Newbury and District CCG Newbury Pre Diabetes Project A real-world implementation of QDiabetes in a CCG Area Tim Walter
Aims of the PreDM Project Raise awareness generally Lifestyle intervention for those at risk Early identification of those at risk of, or already with DM2 without a diagnosis
What to expect from today My Journey Newbury Pre-Diabetes Project Phase 1 Lifestyle Intervention - Surgeries Phase 2 County Show experience Phase 3 Targeted screening As an example to copy/change as you wish Resources www.predm.co.uk
Trends at Falkland Surgery 2000 Type 1 DM = 44 Type 2 DM = 150 (194) 2005 Type 1 DM = 56 Type 2 DM = 250 (306) 2008 Type 1 DM = 66 Type 2 DM = 369 (435) 2012 Type 1 DM = 73 Type 2 DM = 399 (472) 12/11/2013 Total 498 The massive increase in DM is predominantly in the Type 2 group About 3.5% of population
Summary of historic care 1990 s minimise impact (Symptoms and meds) 2000 s move to targets and maximize dose and identify missed diagnosis 2010 s earlier diagnosis (seeking borderline results) of pts with IGT, single Random BS readings etc
QInnovation Inaugural joint 2012-13 winners Funded by QResearch ( in a joint partnership between Emis, Emis NUG and University of Nottingham) 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
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.
Nice PH35 Preventing type 2 diabetes: population and community-level interventions 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
Finnish Diabetes Prevention Study 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.
Components of the project QDiabetes Tool Concept of Pre-Diabetes Early intervention reduces risk by up to 60% (Finnish Study and DPP in USA) Lifestyle interventions (E4H) work in the short term Project looks to combine these to assess practical issues and costs
Newbury PreDM Project 113,000 - mixed clinical system CCG Surgery Process, 1 st 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 2 nd Cohort phase, LV and INPS Starting SystmOne and last EmisWEB practice
Surgery Phase 1 st and 2 nd Cohort Results 50 patients invited per practice (8 surgeries) (30-80% risk calculations) 400 in first 2 cohorts 18% uptake Of those having bloods 14% at diagnostic levels, more with marginal results E4H Average 3kg Weight loss, = 110Kg total in 1st cohort Up to 15Kg loss 1kg =16% risk reduction in DM
Surgery Phase - Costs per practice 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
Newbury Show 60,000 attendees 21-22 nd 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 Stand Newbury Show Pre- Diabetes Stand During a quiet spell!
Newbury Show - Results Potential Audience of 60,000 310 Screened via QDiabetes on ipads 111 targeted HbA1c tests done (Approx 1/3 rd ) 80 Body Fat/Composition Measurements 30 people signed up for E4H classes 5 New diabetics (up to HbA1c = 64) plus 5 HbA1c 42-47 NB Health Promotion vs Detection
Is it financially worthwhile Breast screening 2 million women 15000 diagnoses 96 million pounds 50 pounds per screen 6000 pounds per diagnosis
Is it financially worthwhile Cervical cancer 5 million invites 3.5 million tests 200,000 abnormals 4000 cancers prevented 175 million pounds About 1000 pounds per abnormal, and about 40,000 pounds per cancer prevented
Is it financially worthwhile??? Diabetes Newbury Show 60,000 attendees 310 screened with QDiabetes 111 HbA1c tests 5 New Diabetics Cost per diagnosis 1000 pounds
Phase 3 - Identification Trial this weekend at Falkland Surgery 266 pts with Risk > 15% (without recent bloods done) Half invited to POC Saturday Drop-in Clinic Half Posted letter and blood test form IF numbers are maintained we expect 5% diagnostic rate, and 5% borderline rate
Overall results 30% predictive risk seems to = 14% current DM 15% predictive risk seems to = 5% 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 organize public event
Aims of the PreDM Project Raise awareness generally Radio Berkshire Newbury Weekly News and Chronicle Health Service Journal Pulse Newbury Show 60,000 visitors
Aims of the PreDM Project Lifestyle intervention for those at risk E4H invitations 550 patients 100 attendees Potentially 1/3 tonne weight loss!
Aims of the PreDM Project Early identification of those at risk of, or already with DM2 without a diagnosis Phase 1 - Potentially 14 New DM Phase 2 5 New DM Phase 3 -Invitation for screening One practice 266 patients 11 practices 1500 patients? Anticipated pickup rate of 5% in those responding Possibly 30-70 new diagnoses
The Future Public Health Indicated they wish to repeat the Lifestyle intervention with E4H across NDCCG NDCCG Anticipate asking them to fund the detection arm of the project across the whole CCG population if Falkland Trial successful
Challenges for you -Practices Do you know how many patients have RBS > 11 or FBS > 7 or HbA1c > 47 Have all those patients with RBS > 7 had a recent follow up blood test Have you reviewed the patients with IGT/IFG recently to see if they have been rechecked (20-50% 10yr conversion)
Consider - Practices EmisWEB Activate popups that notify you of possible and probable DM Consider installing QDiabetes Popup
Challenges - Commissioners Incentivize the Practices to do the above Consider how you are responding to NICE Guidance Identification of those with DM (offer screening for those at 15% risk) Prevention of DM (targeted E4H lifestyle interventions) Apply pressure to Software suppliers to integrate risk scoring software in INPS and SystmOne
Resources www.predm.co.uk Thank-you Tim Walter
Caveats 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)
Conclusions 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