NICE Public Health Guidance Update

Diabetes is on the rise in the UK, affecting about 2.8 million people—of whom approximately 90% have type 2 diabetes. Diabetes is 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 budget. Being overweight or obese is the single biggest risk factor for type 2 diabetes; others include having a large waist circumference, a sedentary lifestyle, a previous history of gestational diabetes or a family history of type 2 diabetes and being older than 40. Also people from certain communities and population groups are at an increased risk of developing type 2 diabetes. 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 is particularly aimed at directors of public health and those working at national and local levels with a role in preventing type 2 diabetes. These include primary care teams, as well as those involved in delivering physical activity interventions, community engagement teams and community leaders. The guidance considers early intervention to prevent type 2 diabetes as part of an integrated package of local measures to promote health and prevent a range of noncommunicable diseases (including cardiovascular disease and some cancers), given the common risk factors involved. It points out that lifestyle interventions aimed at changing an individual’s diet and increasing physical activity can halve the number of those with impaired glucose tolerance who go on to develop type 2 diabetes. However, the greatest impact on the levels—and associated costs—of type 2 diabetes is likely to be achieved by addressing these behavioural risk factors in whole communities and populations. The specific recommendations are concerned with the development of an integrated plan for preventing type 2 diabetes and related non-communicable diseases, comprising cost-effective physical activity, dietary and weight management interventions. Interventions should take into account the religious beliefs, cultural practices, age and gender, language and literacy of black, minority ethnic and lower socioeconomic groups. Interventions costing up to £10 per head would need to achieve an average weight loss of about 0.25 kg per head to be cost-effective. Those costing up to £100 per head would need to achieve an average weight loss of about 1 kg per head. Interventions should be tailored for local communities by recruiting and involving lay and peer workers in their