Intended for healthcare professionals

Practice 10-Minute Consultation

Reducing the risk of diabetes

BMJ 2015; 351 doi: (Published 22 September 2015) Cite this as: BMJ 2015;351:h4595
  1. Tahseen Ahmad Chowdhury, consultant in diabetes and metabolism1,
  2. Rupal Shah, general practitioner partner2
  1. 1Department of Diabetes and Metabolism, The Royal London Hospital Whitechapel, London E1 1BB, UK
  2. 2Bridge Lane Group Practice, London SW11 3AD, UK
  1. Correspondence to: R Shah roo_tindall{at}
  • Accepted 25 June 2015

The bottom line

  • People with glycated haemoglobin between 42 and 47 mmol/mol or fasting plasma glucose between 5.5 and 6.9 mmol/L are at high risk of diabetes

  • Weight loss and lifestyle change can reduce this risk considerably

  • Consider metformin or orlistat for prevention of diabetes in people at high risk, if intensive lifestyle intervention is not sufficient or suitable

A 45 year old white man comes to see you to discuss his blood glucose result. This was measured because he had an elevated QDiabetes risk score of 15%,1 as well as a brother with diabetes. His glycated haemoglobin (HbA1c) is 43 mmol/mol (6.1%).

What you should cover

This man is at high risk of developing diabetes. Guidance from the UK National Institute for Health and Care Excellence (NICE) suggests that risk of diabetes should be determined by using a computer based risk assessment tool such as the QDiabetes risk calculator (, Cambridge diabetes risk score, or Leicester practice score.2 If the risk assessment tool suggests elevated risk (for example >10% over 10 years), a fasting plasma glucose or HbA1c test should be offered. Fasting plasma glucose of 5.5-6.9 mmol/L or HbA1c between …

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