Newbury Pre Diabetes Project

A real-world implementation of QDiabetes in a CCG Area

Tim Walter

Newbury and District CCG

QInnovation My Journey – where it started Newbury Pre-Diabetes Project

Phase 1 Within Surgeries Phase 2 County Show experience Phase 3 Targetted screening? As an example to copy/change as you wish

Resources www.predm.co.uk

What to expect from today

Inaugural joint 2012-13 winners Funded by QResearch ( in a joint partnership between Emis, Emis NUG and University of Nottingham)

10k grant (on top of 18k from CCG) Prof. Aziz Sheikh of Primary Care Research & Development at the University of Edinburgh – Smoking Cessation

Myself – Pre-Diabetes Project Plus John Robson and Kambiz Boomla

QInnovation

Jobbing GP NUG – Arun Aggarwal

Diagnosis is Failure QDiabetes QInnovation Liaison with Kambiz and John Pre-Diabetes Project

My Journey

Nice Guidance

Recent National Institute for Health and Clinical Excellence (NICE) guidance has recommended:

•Identifying people at risk of developing type 2 diabetes, using a validated risk assessment score and a blood test (fasting blood glucose or HbA1c) to confirm high risk.

•Providing those at high risk with an intensive lifestyle-change programme to prevent or delay the onset of type 2 diabetes.

Recommendation 3 Developing a local strategy

Recommendation 6 Conveying messages to the local population

Recommendation 8 Promoting a healthy diet: local action

Recommendation 10 Promoting physical activity: local action

Nice PH35Preventing type 2 diabetes: population and

community-level interventions

reduce their weight by more than 5% keep their fat intake below 30% of energy intake

keep their saturated-fat intake below 10% of energy intake

eat 15 g/1000 kcal of fibre or more are physically active for at least 4 hours per week.

Finnish Diabetes Prevention Study

QDiabetes Tool Targeted screening Concept of Pre-Diabetes Early intervention reduces risk by up to 70%

Lifestyle interventions (E4H) work in the short term

Project looks to combine these to assess practical issues and costs

Components of the project

113,000 - mixed clinical system CCG Surgery Process, 1st cohort EmisWEB

Instructions to practices to run the bulk QDiabetes module

Identify patients with > 30% 10yr risk Invitation to have bloods and join E4H Group

Currently ending 2nd Cohort phase, LV and INPS

Newbury PreDM Project

50 patients invited per practice (5 surgeries) (30-80% risk calculations)

250 in first cohort 18% uptake Of those having bloods 14% at diagnostic levels, more with marginal results

E4H – Average 3kg Weight loss, = 110Kg total

Up to 15Kg loss 1kg =16% risk reduction in DM

Surgery Phase – 1st Cohort Results

Admin charge 150 E4H staff cost 400 Accommodation 400

Total cost therefore 1000 per practice Approx benefit – 1DM, average 3kg weight loss per participant, raising profile etc

Surgery Phase - Costs per practice

60,000 attendees 21-22nd September 2 clinicians doing QDiabetes Screening 2 PH Nurses doing HbA1c for those with high scores

3 E4H staff giving advice, BCA and enrolling to E4H Sessions

Newbury Show

Newbury Show Pre-Diabetes StandDuring a quiet spell!

Newbury Show Stand

Potential Audience of 60,000 310 Screened via QDiabetes on iPads 111 targeted HbA1c tests done 80 Body Fat/Composition Measurements 30 people signed up for E4H classes 5 New diabetics (up to HbA1c = 64) NB Health Promotion vs Detection

Newbury Show - Results

Is it financially worthwhile

Breast screening 2 million women15000 diagnoses

96 million pounds50 pounds per screen

6000 pounds per diagnosis

Is it financially worthwhile

Cervical cancer5 million invites3.5 million tests200,000 abnormals

4000 cancers prevented175 million pounds

About 1000 pounds per abnormal, and about 40,000 pounds per cancer prevented

Is it financially worthwhile ???

Diabetes – Newbury Show60,000 attendees

310 screened with QDiabetes111 HbA1c tests5 New Diabetics

Cost per diagnosis 1000 pounds

QDiabetes bulk calculation QDiabetes Template QDiabetes pop-up alert

Resources at www.predm.co.uk

Demo

What can you do?

No proof of results (not enough power) No long term data re weight loss etc. Cost effectiveness

Need to define your terms! Rural Berkshire 3.5% prevalence

Actual 5% ? (wide confidence margins)

Caveats

30% predictive risk seems to = 10% current DM

Letter stating numerical risk seems to trigger response in some of them

E4H making significant impact It is possible to screen surgery populations

It is possible to organise public event

Overall results

QInnovation – go for it Surgery actions – resources online CCG actions – “template” online Not trying to produce research evidence of effectiveness but template for whether it is possible

Any Questions www.predm.co.uk

Conclusions