Obesity, lifestyle and demographics are conspiring to result in an inexorable rise in the prevalence of Diabetes Mellitus Type 2 (DM2) in the UK. Whilst treatment of those identified is crucial, prevention is a vital part of managing this epidemic.
Clinical Commissioning Groups (CCGs) and GP practices are looking for ways to identify and prevent diabetes, and this project is seeking to describe a useful example of how this might be achieved within a CCG locality.
This project aims to take a discrete population of around 100,000 patients, and apply the QDiabetes tool to this population to assess their 10 year risk of developing diabetes.
Once we have identified those at risk via the QDiabetes tool, we will characterise them in terms of demographics, body morphology (height, weight, waist and Body Mass Index(BMI)) and blood values, as well as identifying those discovered by this process as in the Pre-Diabetes or frank Diabetes groups. We will be able to identify the prevalence of co-morbidities such as vascular disease (Heart Disease, Stroke, hypertension etc.) according to their QDiabetes risk level. These would be referenced against established local and national statistics.
We would also seek to assess by means of a semi-structured questionnaire attitudes to seeking support for changes in diet and physical activity within the higher risk group (20% or more, 10 year risk).
This would be with the intention of enrolling these patients into a lifestyle intervention course (Eat4Health, an intensive lifestyle course that runs for 10 weeks), details and results of which would be outside the scope of this study (but obviously it would be one outcome other CCGs and GP practices might like to consider).
Evidence already exists to support individual sections of this study: QDiabetes as a population screening tool, the impact on health of lifestyle interventions, the potential for diet and exercise to reduce conversion to frank Diabetes. Here we aim to define the characteristics of the patients identified and describe a real-world implementation of the QDiabetes Tool that can be rolled out widely.
Once completed we hope that we can establish a “toolkit” for other CCG and practices that includes searches, subject selection criteria, and possible interventions that are evidence based and effective for working GPs.
Public Health have proposed these potential outcomes
1. Organisational level: What it means at the Newbury & District CCG Federation level- In terms of improving early detection, offering early help those at high risk, reduction in CVD risk amongst the participants and their families
2.At a practice level: Addressing adult obesity in the practice population, increased awareness about type 2 diabetes amongst the population, reduction in short/medium and long term risks of diabetes etc
3. At a patient level: Improved physical/mental wellbeing, achievement of 5-10% weight loss, enhanced activity/fitness levels, better awareness on healthy eating/lifestyle amongst the family, better awareness on the available exercise facilities/leisure centres, walking for health initiatives in the community, better diabetes control amongst family members etc