New NICE guidance recommends ‘stepped’ risk assessments for type 2 diabetes and early intervention in cases of high risk.
Risk assessments are recommended for adults aged over 40; adults aged over 25 in certain ethnic groups; and adults with conditions that increase the risk of diabetes.
Individuals at high risk should be offered a blood test and treated through an intensive lifestyle change programme that may include medication.
Diabetes affects an estimated three million people in the UK – predicted to rise to five million by 2025 – and type 2 diabetes accounts for 90% of the total.
NICE observes that individual risk of developing type 2 diabetes can be reduced by 60% through lifestyle changes including diet and exercise.
The new guidance recommends that risk assessments be offered to people (except pregnant women) in the following groups:
• adults aged 40 or over
• adults aged 25 or over who are of South Asian, Chinese, African-Caribbean or Black African origin
• adults with conditions that increase the risk of type 2 diabetes, including obesity, hypertension and mental illness.
Individuals considered at high risk should be offered a blood test (fasting glucose or HbA1c) at least once a year, and the correct level of intervention decided accordingly.
NICE recommends preventative measures such as diet and exercise regimes. Medications such as metformin (to improve insulin uptake) and orlistat (to assist weight loss) may be used to treat ‘pre-diabetes’.
As well as helping to prevent type 2 diabetes, these measures will help to diagnose the condition – it is estimated that 850,000 people in the UK have undiagnosed diabetes.
“We are not just seeing an epidemic of type 2 diabetes, it is a tsunami,” said Professor Kamlesh Khunti, chair of the NICE guidance development group.
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