Future cases of type 2 diabetes could be reduced by much as 80% if more was done to warn patients they were at risk and then encourage them to change their lifestyles, claim UK nurse researchers.
Researchers at the University of Huddersfield said they believed that a combination of diagnosing “pre-diabetes” plus special behaviour clinics could bring about such a major reduction.
“Education alone in its purest form probably isn’t that effective”
Along with York-based district nurse Wendy Youngs, they reviewed evidence on the impact of pre-diabetes diagnosis and whether it was effective in bringing about the necessary changes in lifestyle.
The term pre-diabetes has emerged in recent years to explain impaired glucose regulation, where blood glucose levels are higher than normal, but not high enough for a type 2 diabetes diagnosis.
However, its use remains slightly controversial and open to debate among clinicians, largely because many patients viewed as having it do not progress to diabetes itself.
The Huddersfield researchers concluded that pre-diabetes was a “challenging concept for patients and nurses alike”, but argued that more education and support were required to motivate lifestyle change in the patient at risk.
“This, however, does not need to be medicine led,” they stated in the journal Practical Diabetes International.
“Use of peer and community-based programmes could be not only cheaper, but also have the ability to provide potentially long-term support for people, and would provide continued reduced risk,” they said.
Study author Dr Warren Gillibrand, a registered nurse and senior lecturer, said Scandinavian research had shown that an 80% reduction in type 2 diabetes was achievable.
He also noted that pre-diabetes clinics were increasingly being established in NHS trusts.
“People identified as being at high risk are mainly referred to the clinics by a GP, based on a number of different factors, such as lifestyle, weight, smoking history and biochemical markers,” he said.
A range of interventions, based around patient education, were usually delivered by the clinics, but Dr Gillibrand argued that a stronger action was required – potentially borrowed from mental health.
“Education alone in its purest form probably isn’t that effective,” he said. “There is a need for other mediators – for example behaviour interventions or talking-based psychological therapies in order to initiate lifestyle change.”
The research team now aim to secure funding for a large-scale evaluation of pre-diabetes clinics and different models of educational programme.
Dr Gillibrand estimated that such an evaluation project would probably last two years and require £350,000. At least four NHS trusts in contrasting areas would need to be involved, he noted.
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“The ideal output would be to make the case for pre-diabetes clinics and to support the argument that the Department of Health need to provide greater levels of funding,” he said.
“The prevention of type two diabetes is a national priority,” he added.
However, there are currently no defined criteria for pre-diabetes in the UK and it is not a clinical term recognised by the World Health Organization.
In contrast, the American Diabetes Association has set such criteria for pre-diabetes – a blood glucose measurement of HbA1C 5.7% (39mmol/mol).
Current guidelines on preventing diabetes from the National Institute for Health and Care Excellence note that some clinicians use the term pre-diabetes because it is a “clear way of communicating the presence” of impaired fasting glucose, impaired glucose tolerance and impaired glucose regulation.
“However, some health professionals view the term pre-diabetes as potentially misleading, as progression to diabetes is not inevitable,” the guidance states.
In a position statement, Diabetes UK said it currently uses the term “at high risk of type 2 diabetes” for those with non-diabetic hyperglycaemia.
“Although the term ‘prediabetes’ has become more common in the lay press, in general Diabetes UK won’t use that term because of the lack of clarity over what is meant by prediabetes,” said the charity.