influence of different types of carbohydrate for health, weight control and diabetes prevention. 11
Know Your Internal Triggers
Supports participants to understand and change the psychological factors influencing unwanted behavioural patterns. 12
Eat Out and Party
Helps participants develop skills to maintain healthy eating patterns during social occasions. 13
Feel Fuller for Longer
Helps participants understand the specific role of protein and dairy foods for health, weight control and diabetes prevention. 14
Review and Reset Your Mindset
Helps participants review their progress and set new goals following the mid-programme blood tests. 15
Shopping and Cooking for Diabetes Prevention
Helps participants to develop skills for eating healthily on a budget. 16
Build Your Strength
Helps participants to understand the specific role of resistance activity for health, weight control and diabetes prevention. 17
Relax and De-stress
Helps participants develop skills to manage stress. 18
Moving Forwards
The last session of the programme helps people to celebrate their achievements and set new goals for maintaining their healthier lifestyle.

15. The success of this programme depends on us…
Progress so far
This is a learning process for everyone eg FPG vs HbA1c debate in Bromley
Sutton & Southwark mail campaign, Bromley opportunistic, Lewisham & Wandsworth practice led
Feedback and data being collected in real time to inform the programme development
NIHR bids and NDA pilots
Referrals trickling in
20 referrals from 13 practices
STEPS waiting list exists and is growing
722 referrals for Q1 2016
13% attended
The success of this programme depends on us…

16. Diabetes and high risk of diabetes template

17. Nda data QOF & NDA Indicator Definitions:
DM003 – The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the apreceding 12 months) is 140/80 mmHg or less.
DM004 – The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within athe preceding 12 months) is 5 mmol/l or less.
DM007 – The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the apreceding 12 months.
NDA – T2 Eight Care Processes – The percentage of people with Type 2 or other diabetes receiving the Eight Care Processes.
NDA – T2 Attended SE – The percentage of newly diagnosed people with Type 2 or other diabetes recorded as ‘attended' a astructured education program.

18. Nda data

20. Improvement and assessment framework

22. Delivery scheme
Two virtual clinics. At least one clinic will be held with a consultant diabetologist or GP with a Special Interest (GPSI) in Diabetes. The other clinic will be held with a community diabetes specialist nurse (DSN).
Identify patients to be discussed at the virtual clinic. Searches are available on EMIS enterprise within the Medicines optimisation folder
Complete the indicated information in the outcomes summary spread sheet

23. Thanks for listening
Questions…..