Newbury Pre Diabetes Project Newbury and District CCG A real-world implementation of QDiabetes in a CCG Area Tim Walter
What to expect from today • 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
QInnovation • 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
My Journey • Jobbing GP • NUG – Arun Aggarwal • Diagnosis is Failure • QDiabetes • QInnovation • Liaison with Kambiz and John • Pre-Diabetes Project
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 PH35Preventing 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 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
Newbury PreDM 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
Surgery Phase – 1st Cohort Results 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 - 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 21-22nd 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 Pre-Diabetes Stand Newbury Show Stand During a quiet spell!
Newbury Show - Results 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
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
What can you do? QDiabetes bulk calculation QDiabetes Template QDiabetes pop-up alert Resources at www.predm.co.uk Demo
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)
Overall results 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
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