POSITION
STATEMENT
Title
Date
Prevention of Type 2 diabetes: reducing risk
factors
August 2012
Key points
This position statement summarises current approaches to prevent Type 2 diabetes at a
whole population level1. It covers prevention of Type 2 diabetes in the general population
by reduction of obesity through promotion of healthy eating, maintaining a healthy weight
and promotion of physical activity. Also by raising awareness of risk factors, so that
individuals can take action to modify them.
The prevalence of Type 2 diabetes is rising rapidly - much of this rise can be
attributed to the increase in obesity
The key to preventing Type 2 diabetes is to reduce the overall level of obesity in
the population as a whole, in addition to raising awareness of, identifying and
addressing, risk factors in individuals
This position statement summarises strategies to tackle obesity and to identify and
address modifiable risk factors for Type 2 diabetes in individuals
We set out a number of calls to action.
Introduction
About diabetes
Diabetes mellitus is a condition in which the amount of glucose (sugar) in the blood is too
high because the body cannot use it properly. Insulin is a hormone which helps the
glucose to enter the cells where it is used as fuel by the body. There are two main types
of diabetes.
Type 1 diabetes develops if the body cannot produce any insulin. Type 1 diabetes usually
appears before the age of 40. It is the least common of the two main types and accounts
1
See Position Statement on: Early Identification of people with and at high risk of Type 2 diabetes and interventions for
those at high risk.
for around 10 per cent of all people with diabetes. Type 1 diabetes can not be prevented.
Type 2 diabetes develops when the body can still make some insulin, but not enough, or
when the insulin that is produced does not work properly (known as insulin resistance). In
most cases this is linked with being overweight. This type of diabetes usually appears in
people over the age of 40, though in South Asian people, it often appears after the age of
25. However, recently, more children are being diagnosed with the condition, some as
young as seven. Type 2 diabetes is the more common of the two main types and
accounts for around 90 per cent of the 2.9 million people who have been diagnosed with
diabetes in the UK (1,2,3).
Type 2 diabetes is a serious and long-term health condition. When not well managed it is
associated with serious complications including heart disease, stroke, blindness, kidney
disease and amputation leading to disability and premature mortality.
The numbers of people living with diabetes is increasing rapidly. By 2025, it is estimated
that five million people will have diabetes in the UK (4).
The main risk factors for Type 2 diabetes are:
- Being overweight or obese
- Having a waistline greater than 94 cm (37 inches) for men or greater than 90 cm
(35 inches) for men of South Asian origin. For women, having a waistline greater
than 80 cm (31.5 inches)
- Being more than 40 years old or, for people of South Asian origin, more than 25
years old
- Having parents, or a brother or sister, with Type 2 diabetes
- Being of Black African, Caribbean or South Asian origin
- Being a woman who has had gestational diabetes or has had a baby weighing
more than 4.5kg (9.9lbs) at birth
- Being an overweight woman with a history of polycystic ovarian syndrome
- Having a history of high blood pressure, a heart attack or stroke
- Having ever experienced higher than normal blood glucose levels – impaired
glucose regulation (IGR) - also known as impaired glucose tolerance, impaired
fasting glucose, non-diabetic hyperglycaemia or prediabetes
- Having a mental health condition such as schizophrenia, bipolar illness or
depression, or if someone is taking antipsychotic medication (5).
Obesity is the most potent risk factor for Type 2 diabetes. It accounts for 80-85 percent of
the overall risk of developing Type 2 diabetes (6). Almost two in every three people in the
UK are overweight or obese (7). Therefore, the main strategy for reducing the rising
prevalence of Type 2 diabetes should be to tackle the rise in obesity.
The benefits of preventing Type 2 diabetes not only include the prevention of diabetes
and its complications, but also may extend to the prevention of morbidity and mortality
from CVD, as well as consequent reductions in workload and costs for NHS and reduced
impact on carers and employers of people who are at risk of developing Type 2 diabetes
(8,9).
Current situation
Prevention is Standard One of the National Service Frameworks in England and
Wales (10, 11).
NICE has produced public health guidance on the prevention of Type 2 diabetes at
a whole population level (12). This makes recommendations on:
- Integrating national strategy on Type 2 diabetes with national activities to
prevent other non-communicable diseases (such as cardiovascular disease
and certain cancers).
- National action to promote a healthy diet and physical activity.
- Local needs assessments and strategies, including local action to promote a
healthy diet and physical activity among communities at high risk.
- Training for those involved in helping to spread awareness of the risks and
how to prevent the condition.
-
At national level Governments have a key role in:
Helping people to make healthy food and drink choices
Helping people to be more active
Raising awareness of the risk factors for Type 2 diabetes and other cardiovascular
conditions.
In England the Department of Health’s strategy on obesity (13) sets out good
practice in tackling obesity at a national and local level.
In Scotland, Preventing Overweight and Obesity in Scotland: A Route Map
Towards Healthy Weight was published in 2010 and has formed the basis of
activities aimed at reducing overall levels of obesity in Scotland. This includes a
national indicator to increase the proportion of children who have a Body Mass
Index within the healthy range by 2018 (14).
-
From April 2013 local authorities in England have the lead role in developing and
implementing strategies to tackle obesity. They can do this through:
Commissioning a range of interventions to promote weight management for
individuals. For instance, The National Child Measurement Programme (15)
Prevention strategies which involve local transport, catering providers in schools
and other local authority premises, leisure and recreation providers
Involving the voluntary and community sector.
In Scotland, a Joint Obesity Group has been established made up of Scottish
Government Ministers, food and beverage industry representatives, NHS and local
government. The group is overseeing the implementation of the obesity route map
(16).
-
-
In England, the government has a number of strategies to help people make
healthier food and drink choices.
Change4Life aims to prevent people from becoming overweight by encouraging
them to eat better and move more. The campaign aims to inspire a societal
movement in which everyone who has an interest in preventing obesity, be they
Government, business, healthcare professionals, charities, schools, families or
individuals.
The Public Health Responsibility Deal aims to improve public health and tackle
health inequalities through industry’s influence over food, alcohol, physical activity
and health in the workplace (17). Diabetes UK has not signed up to be a partner to
the Deal as we feel it is insufficiently ambitious in its vision.
The government can also make recommendations on food and drink labelling to
enable healthier choices. In Scotland, this is the responsibility of the Food
Standards Agency
-
-
-
-
As part of whole population prevention strategies there is a need to identify and
provide targeted interventions to address and reduce people’s risk factors for Type
2 diabetes. There are different programmes across the UK.
In England , the NHS Health Check Programme offers a risk assessment to those
between the ages of 40 – 74 every five years to assess people’s risk of heart
disease, stroke, kidney disease and Type 2 diabetes, followed by support and
advice to help them reduce or manage their risk. Despite widespread political
support for the Health Checks Programme, and a strong policy focus in the
Department of Health, implementation so far has been patchy and, in many places,
poor. Only three quarters (77%) of the NHS Health Checks expected to be offered
in 2011-12 were offered and only half (51.6%) of the NHS Health Checks offered
have been taken up (18).
In Scotland, the Keep Well and Well North programmes target prevention activities
in high risk communities. Also in Scotland, the Life begins at 40 programme,
operated by NHS 24, offers a telephone health check to people who have turned
40.
Diabetes UK Cymru is working with the Welsh Government and Public Health
Wales to deliver a large risk assessment and awareness raising campaign on
diabetes prevention.
In addition, the Diabetes UK risk score, produced in collaboration with Leicester
University, can be used by individuals to identify their risk of developing Type 2
diabetes and encourages those at moderate to high risk to go to their GP to get
tested for diabetes. This is promoted via various routes; some of the most
successful ways include the availability of the risk score on line and Diabetes UK
roadshows. [http://www.diabetes.org.uk/riskscore] Healthcare professionals also
can request it separately to use in their practice.
The Diabetes UK roadshow raises awareness of the risk factors of Type 2 diabetes
in addition to conducting risk assessments for individuals.
Diabetes UK has embarked on a programme of awareness-raising within Black, Asian
and Minority Ethnic communities by recruiting “Community Champions” – volunteers who
are trained to deliver healthy lifestyles / diabetes awareness messages, through a
combination of information stands and talks at community centres, places of worship and
at festivals and events. Community Champions receive training on key aspects of
diabetes, its prevention and how to live with diabetes and avoid complications. The
scheme has proved to be highly successful in London, where over 100 Champions have
been trained, and is now being rolled out in other parts of the UK. Some champions have
been trained to undertake the Diabetes UK risk assessments, and others have become
“Dual Champions” in partnership with the British Heart Foundation.
Diabetes UK calls to action or Recommendations
Diabetes UK shares the view of many critics that voluntary approaches to
regulating the food industry, such as the Public Health Responsibility Deal, will fail
to deliver. We are calling for a more robust approach.
We also urge the Government to recommend that traffic light labelling is used
consistently on front-of-pack across all appropriate products because they help
people compare the nutritional content of products at-a-glance and make informed
choices. There is evidence that people find the traffic light system easiest to
understand (19).
We are calling for a commitment to ban the marketing of foods high in salt, sugar
and fat to children.
Diabetes UK supports the NICE guidelines on prevention of diabetes and calls for
action to ensure that commissioners and providers of health services and local
authorities are engaged in fully implementing this guidance.
Health and well being boards need to develop an integrated plan to prevent Type 2
diabetes and other related conditions (including CVD) that includes local
communities at high risk.
-
-
We are calling for full implementation of the NHS Health Checks programme in
England:
The Department of Health must ensure implementation of the NHS Health Checks
Programme is coordinated and local agencies are fully funded to deliver the
programme.
Health and wellbeing boards and Directors of Public Health have a crucial role in
ensuring that the programme is comprehensively commissioned locally.
In Scotland, we are calling for the findings of the Scottish Needs Assessment
Programme to be acted on as soon as possible, in order to make progress towards
the introduction of a vascular risk management programme (20).
Further work is needed to ensure that key prevention messages get to hard to
reach communities, making use of translating information, providing culturally
sensitive information and using the extensive specialist ethnic media sources,
including television and radio, as well as working with religious and community
organisations.
All individuals, even if they are at lower risk, should be given advice and support
based on their individual risk factors so that they can take action to reduce their
overall risk of developing Type 2 diabetes.
Conclusion
There is an urgent need to act now in order to address the rise in Type 2 diabetes. We,
therefore, call for all strategies to be implemented fully on a population wide basis,
including targeting communities at high risk.
Further information
NICE Guidance http://www.nice.org.uk/guidance/PH35
Healthy lives, healthy people: a call to action on obesity in England< Department of
Health, October 2011
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA
ndGuidance/DH_130401
Public Health Responsibility Deal article in Update
http://www.diabetes.org.uk/upload/Professionals/Publications/Summer%202011/No
%20deal%20web.pdf
Food labelling consultation briefing, May 2012
http://www.diabetes.org.uk/Documents/Position%20statements/food-labellingbriefing-0512.pdf
Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy
Weight The Scottish Government, Edinburgh 2010
http://www.scotland.gov.uk/Publications/2010/02/17140721/0
References
1. Quality and outcomes framework (QOF) 2011:
England: http://bit.ly/qof2011e
Northern Ireland: http://bit.ly/qof2011ni
Scotland: http://bit.ly/qof2011s
Wales: http://bit.ly/qof2011w
2. Department of Health (2007). About diabetes http://bit.ly/DHaboutdiab
3. Department of Health (2001). National service framework for diabetes
http://bit.ly/NSFdiab
4. Figures based on AHPO diabetes prevalence model: http://bit.ly/aphodiabetes
5. Diabetes UK publication ‘Measure up for a healthy lifestyle’
6. Hauner H (2010). Obesity and diabetes, in Holt RIG, Cockram CS, Flyvbjerg A et al
(ed.) Textbook of diabetes, 4th edition. Oxford: Wiley-Blackwell
7. World Health Organisation (2005). What is the scale of the obesity problem in your
country? http://bit.ly/whoBMI
8. Richard E Pratley, Glenn Matfin. Pre-diabetes: Clinical Relevance and Therapeutic
Approach. Br J Diabetes Vasc Dis 2007; 7(3):120-129.
9. Alberti KGMM, Zimmet P, Shaw J. International Diabetes Federation: a consensus on
Type 2 diabetes prevention. Diabet Med 2007; 24: 451–63.
10. National Service Framework for Diabetes: Standards, Department of Health, 2001
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuid
ance/DH_4002951
11. National Service Framework for Diabetes (Wales) – Standards, Welsh Assembly
Government, 2002
12. Preventing Type 2 diabetes: population and community-level interventions in high risk
groups and the general population NICE Guidance http://www.nice.org.uk/guidance/PH35
13. Healthy Lives, Healthy People: A call to action on obesity in England, Department of
Health, October 2011
14. Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy
Weight The Scottish Government, Edinburgh 2010
15. http://www.noo.org.uk/NCMP
16. The Improvement Service, ELECTED MEMBER BRIEFING NOTE No. 9, The Obesity
Time Bomb: Why It’s Everyone’s Business. Improvement Service May 2011
17. http://www.dh.gov.uk/health/category/policy-areas/public-health/phrd/
18. Department of Health NHS Health Checks, 28th June 2012, Number of eligible people
that have been offered and received NHS Health Checks)
http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/
Integratedperfomancemeasuresmonitoring/DH_129481
19.http://www.diabetes.org.uk/About_us/Our_Views/Position_statements/Food-labellingconsultation-briefing/
20. ScotPHN report. Updating the Scottish Needs Assessment Programme Report on
Type 2 Diabetes: Screening and Prevention. Part A: Project Group Conclusions on
Screening and Prevention and Recommendations. November 2011
Last reviewed
August 2012
Due for review
August 2013