Helping NICE update type 2 diabetes prevention guidelines

Type 2 diabetes is a major public health priority in the UK; affecting around 3 million people and costing the NHS £14 billion annually. With 5 million people thought to be at risk of developing the disease, NHS England has recently launched the NHS Diabetes Prevention Programme (NHS DPP); an intensive lifestyle intervention comprising diet, exercise and weight loss components, which will be available to 100,000 individuals annually.

A team in HEDS led by Alan Brennan has completed a series of projects over the past two years to estimate the cost-effectiveness of the NHS DPP, using a diabetes prevention model developed as part of the School for Public Health Research funding. The most recent project was commissioned by NICE to help them update the guidelines around diabetes prevention, which currently advise that all individuals at high risk (determined via blood sugar measurements) should be offered intensive lifestyle intervention. NICE were interested in determining which population subgroups should be prioritised and whether metformin; a drug currently used to treat type 2 diabetes, would also be a cost-effective method for prevention.

The HEDS team found that whilst both interventions are likely to be cost-effective options for all subgroups, certain subgroups are likely to benefit much more than others. However, subgroup ordering is highly dependent upon the assumptions implemented around intervention effectiveness and duration of effect in different subgroups; both areas for which available data is limited. One consistent finding was that high risk individuals with the highest blood sugar should be prioritised over those with lower blood sugar for both interventions. However, differences between interventions were also found, with the NHS DPP potentially more likely to benefit a middle-aged population with lower BMI, whilst metformin may be more likely to benefit a younger population with higher BMI.

More details of the SPHR diabetes prevention model can be found here.