Newbury and District CCG
Newbury Pre Diabetes Project
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
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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
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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 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
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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
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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 Stand
Newbury Show PreDiabetes Stand
During a quiet spell!
Newbury Show - Results
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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
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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