Type 2 diabetes costs the NHS £8.8billion per year and prevalence is ever increasing. Without intervention, 50% of people with its precursor condition, impaired glucose tolerance (IGT), will develop the condition within ten years. Salford, a city with high deprivation and obesity levels, has approximately 7000 people with IGT.
Working collaboratively with NHS Salford (now NHS Salford CCG) and the Salford diabetes team, we utilised the existing diabetes care call service and developed a six month, proactive lifestyle education and support programme for people with IGT. The telephone service was piloted in seven GP practices and delivered by trained health advisors using resources developed in-house. Resources included electronic education scripts, a patient information leaflet and a DVD. Participants were encouraged to set and discuss lifestyle goals at each telephone appointment. Blood tests, weight and BMI were recorded in general practice at baseline, on completion of the programme (6 months) and 12 months post-discharge.
We worked collaboratively with key stakeholders from NHS Salford (now NHS Salford CCG) and the Salford diabetes team to design, deliver and evaluate a lifestyle education programme for people with IGT to prevent them from developing type 2 diabetes.
At 6 months there were statistically significant reductions in fasting blood glucose (FBG), weight and BMI and these were maintained at one year post-discharge (18 months). Whilst all 55 participants completed the project only those with results at baseline, 6 months and one year post discharge were included in the analysis.
- At 6 months, mean FBG reduced from 6.2mmol/l to 5.8mmol/l, a fall of 0.4mmol/l CI 0.21-0.59, p<0.0002
- At 18 months, mean FBG reduced from 6.2mmol/l to 5.9mmol/l, a fall of 0.29mmol/l CI 0.07-0.51, p<0.01
- At 6 months, 73% (n=28) participants had confirmed weight loss
- At 18 months, 68% (n=26) participants had confirmed weight loss.
Participant feedback was overwhelmingly positive:
- 90% of participants felt they received relevant, up-to date advice
- 88% of patients achieved or partially achieved their lifestyle goal.
Participating GP practices also reported high levels of confidence in the ability of IGT care call to provide their patients with evidence-based information and motivational support.
Following completion of the IGT care call project in 2011, additional funding was granted to offer the service to all Salford GP practices making it available to all participants with IGR. As a result of participant feedback, the programme was extended and a choice of pathways offered. The IGR project ran from April 2012 to December 2013.
The project was recognised with a QiC (Diabetes) award and highly commended in HSJ Care Integration awards.