[Skip to content]

.

Regional Innovation Fund 2010/11 Project: LTC 20031

Implementation of a systematic diabetes prevention programme care pathway within a primary care setting

University Hospitals of Leicester NHS Trust & NHS Northamptonshire
This project will support the implementation of a systematic diabetes prevention programme within 6 GP practices in Northamptonshire; this will involve an evidenced-based approach to identify high risk patients and provide them with lifestyle advice through the evidence-based Walking Away from Diabetes structured educational programme.
 
In the United Kingdom (UK), over two million individuals have been diagnosed with Type 2 diabetes (T2DM), a debilitating disease that has a significant impact on health care resources. In order to reverse the increasing prevalence of T2DM, the Department of Health have recently implemented the NHS Health Checks Programme for all individuals between 40 and 74 years of age.
A large proportion of the budget originally allocated to this initiative (40%), was aimed at identifying and providing intensive lifestyle advice to those with Impaired Glucose Regulation (IGR) as this group have a particularly high risk of developing diabetes.
However, although the implementation of locally relevant research within primary care is taking place throughout Europe and the USA, this has not happened within the United Kingdom. PCTs and GP practices locally are predominantly focusing on those patients with high (≥20%) cardiovascular disease risk as measured through the Framingham risk score, and, where IGR is targeted, it is done so on an ad-hoc basis lacking an evidence base.
We have shown that the overlap between those with IGR and a high CVD risk is relatively small (Framingham does not include glucose as a risk marker), therefore the majority of those with IGR are not being identified or treated within primary care, subsequently the future burden of T2DM is not being adequately targeted.
 
The proposal aims to implement findings from a gold-standard research programme into usual health care practice in order to fill an unmet need in the identification and management of individuals with non-diabetic Impaired Glucose Regulation (IGR- also commonly referred to as “prediabetes”).
IGR refers to those with diagnosed impaired glucose tolerance, impaired fasting glucose or an HbA1c of between 6.0 - 6.5%.
This bid is innovative because it will be the first time in the East Midlands region that a systematic and evidence-based identification and treatment pathway for those with IGR has been implemented within usual primary care.
Six GP practices in Northamptonshire will receive extensive training in implementing a validated and evidence-based pathway for identifying and promoting self-management in those with a high risk of diabetes. This will involve helping GPs and practice nurses identify those with IGR through automated risk score technology and a simple measure of glycaemia (HbA1c 6.0 - 6.5%); which shows that this is the cheapest and most efficient way of identifying those with the highest risk of diabetes.
High risk individuals will then be referred onto a structured education programme, called ‘Walking Away from Diabetes’ with proven efficacy, to be run in each GP practice.
The programme will be delivered by two trained educators to 10 individuals over 3.5 hours and has been specifically adapted to the needs of primary care. The Walking Away from Diabetes programme is aimed at promoting increased physical activity, based around pedometer (step counter) use, to levels that are consistent with the current physical activity recommendations (150 minutes of moderate exercise per week). Dietary factor and knowledge of diabetes risk are also targeted.
All educators will be fully trained and quality assessed by national trainers accredited through the established DESMOND programme. Educator training consists of a full days training programme.

 

  • Information provided on risk status before the development of an overt chronic disease (research has shown that those identified with IGR through screening do not suffer increased emotional distress)
  • Treatment through an intensive lifestyle modification programme (Walking Away from Diabetes) leading to a reduced risk of diabetes and improved quality of life
  • Increased patient choice
  • Legacy of patient centred care
   
  • Training on how to identify and refer those with IGR
  • Training to deliver an evidence-based lifestyle promotion programme with quality assurance
  • Access to locally relevant systems to meet national initiatives
 
This project will deliver a cost-effective method of preventing diabetes.
We have previously shown that screening for Type 2 diabetes and IGR and providing intensive lifestyle management is highly cost-effective (£6242 per Quality Adjusted Life Year (QALY)). We have also shown that the expected reduction in the relative risk of Type 2 diabetes 24 months after our programme is greater than 60%.
Therefore given that the average annual cost associated with treating Type 2 diabetes, over and above other health conditions, is estimated at over £800 per patient and that our prevention pathway is estimated at £80 per patient, this implementation programme could provide a substantial cost saving.
LTC 20031 Image
contact innovator button resized

 

Contact the Innovators

Melanie Davies & Bernie Stribling, University Hospitals of Leicester NHS Trust

Steven Rogers, NHS Northamptonshire

Melanie.davies@uhl-tr.nhs.uk

bernie.stribling@uhl-tr.nhs.uk,

Stephen.rogers@northants.nhs.uk

 

Download case study button resized

 

 Documents to Download

See the project featured in the East Midlands Regional Innovation Fund Projects Brochure on Page 48

East Midlands EXPO Poster