Prevention and remission of type 2 diabetes (SIGN)
- 35. National Institute for Health and Care Excellence (NICE). Type 2 diabetes: prevention in people at high risk. London; 2012.
Introduction
Following a diagnosis of prediabetes (HbA1c level of 42–47 mmol/mol (6.0–6.4%) or an FPG level of 6.1–6.9 mmol/L) it may be possible to prevent or delay progression to type 2 diabetes by addressing modifiable risk factors.
Personalised assessment and advice tailored to the individual that takes into consideration their needs, preferences and social determinants of health (see The need for a guideline) are key. Evidence-based behavioural changes may be very challenging for some people, for example, their social and financial circumstances may make certain eating patterns or food choices difficult. An individual’s circumstances could change, so this tailored approach is appropriate at any point of contact throughout an individual’s prevention journey. Goal setting is therefore an ongoing process.
This section focuses on the content and delivery of type 2 diabetes prevention programmes. A type 2 diabetes prevention programme is an evidence-based, quality-assured programme that incorporates dietary change guidance with energy restrictions and physical activity, underpinned by behaviour change. The aim is to achieve a healthy weight and maintain this in the long term.
The recommendations are adapted from sections 1.7–1.14 of NICE PH38: Type 2 diabetes: prevention in people at high risk.35 Recommendations were identified for self management, lifestyle, diet, weight management, physical activity and behaviour change. No recommendations were identified for standalone education interventions or psychological wellbeing interventions. For people at increased risk of cardiovascular disease and hypertension, lipids and smoking status should be assessed and managed as part of holistic care. While the following risk factors are not covered in the recommendations advice, if appropriate, people should be signposted or referred to relevant services for smoking, alcohol and sleep.
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In those with risk factors, reassess the individual’s risk factors at least once a year, and review any changes in behaviour or social circumstances or any practical lifestyle changes people at high risk have made. Use the review to help reinforce engagement in reducing modifiable risk behaviours. The review could also provide an opportunity to discuss any barriers and to help motivate people to restart any positive behaviours that may have lapsed.
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Tailor consultation to consider systemic, structural and socioeconomic factors.
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For people with a diagnosis of prediabetes (a high risk score and an HbA1c of 42–47 mmol/mol (6.0–6.4%) or a fasting plasma glucose of 6.1–6.9 mmol/l):
- Tell them they have prediabetes but that this does not necessarily mean they will progress to type 2 diabetes. Explain how their risk can be reduced. Briefly discuss their particular risk factors, identify which ones can be modified and discuss how they can achieve this.
- Offer them referral to evidence-based, quality-assured programmes which include behaviour change, support on diet, physical activity and the wider social determinants of health.
- Signpost them to additional information, support and services from reliable sources (see Sources of further information).