Summary
This project is about raising awareness of the risk factors that affect whether a person may develop type 2 diabetes in the future. Not many people know that they may be at risk, nor that they could potentially prevent or delay the development of the condition by making small lifestyle changes. The initiative draws on a team of community volunteers who have been trained to undertake risk assessments in the community, who are then followed up - where appropriate - by a range of offers to suit the individual. The approach has been successfully throughout North East Lincolnshire with other programmes, rapidly enlisting local people in providing a participative solution to early recognition, increased awareness and timely intervention.
Results
Data was collected for 1,117 people who undertook the risk assessment, focusing on the 362 that scored moderate to high risk of developing diabetes in the next ten years. Waist measurement reduction from first assessment was repeated at 3 month, 6 month, 9 month and 12 month intervals. At 3 months there was an average waist loss of 4.3”, although the 6 and 9 month follow ups could not be achieved due to capacity issues. Of these, 2,811 people indicated their wish to self- manage, with offers ranging from GP referral, to health trainer service, to walking and tai chi groups. All who consented to follow-up were automatically referred to their GP.
Challenge
Diabetes prevalence in North East Lincolnshire, estimated by the National Diabetes Information Service, was 7.5% of people aged 16 years and older in 2012. If current trends in population change and obesity persist the total prevalence of diabetes is expected to rise to 8.4% by 2020 and 9.2% by 2030. Across England a third of the projected rise of diabetes prevalence can be attributed to the increasing prevalence of obesity. If obesity levels in North East Lincolnshire could be maintained at the rates found in 2010 there would be 300 fewer people with diabetes in 2020 equivalent to 2.8% of people projected to have diabetes. By 2030 a static prevalence of obesity would mean an estimated 900 fewer people projected to have diabetes.
Objectives
To identify people in community settings who were likely to develop Type 2 diabetes in the next ten years, unless preventative action was taken. To provide a group education session and support group (‘Time to Measure Up’) to encourage people to make small lifestyle changes, facilitated by a diabetes nurse educator. To provide a referral mechanism for GPs and Practice Nurses for their pre-diabetes patients to offer them support to make lifestyle changes and to monitor patients in the target group. A target of undertaking 1000 pre-diabetes risk assessments during the first year of the project from April 2014 to March 2015 was set.
Solution
Those identified as moderate to high risk of diabetes, using a questionnaire tool adapted from Leeds University and Diabetes UK, were advised to attend their GP for further screening. In order to maximise the impact of the initiative, a diabetes nurse educator was included in the volunteer team which helped to minimise the risk of people not acting on information and also, with consent, maximised successful follow up. The Clinical Commissioning Group undertook a review of diabetes services in 2013 with patients, carers and nurses and identified that practice nurses had an urgent need for more support in terms of education and pre-diabetes risk support for patients. This project offers that support in the form of a nurse educator who also provides education support for practice nurses in up-skilling them in diabetes, and also providing additional support for the only Specialist Nurse in Diabetes in the area.
Learnings
The promotion of the initiative has been key to its success, not only in media terms, but also in the way it is portrayed – it has deliberately not been described as a weight loss programme. The free provision of sessions has also been key in maintaining attendance. The capacity required to deliver the programme to its optimum is more than predicted, particularly in relation to the ‘follow up’ element. The duration of the ‘Time to Measure Up’ group education programme of 4 monthly sessions needs to be extended: people need constant support to keep on track. There must be several routes to referral into the system: GP referral via NHS Health Check data; Community opportunistic identification and Practice Nurse referral. Without the community element, the very real risk would be a widening of health inequalities. It is important in the future to broaden the offer of exercise programmes for those who wish to participate in that way.
Evaluation
The potential future impact of this initiative over 10 years could represent savings to the local health economy of between £34m and £65m.
