Draft guidance has been published relating to the identification of people at high risk of developing type 2 diabetes and the provision of clinically and cost effective interventions to help reduce the risk or delay the onset of the condition. The guidance is based around five reviews, a network meta-analysis and cost-effectiveness modeling undertaken by the ScHARR Public Health Collaborating Centre with considerable input from HEDS. The five reports that fed into the guidance process are given below, with HEDS staff hypertexted.
Preventing the progression of pre-diabetes to type 2 diabetes in adults. By Maxine Johnson, Emma Everson-Hock, Roy Jones, Helen Buckley Woods, Elizabeth Goyder, Jim Chilcott and Nick Payne.
Preventing the progression of pre-diabetes to type 2 diabetes in adults. By Roy Jones, Crystal Freeman, Maxine Johnson, John Stevens, Helen Buckley Woods, Louise Guillaume, Clare Gillies, Elizabeth Goyder, Jim Chilcott, Nick Payne.
Prevention of type 2 diabetes: Reviewing mechanisms of successful interventions and translation of major trial evidence to practice. By Maxine Johnson, Roy Jones, Crystal Freeman, Helen Buckley Woods, Mike Gillett, Vishal Ram, Annabel Sidwell, Elizabeth Goyder, Jim Chilcott and Nick Payne.
Preventing the progression of pre-diabetes to type 2 diabetes in adults. By Maxine Johnson, Crystal Freeman, Josie Messina, Roy Jones, Helen Buckley Woods, Elizabeth Goyder, Jim Chilcott and Nick Payne.
Prevention of type 2 diabetes: Economic Review and Modelling. Mike Gillett, Jim Chilcott, Liddy Goyder, Nick Payne, Praveen Thakola, Crystal Freeman, Maxine Johnson and Helen Buckley Woods.
So what did it all boil down to…? The cost-effectiveness modeling indicated that “based on existing evidence, screening for pre-diabetes is highly likely to be cost-effective, and, taken in combination with the modelling carried out for this review, the most cost-effective strategy is likely to involve:
Use of routine primary care data as a first step in the screening process but where this is not possible, self-assessed risk scoring may substitute for routine primary care data;
Using HbA1c or FPG as both a subsequent screening and confirmatory diagnostic test;
Use of relatively intensive lifestyle interventions followed by a maintenance component and use of metformin if these fail to achieve risk reduction;
A re-screening interval of three to five years for those who would not otherwise be recalled sooner."
