Publication, Part of National Diabetes Audit: Non-Diabetic Hyperglycaemia, Diabetes Prevention Programme

Non-Diabetic Hyperglycaemia, 2020-21, Diabetes Prevention Programme

Publication Date:: 14 Jul 2022
Geographic Coverage:: England
Geographical Granularity:: Country, Provider
Date Range:: 01 Jan 2020 to 31 Mar 2021

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Introduction

Summary

The NHS Diabetes Prevention Programme (NHS DPP) is a joint commitment from NHS England & Improvement, Public Health England (now Office for Health Improvement and Disparities) and Diabetes UK to deliver, at scale, evidence based behavioural interventions that can prevent or delay the onset of type 2 diabetes in adults who have been identified as having non-diabetic hyperglycaemia (NDH).

This report primarily uses data from English GP practice systems for the period January 2020 to March 2021 inclusive, and data generated by providers of the Diabetes Prevention Programme relating to referrals up to March 2021 inclusive. The GP data is only for people diagnosed with NDH.

During 2020-21 healthcare services have been under increased pressure due to COVID-19. Despite the difficulties of the last year, GP practices have continued to diagnose and monitor people with NDH, and to refer them on to a Diabetes Prevention Programme that swiftly pivoted to a remote service.

In 2021,

440,260 people were newly diagnosed with NDH.
New diagnoses continued to be made amongst people of similar demographics to earlier years.
39% of all people with NDH had glycaemic tests and BMI (body mass index) checks (56% in 2019-20).

More than 2 million people in England are currently diagnosed with NDH, as GP practices continue to identify and record NDH diagnoses.

Recommendations

Recommendation 1

GP practices should continue to identify and appropriately record NDH diagnoses in their clinical systems.

In 2017-18, 1.3 million people were known to be diagnosed with NDH.

In 2018-19, 5% had type 2 diabetes.
In 2019-20, 10% had type 2 diabetes.

At the end of the 2020-21 audit period,

13% were diagnosed with type 2 diabetes,
76% still had NDH,
8% had died,
3% had an unknown outcome.

Recommendation 2

GP practices should appropriately offer to refer eligible people with NDH to the Diabetes Prevention Programme to reduce their risk of developing type 2 diabetes.

Obesity and higher levels of HbA1c were associated with greater risks of progression to type 2 diabetes. This shows how key it is to affect lifestyle change through the Diabetes Prevention Programme (DPP). More than 1 million people with NDH had a glycaemic test result in 2020-21 which would make them potentially eligible to the DPP, including 85% of people diagnosed with NDH in 2020-21.

To the end of March 2021, 663,020 people had been referred to the DPP, although only 408,065 had an NDH diagnosis in their GP record, and there remains significant geographical variation with as many as 4 out of 5 DPP referrals involving people with no GP record of a hyperglycaemia diagnosis, in some CCGs.

Recommendation 3

GP practices should conduct annual glycaemic tests (HbA1c, or fasting plasma glucose) and BMI checks for people with NDH, endeavouring to provide these care processes across all groups.

Although care process rates dipped overall under COVID-19 pressures - 67% of people with NDH had a glycaemic test, and 46% had BMI monitoring - the audit found noticeable variation in how well people were being monitored across demographic groups. People who were of black ethnicity, those aged under 40, and people who had been diagnosed with NDH more than 10 years ago were less likely to have had glycaemic tests or BMI checks, whilst people over 65 were most likely to have had care processes completed.