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 What to expect from today

 Inaugural joint 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 PH35 Preventing 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, 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 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 – 1 st 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  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

Newbury Show Pre- Diabetes Stand During 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 women 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

 QDiabetes bulk calculation  QDiabetes Template  QDiabetes pop-up alert  Resources at  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  Conclusions