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Can NICE prevent diabetes?
  1. Edwin A M Gale
  1. Correspondence to Professor Edwin A M Gale, Department of Diabetic Medicine, University of Bristol, Learning and Research, Southmead Hospital, Bristol BS10 5NB, UK; Edwin.Gale{at}bristol.ac.uk

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The rising tide

Diabetes (diagnosed or undiagnosed) currently affects 7.4% of the UK population, and is projected to reach 10% by 2030.1 Conventional wisdom (with just a hint of moral censure) attributes the rising prevalence of diabetes to obesity and physical inactivity. It would however be just as true to lay the blame on increasing longevity, for glucose tolerance deteriorates with age, and we live much longer than we did. By their ninth decade, 55% of European males and 74% of females will have diabetes, undiagnosed diabetes or some form of glucose intolerance.2 Diabetes is also on the increase because of simpler diagnostic tests, lower diagnostic thresholds and health policies that reward primary care physicians for finding new cases. Last but not least, those with diabetes now live longer following diagnosis, whether due to better care or lead-time bias,3 thus adding to the prevalence of the condition (figure 1). The diabetes epidemic thus reflects increased longevity, better diagnosis of diabetes and longer survival, all of which might be considered desirable outcomes. Diabetes itself is highly undesirable, however, and elements of a national strategy are now in place to reduce its impact upon our population.

Figure 1

Anatomy of the diabetes epidemic. The prevalence of diabetes represents the balance between incidence and mortality. Incidence is affected by age, obesity and earlier diagnosis, and prevalence is affected by survival following diagnosis. A rising prevalence of diabetes thus reflects both positive and negative aspects of population health.

This strategy is outlined in recent National Institute for Clinical Excellence (NICE) guidance entitled Preventing type 2 diabetes: risk identification and interventions for individuals at high risk. This, as the title indicates, advocates identification of those at increased risk rather than population screening,1 and outlines a two-step strategy. Stage 1 uses objective measures and questionnaires to assess …

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