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a bathroom scales imageOctober 23 2017

GP referrals of patients at risk of developing type 2 diabetes reduced the number of people going on to develop diabetes, a new study has found. 

“The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact,” said the researchers. The study has been published in BMJ Open Diabetes Research & Care.

Patients were selected with non-diabetic hyperglycaemia (NDH) – having a fasting plasma glucose of ≥5.5 to ≤6.9mmol/L and/or glycated hemoglobin (HbA1c) ≥42 to 47mmol/mol (6.0%–6.4%), and a body mass index (BMI) ≥30 kg/m2.

The researchers monitored 149 patients who were deemed eligible for the Weight Watchers’ diabetes prevention programme, “an intensive lifestyle intervention which included a 90 minute activation session followed by the offer of 48 weekly Weight Watchers community group meetings.” Of those approaching Weight Watchers, 79% attended an activation session (117 eligible patients) and 77% started the weekly sessions. Three quarters were women and 90% were white.

Participating in the programme resulted in a mean reduction in HbA1c of 2.84 mmol/mol at 12 months (from 43.42±1.28 to 40.58±3.41, p<0.01). In addition, 38% of patients returned to normoglycemia and 3% developed type 2 diabetes at 12 months. There was also a mean weight reduction in BMI of 3.2 kg/m2 at 12 months (35.5 kg/m2 ±5.4 to 32.3 kg/m2 ±5.2, p<0.01).

“Using an NHS GP referral pathway into a one-year DPP delivered by this commercial weight management provider achieved statistically significant reductions in measures of type 2 diabetes risk,” said the researchers.

RCGP Chair Professor Helen Stokes-Lampard said the findings were “both positive and encouraging, and are certainly something for commissioners to consider.

“However, organised weight management programmes won’t work for everyone so GPs and our teams will continue to play a pivotal role in managing the vast amount of diabetes care in the community, advising patients about lifestyle changes that can improve their health, so we must ensure that general practice has the investment it needs, and the appropriate number of GPs and nursing colleagues, to do this properly.”

Links:
BMJ announcement       
C Piper et al. ‘Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for nondiabetic hyperglycemic patients referred by primary care in the UK’. BMJ Open Diab Res Care 2017;5:e000418       
RCGP comment    

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