- Hilary Chatterton, technical analyst1,
- Tricia Younger, associate director2,
- Alastair Fischer, technical adviser-health economics2,
- Kamlesh Khunti, professor of primary care diabetes and vascular medicine3
- on behalf of the Programme Development Group
- 1National Institute for Health and Clinical Excellence, Manchester, UK
- 2National Institute for Health and Clinical Excellence, London WC1V 6NA, UK
- 3Biological Sciences and Psychology Department of Health Sciences, University of Leicester, Leicester, UK
- Correspondence to: T Younger
Almost three million people in the United Kingdom have diabetes and 850 000 people may be undiagnosed. It has been estimated that five million people will have diabetes by 2025. About 90% of them will have type 2 diabetes.1
About 15% (one in seven) of adults have impaired glucose regulation,2 and an estimated 5-12% of these people develop type 2 diabetes each year.1 People with impaired glucose regulation are 5-15 times more likely to develop type 2 diabetes than those with normal glucose values.3 Successful prevention requires population based action for the whole community,4 together with interventions targeted at those at greatest risk.
This article summarises the recommendations from the National Institute for Health and Clinical Excellence (NICE) on the identification and management of type 2 diabetes in people aged 18 or more who are at high risk.5
NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When limited evidence is available, recommendations are based on expert testimony and the Programme Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
Risk identification: stage 1
Use a risk assessment tool, validated for use in UK populations. This can be a self assessment or opportunistic assessment at general practice surgeries, health centres, community pharmacies, dental surgeries, occupational health departments, optical practices and eye hospitals, prison health services and workplaces, job centres, local authority leisure facilities, shops, libraries, faith centres, residential and care homes, and day centres.
General practitioners and other primary healthcare professionals should use a validated computer based risk assessment tool to identify people on their practice register at high risk of type 2 diabetes. Risk factors include increasing age, ethnicity (South Asian, African-Caribbean, Chinese, or black African …