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NICE has today (Tuesday 10 May) published new guidance on preventing type 2 diabetes in the general population, and among high-risk groups. These groups include people of South Asian, African-Caribbean, black African and Chinese descent, and those from a lower socio-economic background, where the incidence of type 2 diabetes is higher than in the general population.

The guidance will be launched at the NICE Annual Conference 2011 at the ICC in Birmingham on Tuesday 10 May at an exclusive session with Dr Rowan Hillson MBE, National Clinical Director for Diabetes and other key speakers.

Type 2 diabetes is a long-term (chronic) condition that occurs when not enough insulin is produced by the body for it to function properly, or when the body's cells do not use insulin properly.

Diabetes is on the rise in the UK, affecting around 2.8 million people - around 90% have type 2 diabetes. In 2009 alone, about 150,000 people were diagnosed with diabetes^1. Diabetes is also estimated to account for at least 5% of UK healthcare expenditure, with drug costs alone for people with type 2 diabetes accounting for about 7% of the total NHS drugs budget². With rising numbers affected by the condition, the incidence of serious complications is also on the rise. These include cardiovascular disease (CVD) and foot problems such as ulcerations and gangrene. Diabetes is also the leading cause of blindness in people of working age in the UK³ due to a condition called retinopathy⁴.

People from certain communities and population groups are at an increased risk of developing type 2 diabetes. In the UK, people of South Asian origin are up to six times more likely to have type 2 diabetes than the white population⁵. They are also likely to develop type 2 diabetes 10 years earlier⁶. Being overweight or obese is the single biggest risk factor for type 2 diabetes; others include having a large waist circumference⁷, a sedentary lifestyle, a family history of type 2 diabetes, and being older than 40. People from lower socioeconomic groups are also at greater risk, and are three and a half times more likely to experience ill health as a result of diabetes than those in more affluent groups⁸.

Given that the risk factors for type 2 diabetes are also common to other chronic diseases including cardiovascular disease and some cancers, the guidance is able to draw on evidence from existing NICE guidance to underpin many of its recommendations for both local and national interventions as part of a comprehensive prevention strategy.

The guidance recommends that commissioners and healthcare providers working in local and national public health services, in partnership with the NHS, local authorities, the commercial sector and voluntary organisations should:

• consider integrating national strategies to help prevent type 2 diabetes, cardiovascular disease and certain cancers.
• use local and national tools and data from public health data collection agencies and the census to identify local communities at high risk of developing diabetes to assess their specific needs.
• create local environments (using planning regulations) that encourage people from black and minority ethnic (BME) and lower socio-economic groups to be more physically active and to adopt a healthier diet by ensuring local shops stock good quality, affordable fruit and vegetables.
• address issues such as stigma and fatalism regarding the development of diabetes and the assumption that illness is inevitable. Also address misconceptions about what constitutes a healthy weight.
• tailor interventions for local communities by recruiting and involving lay and peer workers in their development; use community resources, links and outreach projects to improve awareness and increase accessibility to these interventions.
• work with food manufacturers, caterers and retailers to improve some prepared foods to decrease calories, saturated fat and salt content, and improve food labeling.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: "Type 2 diabetes is a big health problem in the UK, and is particularly prevalent in certain groups, so it is very important that there is comprehensive, evidence-based guidance in place that can help address this serious condition. I am sure this guidance will be welcomed as a helpful aid to help prevent diabetes."

Professor Nick Wareham, Director, Medical Research Council Epidemiology Unit, Cambridge, and Programme Development Group chair said: "Population and community interventions that achieve small but significant shifts in people's diet and physical activity levels are likely to be the most effective way of reducing the risk of type 2 diabetes at a national level. I am confident that this guidance will help bring about the changes needed to stop people developing this serious, life-affecting condition."

Marie Cummins Regional Programme Manager, NHS Diabetes, and Programme Development Group member said: "NHS Diabetes was delighted to be involved in the development of this important guidance. Type 2 diabetes is affecting more and more people every year, and the risk of developing it is higher amongst certain groups, but there are things we can do to prevent it, like taking regular exercise, eating healthily and maintaining a healthy weight - small steps that could make a big difference in the long run. This guidance has clear, common sense recommendations that will help stem the tide, I am sure."

Dr Neel Basudev, GP, London, and Programme Development Group member said: "As an inner London GP, I am seeing increasing numbers of patients in my practice with diabetes, which is a real concern. It is a serious, long-term health problem, so it is vital we take steps now to ensure that fewer people go on to develop the condition. The recommendations in this guidance are wide-ranging but straight-forward, and I hope will go some way in helping this public health epidemic."

Sabina Syed, Community member, Programme Development Group said: "I have experienced first-hand the effects of diabetes in my community so I think it's very important for people to be fully aware of the risks of this serious condition and take all the steps they can to prevent it. I am pleased this new guidance is being published and I hope it will act as a catalyst for practical action to help communities understand more about this condition and move them to change their lifestyles accordingly."

The guidance is available from Tuesday 10 May on the NICE website at: http://www.nice.org.uk/guidance/PH35

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Notes to Editors

1. The guidance is being launched at the NICE Annual Conference 2011 at the ICC in Birmingham on Tuesday 10 May at an exclusive session with speakers including: Dr Rowan Hillson MBE, National Clinical Director for Diabetes, Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE,Professor Nick Wareham, Director, Medical Research Council Epidemiology Unit, Addenbrooke's Hospital, Cambridge, and Programme Development Group chair, and Akeem Ali, Director of Public Health, Herefordshire County and Programme Development Group member. Please see website for further details on the conference: http://www.niceconference.org.uk/home

2. The guidance is available from Tuesday 10 May on the NICE website at: http://www.nice.org.uk/guidance/PH35

3. The guidance on type 2 diabetes - preventing the progression from ‘pre-diabetes' to type 2 diabetes among high-risk groups is expected to be published in May 2012. Further details can be found at: http://guidance.nice.org.uk/PHG/Wave19/62

4. The NICE public health guidance development process: An overview for stakeholders including public health practitioners, policy makers and the public (second edition, 2009) is available at: www.nice.org.uk/phprocess

References

1. Diabetes UK.

2. Waugh N, Scotland G, McNamee P et al. (2007) Screening for type 2 diabetes literature review and economic modelling. Health technology assessment 11: 17 online. Available at: www.ncbi.nlm.nih.gov/pubmed/17462167

3. Kohner et al (1996) Report of the Visual Handicap Group, Diabetic Medicine, 13, (Suppl. 4.) S13-S26

4. Retinopathy is a complication of diabetes that affects the blood vessels of the retina.

5. Department of Health (2001) Modern standards and service models - diabetes: national service framework standards.

6. Nicholl CG, Levy JC, Mohan V et al. (1986) Asian diabetes in Britain: a clinical profile. Diabetic Medicine 3: 257-60

7. Men are at high risk if their waist circumference is 94-102cm; they are at very high risk if it is more than 102cm. Women are at high risk if their waist circumference is 80-88cm; the risk is very high if it is more than 88cm.

8. Department of Health (2002) National service framework for diabetes: standards - supplementary information. Health inequalities in diabetes.

About NICE

1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient carethrough NHS Evidence.